Shows two smiling white men wearing formal shirts and ties. They're both running for attorney general of North Carolina in a state race.
Josh Stein, left, and Jim O’Neill, right, are vying to be the state’s top law enforcement officer.

The race for attorney general is expected to be a close one between Democrat Josh Stein, who has held the position since 2017, and Republican Jim O’Neill, who has been Forsyth County’s  district attorney since 2009.

By Greg Barnes and Anne Blythe

Jim O’Neill, Republican from Winston-Salem

Age: 54

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Political experience: O’Neill was appointed Forsyth County District Attorney in 2009 and is serving his third elected term. He ran for the state attorney general in 2016 and was defeated in the Republican primary. He also serves as vice president of the North Carolina Conference of District Attorneys.

Education/personal: O’Neill went to Duke University on a lacrosse scholarship and received a BA in 1988.  After graduation, he earned his law degree from New York University Law School while working part time.

Josh Stein, incumbent Democrat from Raleigh

Age: 54

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Political experience: Stein became North Carolina’s 50th state attorney general in 2017. He was a state senator in the General Assembly from 2009 to 2016.

Education/personal: Stein is a Chapel Hill High School graduate, and holds an undergraduate degree from Dartmouth College. After college, he taught English and economics in Zimbabwe. Stein then went on to earn degrees from Harvard Law School and the Harvard Kennedy School, which focuses on policy. He worked as a lawyer before serving as senior deputy state attorney general for Consumer Protection from 2001 to 2008.

Affordable Care Act

Stein filed a petition with the U.S. Supreme Court in January asking it to review a decision by the U.S. 5th Circuit Court of Appeals that ruled on Texas v. United States, which was filed in 2018 by 20 Republican state attorneys general and governors challenging the constitutionality of the Affordable Care Act. They contend that once Congress did away with the individual mandate penalty, the entire act should be struck down. In May, Stein filed a brief with other Democratic state attorneys general and others in the Supreme Court arguing against the Fifth Circuit ruling.

“Access to quality healthcare may be a matter of life and death and is absolutely crucial in the effort to build a stronger North Carolina, particularly during a pandemic,” Stein said in a recent email to North Carolina Health News. “During my time in office, I have consistently fought to defend the Affordable Care Act, maintaining health insurance coverage for millions of North Carolinians and protecting the millions of North Carolinians who have pre-existing conditions.”

Efforts to reach O’Neill were unsuccessful. His campaign literature and recent social media do not address the ACA.

Reproductive health

Stein has argued in multiple legal filings in support of women’s access to contraception and other forms of reproductive health care. He joined with other Democratic state attorneys general challenging the Trump administration’s rewrite of Title X to impose what he described as a “gag rule” on health care professionals.

“I strongly oppose unduly burdensome and medically unnecessary restrictions on reproductive health centers,” Stein said. “I have long supported funding for family-planning services aimed at reducing unintended pregnancy and sexually transmitted infections. As AG, I am also a strong advocate for protecting patients, doctors, and other health-care professionals at reproductive healthcare clinics from violence, harassment, threats, and intimidation. I will use the tools at my disposal to protect reproductive freedoms.”

There was no campaign literature on O’Neill’s site about this issue, he did not answer questions on the conservative ivoter guide website. On the isidewith voter guide site, he answered “Pro-life” in response to the question, “What is your stance on abortion?”

Medicaid expansion

Stein has advocated for the expansion of Medicaid as state attorney general and as a state senator. “Expanding Medicaid is the single most effective thing we could do in North Carolina to address the opioid epidemic and a host of other public health issues,” Stein said. “I have urged North Carolina’s legislature to take the federal government up on its offer to expand Medicaid and cover the 500,000 North Carolinians without insurance. Not only would this action significantly improve the health of our people, it would also improve the health of our rural hospitals and communities and create jobs. It’s a no-brainer.”

In campaign literature online, there is no indication that O’Neill has taken a stand on Medicaid expansion.

Mask/no mask

Stein stands behind the face mask. “I believe in science and doing what I can to keep the people around me safe and healthy,” Stein said. “For that reason, I wear a mask — and encourage all North Carolinians to do so as well.”

O’Neill spoke at a Trump rally in Winston-Salem in September without a face mask on, but it is unclear where he stands on the issue.

Rural health care financing

The attorneys general in North Carolina plays a regulatory role in the oversight of hospital mergers.

“As a result, I’ve heard from thousands of North Carolinians who have shared their serious concerns about consolidation,” Stein said.

Stein played a crucial role in HCA Healthcare’s purchase of Mission Health.

“I am proud of the deal we helped negotiate in western North Carolina; because of my office’s work, more hospitals and clinics will stay open longer and more western N.C. counties will be represented in the decisions the new Dogwood Health Trust makes,” Stein said. “I will continue to work hard on behalf of North Carolinians as I review deals of this sort.”

O’Neill’s campaign site does not address this issue.

The opioid crisis

Stein has made it a priority during his four years as state Attorney General to bring together law enforcement officers, families who have lost loved ones to the opioid crisis and professionals and others fighting against it.

“The opioid crisis continues to tear families apart all over our state,” Stein said.

Stein helped draft and shepherd through the legislature the Heroin and Opioid Prevention and Enforcement Act, or HOPE Act, the Strengthen Opioid Misuse Prevention and Enforcement Act, or STOP act, and The Synthetic Opioid Control Act.

In coordination with the state Department of Health and Human Services, his office has been part of a  public awareness campaign to try to prevent people from getting involved with opioids in the first place.

He also has worked with a small group of state attorneys general trying to negotiate a multi-billion-dollar settlement with drug companies that played a role in the crisis. “These companies helped to create and fuel this epidemic, and I am working hard to ensure that they pay to clean up the mess they’ve made,” Stein said. “There is no silver bullet to resolve the opioid crisis, and we need to work together at every level of government and with community organizations, leaders, and members to prevent misuse and addiction.”

As district attorney, O’Neill created DATA, District Attorney Treatment Alternatives. Many opioid abusers end up in jail, accused of low-level criminal offenses. In February, during his primary campaign, O’Neill described the program during an interview with WRAL’s Travis Fain.

“What we have done is we have gone into the local jail, and have identified those opioid abusers and heroin users and we’ve offered them an opportunity to come and get clean,” O’Neill said. “I negotiate with a company called Alkermes, which produces a drug called Vivitrol. Vivitrol blocks somebody’s ability to get high off of heroin or opioids. I went over to the jail and said ‘If you enter my program and we’re able to get you clean and you stay on the straight and narrow, we’ll dismiss your charges against you, low-level felonies.”

After one year, O’Neill said, every person who entered the program was testing clean, no one had any new contacts with law enforcement, and the enrollees had jobs for the first time in their lives.

“It’s been really life-changing for so many families,” O’Neill added. “What I’m proud to tell you now is that the legislature has taken notice of what we’ve done. They’ve put aside millions of dollars to try and replicate my idea across the state.”