Roy Cooper was born and raised in Nash County and most recently served two terms of governor of North Carolina. Before that, he was elected as state’s attorney general for four terms. He was also elected to the N.C. General Assembly and served in both the House of Representatives and the state Senate.
Candidate Q&A
NC Health News reached out to Cooper’s campaign multiple times looking for answers to our list of questions and talked with a spokesperson who said they wouldn’t be able to fill out the questionnaire. The spokesperson directed us to Cooper’s campaign webpage titled Making Health Care Affordable.
To give readers information, we combed the internet and social media for statements by Cooper and material from his campaign website that could address the themes in our questions.
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?
As North Carolina spent years debating Medicaid expansion before passing it in 2023, Cooper pushed for what he called “pure Medicaid expansion.” He told the News & Observer in 2019 that “it costs more to enforce premiums and work requirements than it’s worth. We’ve seen it in other states, and in addition, most of the people we’re talking about, the vast majority of people are already working, […]”
During a roundtable discussion in September 2025, Cooper criticized the One Big Beautiful Bill.
“This bill is designed to intentionally make it more difficult for people who are working and are qualified to get signed up because of all of the requirements,” he said. “They’ve made it so much harder with all of these new rules that so many people who are working and deserve to have their health insurance and qualified are gonna get kicked off, and that doesn’t have anything to do with waste fraud and abuse.”
What would be your plan for ensuring the future security/strength of Social Security and Medicare?
“Older North Carolinians spent their careers working hard, paying into the system and playing by the rules, believing they would have Social Security when they retire. Today, [some in Congress] are undermining it at every turn to give tax breaks to the wealthy. We must protect and strengthen Social Security for current recipients and future generations, and in the U.S. Senate, I’ll work with anyone I can to do just that,” Cooper said in a recent candidate Q&A with AARP.
When the AARP asked about Medicare, he said: “When I was governor, North Carolina made enormous progress on health care. I built a bipartisan coalition around the state, successfully bringing health care to hundreds of thousands of working people by expanding Medicaid. I’ll use that same problem solving in Washington to work against federal cutbacks to Medicare; work to expand Medicare benefits to include dental, vision and hearing coverage; and require Medicare to broaden negotiations with drug makers to make more prescription medicines affordable. As Senator, I will work with anyone I can to stand up to attacks on health care and make health care more affordable.”
What would you support in Congress as a plan to help control health care/ pharmaceutical costs?
Cooper’s campaign website says he “believes that doctors should decide your health care, not insurance companies and he’d reverse the Affordable Care Act tax credit expiration and cuts to Medicaid that leave people without the coverage they need and drive up prices for everyone. He’d also require Medicare to broaden negotiations with drug makers to make prescriptions more affordable and strengthen oversight of hospital mergers that put profits over patients.
“He’d crack down on pharmacy benefit managers that pocket savings instead of passing them on to patients, curb surprise billing and cap annual out-of-pocket costs for prescription drugs. He’d prevent medical debt by requiring hospitals to auto-enroll patients in charity care and increase enforcement of upfront pricing to make health care costs more transparent.”
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?
As governor, Cooper signed Medicaid expansion into law, which allowed more than 700,000 low-income residents — including many in rural communities — access to health insurance. Medicaid expansion was a huge boost to rural hospitals.
“Many of these hospitals just simply were treating too many patients who didn’t have health insurance,” Cooper told NC Health News in 2024. Local elected officials “recognized that Medicaid expansion would allow a lot of the people who live in their county to get health insurance to help keep these rural hospitals from closing.”
During the third anniversary of the signing of Medicaid expansion, Cooper said it was the “working families bill of the decade” which will inspire his fight as senator to lower health care costs.
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?
“It’s alarming to see reports on the potential of humans losing control of AI,” Cooper wrote on social media on Sept. 15, 2026. “We should heed the warnings sounded by the CEOs of these companies calling to slow down the pace of their own AI development. The President has said he believes no action is necessary, but it’s clear federal guardrails and oversight are needed to make sure people are protected. Congress needs to bring top experts together and get to work.”
Where do you stand on federal vaccine policy? What should be done to prevent future disease outbreaks?
During his time as governor, Cooper led North Carolina through the COVID-19 pandemic and took a pro-vaccine position. He encouraged members of the public to get vaccinated to prevent the spread of the virus. In 2021, his administration required vaccine verification for state employees and encouraged other employers to do the same.
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?
Cooper has indicated that the federal regulations aimed at preventing pollution are not strong enough. For example, as governor, he vetoed a state bill in 2023 saying it would lead to more water pollution because federal regulations are too weak.
“The provision in this bill that severely weakens protection for wetlands means more severe flooding for homes, roads and businesses and dirtier water for our people, particularly in eastern North Carolina,” Cooper said. “This provision coupled with the drastic weakening of federal rules caused by the U.S. Supreme Court’s recent decision in the Sackett case, leaves approximately 2.5 million acres, or about one half of our state’s wetlands, unprotected.”
PFAS contamination is a nationwide issue; how do you address it while balancing public safety and business interests?
Cooper was governor when GenX was detected in the Cape Fear River in 2017. He directed state agencies to investigate the contamination, pressured Chemours to stop releases and urged federal regulators to conduct health assessments.
Cooper pushed for stronger state water-quality standards for PFAS and supported efforts to hold chemical manufacturers financially responsible for testing and treating contaminated drinking water. In 2023, he opposed Chemours’ plan to import PFAS-containing waste from the Netherlands and asked the EPA to reverse its approval, which the agency ultimately did.
His administration also promoted research, public awareness and stronger protections for drinking-water supplies.
“North Carolinians deserve clean, safe air and water and my administration has worked relentlessly to learn more about emerging compounds and hold polluters accountable. We know these chemicals can pose health risks and legislators need to give state regulators the tools to keep families safe and ensure polluters, not consumers and taxpayers, bear the cost of testing and treatment for chemicals in the water,” Cooper said in 2023.
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?
“Roy Cooper believes that data centers should pay the full cost of the energy they use, and prevent those costs from being passed on to locals. He also believes that local communities should be fully involved in any decision made about potential data centers in their neighborhoods,” his campaign website states.
Cooper’s plan also includes reducing “utility costs for consumers by working to encourage large tech companies to build their own energy sources.”
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