Obamacare, Medicaid key issues in House District 41

One of the main issues in the race for House District 41 is health insurance — specifically whether and how the state should deal with Medicaid expansion under the Affordable Care Act.

The incumbent, Gale Adcock, a Democrat and a nurse practitioner, wants the state to expand Medicaid so more of the state’s low-income and disabled residents have health insurance.

“As a nurse, and a health care administrator, I found it unbelievable that the 2013 legislature decided to send our federal tax dollars to states like Ohio and Florida to expand their Medicaid programs while rejecting this insurance coverage for almost 500,000 of our own citizens,” Adcock wrote on her website.

Republican Chris Shoffner, a health care consultant, told Carolina Journal he wants North Carolina to ask for a waiver from the federal government that would allow the state to draw up its own approach to expanding health insurance coverage under the Affordable Care Act. He also wants the state to work on controlling health care costs for state employees.

“Whether I’m elected or not, that’s where I’m spending my efforts,” Shoffner said.

House District 41 covers the west end of Wake County, including Apex, Cary, and Morrisville. About 43 percent of the district’s 63,478 voters are unaffiliated, according to the North Carolina State Board of Elections. About 30 percent are Republican, and 27 percent are Democratic. The remaining 6 percent are Libertarian.

Adcock, 62, the chief health officer at the SAS Institute, narrowly defeated Tom Murry, the two-term Republican incumbent, by less than 800 votes in 2014. She did not return phone calls or an e-mail from CJ.

Brian Fitzsimmons, chairman of the Wake County Democratic Party, said the district is one “that will continue to go back and forth.” The North Carolina FreeEnterprise Foundation, which tracks state elections, ranks the district competitive based on its conventional voting behavior since 2008.

Fitzsimmons said perhaps the most pressing issue facing the district is funding for public education. The county school board passed a budget in August that included $17 million in program cuts such as reducing how often schools are cleaned, and leaving thermostats at lower settings in the winter.

About 59 percent of the district’s funding comes from the state, and the district is getting less money from the state for each student than it did in 2008, according to the district.

“They can’t always supplement the full difference,” Fitzsimmons said.

John Bryant, chairman of the Wake County Republican Party, said if Democrats hold the seat it would enhance the party’s chances of picking up enough seats to break the Republicans’ veto-proof majority in the House.

“I think it will be close,” Bryant said. “We have two very qualified candidates.”

Adcock has raised more than $156,000, including a $45,000 loan from her husband, Kevin, according to campaign filings. About $83,449 was donated by individuals. Political committees such as PACs donated about $22,200. Shoffner had raised $1,177, by June 30, all from individuals.

Adcock was one of the House sponsors of a bill that would create a nonpartisan redistricting commission. A federal court case was filed challenging the districts used to elect state lawmakers in North Carolina, and another has challenged the state’s congressional districts. In North Carolina the General Assembly redraws electoral maps. It is among the top states for redistricting litigation.

Adcock also was one of the sponsors of a bill that would require the state to build a database and website with information on North Carolina grants and contracts.

Before she was elected to the General Assembly, she was a member of the Cary Town Council and the mayor pro tem. She has degrees in nursing from East Carolina University and UNC-Chapel Hill.

Adcock didn’t list any debts or business interests in a nonpublicly owned company in her Statement of Economic Interest. Her husband, Kevin, a compensation specialist for the city of Greensboro, has an investment of $10,000 or more in Phillip Morris International, according to her filing.

Shoffner, 49, is a self-employed health care consultant, according to his Statement of Economic Interest. He has a bachelor’s degree in business administration from N.C. State University.

He has business interests in MBA Ventures LLC, Physician Care Direct LLC, and True CB. He listed four bank debts with another family member of $10,000 or more, excluding a home mortgage. Shoffner said the debt was car loans.

Shoffner’s wife, Melissa, is a business analyst at First Citizens Bank.

North Carolina has one of the highest rates of uninsured people in the nation, according to the National Center for Health Statistics in Atlanta. About 15.6 percent of North Carolina residents were uninsured in 2015. The only states with higher percentages of uninsured residents were Alaska, Oklahoma, South Carolina, and Texas.

Blue Cross Blue Shield of North Carolina, the largest health insurance company in the state, and the only company to offer Affordable Care Act plans in all 100 counties, lost $282 million in 2015 on plans purchased under the ACA.

In a WRAL candidate questionnaire Shoffner provided to CJ, he listed reducing waste in the State Health Plan, and lowering Medicaid expenses as among his top priorities.

The State Health Plan provides health care coverage to more than 700,000 teachers, state employees, retirees, and others. About 2 million people are covered by Medicaid or CHIP, the Children’s Health Insurance Program.

Gov. Pat McCrory and the Republican-led General Assembly have opposed expanding Medicaid, saying its structural problems and processes need to be fixed first. It had amassed nearly $2 billion in losses in four years as McCrory assumed office after the 2012 election.

Thirty-one other states and the District of Columbia have expanded their Medicaid programs to include able-bodied adults with incomes up to 138 percent of the federal poverty level or $33,534 for a family of four. Many of those states saw their state budgets grow due to higher than expected costs of their Medicaid expansion.

In the WRAL questionnaire Shoffner said he wants to have a defined benefit plan for “primary care only” for people who don’t qualify for Medicaid.

Shoffner said on his website that his plans will save North Carolina about $2 billion of the $7 billion the state currently spends on health care.

Shoffner said Union County employees who participated in a direct primary care program — in which workers paid a set quarterly or annual fee to a family physician for most routine services  — saw a 38 reduction in medical expenses along with less absenteeism and more job satisfaction.

“The basis for a 1332 state innovation waiver [allowing a state to allow alternative medical coverage plans to some residents while complying with Obamacare] would center around better access to primary care,” Shoffner said. “Using payment reform. That’s the magic in the Union County example.”

A July report by the Government Accountability Office said that federal rules may limit states from applying for the waivers. Vermont and Hawaii have applied for those waivers. North Carolina applied for a separate program waiver earlier this year for its Medicaid reform model.