Raymond Smith Jr. is running as the Democratic challenger for Congress in District 3. The district includes Beaufort, Carteret, Craven, Dare, Duplin, Hyde, Jones, Onslow, Pamlico, Sampson counties, and parts of Pitt county.
Born and raised in Goldsboro, Smith is a U.S. Army Gulf War combat veteran and former military policeman. He served in the N.C. House of Representatives from 2019-2023. He was also the first African American at-large member of the Wayne County Board of Education, and became vice chairman of the board.
Candidate Q&A:
What do you see as the biggest financial and administrative challenge to implementing the work requirements for Medicaid that were included in the One Big Beautiful Bill?
The biggest challenge is the cost of building and operating a system that verifies work hours and exemptions without taking health coverage away from people who qualify. That means computer systems, trained staff, accurate records, notices and appeals. County social services departments will have to handle that responsibility while families navigate another layer of paperwork. The federal requirement generally begins January 1, 2027, and requires certain adults to meet an 80- hour monthly standard, with exceptions.
North Carolina has debated this before. Carolina Cares was introduced in 2017, before I entered the legislature. Democrats raised concerns about people who couldn’t find suitable employment and about requirements that could delay access to coverage. Those concerns deserve attention today, especially in rural communities where employment, transportation and internet access can be limited.
My record is clear. I co-sponsored House Bill 5 to close the Medicaid coverage gap in 2019 and was a primary sponsor of House Bill 470, Medicaid Expansion, in 2021. Neither received a House floor vote. I supported getting people covered, and I would support repealing requirements that make paperwork a barrier to care. While the law remains in place, I would press for adequate implementation funding, automatic verification wherever possible, clear exemptions and meaningful appeals. Health care helps people remain healthy enough to work.
Taking it away can undermine that very goal.
What would be your plan for ensuring the future security/strength of Social Security and Medicare?
I have been paying in to Social Security since I was 15 years of age, when I was hired for my very first job as a service station attendant. Congress has a responsibility to keep those commitments. I oppose privatizing Social Security, cutting earned benefits or raising the retirement age to make working people carry the burden of fixing the program.
For Social Security, I would support requiring people with very high earnings to contribute more of their wages above the current taxable limit. Any legislation must include an independent analysis showing how it improves long-term funding. We also need enough staff to process retirement and disability claims accurately and promptly.
For Medicare, I would strengthen prescription drug negotiation, address improper payments and excessive payments to private Medicare Advantage plans, and protect access to doctors and hospitals. Fraud enforcement should focus on actual wrongdoing without creating obstacles for patients receiving legitimate care. Congress should address these programs’ finances now, with public hearings and clear numbers, instead of waiting until a crisis gives someone an excuse to cut benefits.
What would you support in Congress as a plan to help control health care/ pharmaceutical costs?
I would protect and expand Medicare’s authority to negotiate prescription drug prices, preserve limits on patients’ out-of-pocket drug costs, and support extending affordable insulin protections beyond Medicare. Negotiated prices for the first ten selected Medicare drugs took effect in January 2026. Congress should build on that work.
I have already voted to address the prescription drug system. In 2021, I voted for Senate Bill 257, the Medication Cost Transparency Act. That law required pharmacy benefit managers to be licensed and added consumer protections. These companies manage prescription benefits between insurers, pharmacies and manufacturers. Their financial arrangements should be transparent, and patients should receive the benefit of negotiated savings.
In Congress, I would support stronger oversight of those middlemen, protect independent pharmacies, and challenge practices that delay access to lower-cost generic and biosimilar medicines. I would also support affordable insurance coverage, enforce protections against surprise bills, and scrutinize hospital and insurer mergers that reduce competition. A family needs an affordable total bill, including premiums, deductibles and prescriptions.
What steps would you take to improve access to health care in rural areas? How do we make the Rural Health Transformation Program successful in North Carolina?
People in eastern North Carolina need care close enough to reach and affordable enough to use. I would protect Medicaid coverage, strengthen community health centers and rural hospitals, and expand access to maternity care, mental health treatment and emergency services. We also need more providers. I would support rural residency programs, scholarships and loan repayment for health professionals who commit to serving these communities.
Transportation must be part of that plan. My experience directing public transportation taught me that an appointment does little good if someone cannot get there. I would support reliable medical transportation and telehealth backed by affordable broadband, while preserving access to in-person care.
North Carolina received approximately $213 million for the first year of the Rural Health Transformation Program. I want that investment to reach communities with the greatest needs, with local providers and residents helping shape the decisions.
Success should be measured by shorter travel distances, timely appointments, filled provider positions and services that remain available after the grant ends. Spending and results should be public, and smaller providers should receive help applying. Temporary funding cannot substitute for dependable insurance coverage and a lasting source of payment for care.
The rollout of AI is moving fast, including in health care, and leaders in that space are calling for things to slow down. What federal moves should be taken to regulate it, if at all?
I support federal safeguards that match the risk. Software that helps schedule an appointment is different from a system that recommends treatment or influences whether an insurer approves care. The greater the potential harm, the stronger the testing and oversight should be. The FDA already regulates certain AI-enabled medical devices, so Congress should strengthen existing protections and address gaps.
Before high-risk systems are used, they should be evaluated for accuracy, patient safety and performance across different populations. They also need continued monitoring as the technology changes. Patients should know when AI materially affects their care and have access to a qualified person who can review and challenge the decision.
I would support prohibiting insurers from denying medically necessary care solely through an automated decision. I also want enforceable limits on using, sharing or selling identifiable health information, including information collected outside traditional medical settings. Where safety has not been demonstrated, deployment should pause. A company’s desire to move quickly does not relieve it of responsibility for the consequences.
Where do you stand on federal vaccine policy? What should be done to prevent future disease outbreaks?
Federal vaccine policy should be guided by credible scientific evidence, independent medical review and transparent safety monitoring. I support access to recommended vaccines and clear explanations of their benefits, risks and medical exceptions. People deserve honest answers to their questions.
My voting record [in the N.C. General Assembly] reflects support for access. In 2021, I voted for House Bill 96, which expanded the vaccines and medications that qualified pharmacists could administer. Local pharmacies can provide an important point of access for families who face difficulty getting a medical appointment.
Preventing outbreaks also requires dependable funding for local health departments, laboratories, disease surveillance and rapid response. We need trained personnel, reliable supplies and coordination among federal, state and local agencies before an emergency occurs. I support evidence-based school vaccination requirements with legitimate medical exemptions, while recognizing the states’ role in setting those requirements. Public trust depends on consistent standards and a willingness to explain what the evidence shows and where uncertainty remains.
We’ve had some high-profile food contamination outbreaks, yet the federal government is pulling back on regulation of food, air and water. What level of federal regulation do you support and why?
I support enforceable federal standards that protect people from contaminated food, polluted air and unsafe drinking water. These problems cross county and state lines. Families cannot inspect a processing plant or test every pollutant coming out of a smokestack themselves.
For food safety, I support adequate inspection staffing, prevention measures, prompt recalls and the ability to trace contaminated products to their source. Federal food safety law already emphasizes prevention and inspections. Those responsibilities need funding and enforcement to mean anything.
For air and water, standards should reflect credible evidence about exposure and health effects. Businesses need clear requirements, predictable decisions and reasonable assistance meeting them. Farmers and small businesses should have access to technical help, and Congress should eliminate paperwork that serves no protective purpose. But reducing unnecessary paperwork is different from weakening a health standard. Responsible businesses should not have to compete against companies that save money by putting the public at risk.
PFAS contamination is a nationwide issue; how do you address it while balancing public safety and business interests?
Public safety has to come first. I would support enforceable, science-based limits on harmful PFAS, public reporting of contamination, and funding to test and treat public water systems and private wells. Eastern North Carolina families should not have to pay the entire cost of addressing pollution they did not create.
We need to stop contamination at its source as well as remove it from drinking water. I would support stronger discharge controls, disclosure of releases and holding responsible polluters accountable for cleanup. At the same time, water utilities, farmers and other parties that receive contamination should not automatically be treated as though they caused it.
Businesses should receive clear standards, practical compliance schedules and help moving to safer alternatives. Any extension should be justified by actual implementation needs and include protections for people exposed in the meantime. EPA has proposed changes affecting PFAS drinking-water requirements and compliance timelines. I would scrutinize those changes rather than assume that a delay protects the public.
The building and placement of data centers have become a big issue, particularly in many rural communities. What should be the federal government’s role, if any, in how these are developed?
I am vehemently opposed to building additional data centers until their social, utility-cost, environmental and health impacts have been adequately studied. Communities need credible answers before they commit land, water, electricity and public incentives to projects with consequences that can last for decades.
Congress should require meaningful disclosure of projected electricity and water use and support independent studies of effects on utility bills, water supplies, noise and public health. Developers should pay the costs their projects impose on the grid and other infrastructure. Those costs should not be shifted onto households, farmers and small businesses.
Local governments should retain authority over land-use decisions, with residents given a real opportunity to participate. Federal policy should establish protections and require cumulative impacts to be considered when several facilities are proposed in the same region.
The information processed by these facilities also deserves scrutiny. Individuals often have little practical control over how their personal information is collected, shared or sold. I support a comprehensive federal privacy law that gives people meaningful rights to access, correct and delete their information and opt out of its sale, with enforceable limits on the use of sensitive data.
Is there anything else you would like readers to know?
I have dedicated my life to public service, I approach these issues as a combat veteran, former classroom teacher, former vice chairman of the Wayne County Board of Education and former minority whip in the North Carolina House. My undergraduate degree is in Supply Chain Management, so I understand why prices are high, and what it will take to bring them down. My Masters degree is in Public Administration, and I have managed public services and budgets, as well as understand that a policy has to work for the people expected to live with it.
My health care priorities are grounded in action. I helped introduce Medicaid expansion legislation, voted for prescription benefit oversight and supported greater access through local pharmacies. I will bring that same approach to Congress.
People across eastern North Carolina are trying to afford their medicine, find a doctor and keep their families healthy. They deserve a congressman who listens, understands his authority and uses it. Congress must pass workable laws, fund the responsibilities it creates and hold the executive branch accountable for carrying them out.
Republish our articles for free, online or in print, under a Creative Commons license.
