Ray Russell’s Statement on Healthcare in North Carolina: 

A healthy North Carolina is a prosperous North Carolina. Community health is a big topic, much bigger than a traditional “healthcare” discussion. Healthy living happens best when citizens have educational and job opportunities, living wages, good food, live in safe communities, and have clean air and water. In Ashe and Watauga Counties, we enjoy the extra advantage of living in one of the most beautiful regions on the planet. But even in healthy communities, people get sick, have accidents, and age. The topic addressed here is how we as a community and state address care for people who are sick or injured.

Caring for families is a North Carolina value. We value the right to affordable healthcare and prescription medications that don’t bankrupt families!

In Ashe and Watauga Counties, we are blessed with excellent local hospitals thanks to the hard work and skill of so many people. We are also fortunate to have caring, dedicated individuals who devote their careers to helping those struggling to pay for healthcare (like AppHealthCare, High Country Community Health, the Community Care Clinic, the free pharmacy at the Hunger and Health Coalition, Ashe Health Alliance, and so many more). But we also have a shortage of medical professionals and rural hospitals are struggling financially.

Our campaign has knocked on over 3,300 doors. When asked, “What matters to you?”, one of the most common answers is “affordable health care.” At one doorstep, the woman at the door broke into tears saying, “I’m not a deadbeat. I’ve worked since I was 14 years old, but I can’t afford my asthma medicine.”

In addition to meeting citizens at their doorstep, I have met with the executive teams at Ashe Memorial Hospital and Appalachian Regional Medical Center. We discussed healthcare issues with about thirty medical professionals at a forum last May. I have talked with scores of doctors and local community health professionals. Our goal is to know what issues really matter to you and to seek solutions to meet the medical needs of the community and reduce cost for all.

Medicaid Expansion

The single worst decision in the NC Legislature over the past 5 years is its failure to expand Medicaid coverage. Expanding Medicaid would help hardworking but low-income North Carolinians and their children.

This program was offered to states in 2013 as a part of the Affordable Care Act to assist people just above the federal poverty level. Most of these people have jobs, but not good-paying jobs. And they are not able to afford even subsidized health insurance through the ACA.

Beyond the harm to families, here is how NC is hurt by the Legislature’s failure to expand Medicaid:

  • NC’s economy loses $10.6 million per day ($4 billion per year). This is money we already pay in federal taxes. [1]
  • Our federal tax dollars are going to the other 34 states where Medicaid has been expanded and we get nothing in return.
  • 43,000 jobs have been lost. [2]
  • Rural hospitals are being hurt. 40% of rural hospitals in America are operating at a loss and several rural hospitals in North Carolina have closed in the last 5 years. [3] Ashe County raised its sales tax, mostly to help Ashe Memorial Hospital.

Thirty-three (33) states have expanded Medicaid. Virginia did it last year. Utah and Maine will be next. Yes, Utah—one of the most solidly Republican states in the country is about to expand Medicaid with public support of nearly 2/3 of its citizens supporting the plan.

States that expanded Medicaid are faring better than the few who have not. A recent study from Ohio tells the story.

“Ohio Medicaid Director Barbara Sears says the analysis shows Medicaid expansion has cut in half the number of uninsured Ohioans. Ninety-six percent of people in the program with opioid addiction got treatment, and 37 percent of smokers were able to quit. One-third reported improved health, including better access to medical care for high blood pressure and diabetes. ER visits went down 17 percent, and there was a 10 percent increase in the number of people seeing primary care doctors. And most recipients said Medicaid expansion made it easier to find work, earn more money and care for their families.” [4]

Medicaid expansion would directly help all North Carolinians by stabilizing everyone’s health care costs. For many people without health insurance, the only medical care they can receive is by going to the emergency room where everyone by law must be treated. That leaves our local hospital with millions of dollars of uncollectable debt. To offset those losses, hospitals are forced to charge the rest of us more for the services we receive. Medicaid expansion would greatly reduce that uncollectable debt (by about $2.5 million locally), and all of us would benefit.

My opponent in this election is deceiving voters.

  • He intentionally confuses Medicaid expansion with universal health care.
  • He claims that the federal government will phase this out (a claim with zero evidence).
  • He claims the program will cost North Carolina, when it will actually bring money and jobs to the state.

Last summer, the NC House with bipartisan support voted to study the effects of Medicaid expansion. My opponent voted “No” on even studying Medicaid expansion. He knows any legitimate study would expose his deceptive statements. Being wrong is bad enough; being willfully and perpetually wrong is worse.

We can invest in wellness or we can invest in illness. I choose wellness because healthy citizens make a prosperous NC!

Self-Employed Struggling with Health Care Costs

I know people paying $40,000 per year for their families’ health care. That’s a bitter pill to swallow at any income level. These people are farmers, entrepreneurs, small business owners, real estate agents, etc.

States have options to help the self-employed who do not qualify for ACA subsidies. Those options include: allowing non-profits to create healthcare groups that have the effect of providing insurance even though they are not technically insurance. Tennessee and Iowa are working on providing coverage through Farm Bureau for farmers. We should explore the same in North Carolina. (A bill to do this was introduced in this year’s legislative session but did not become law.) We should explore ways to create cohort groups for shared risk and reduce insurance costs and reexamine the use of high-risk pools to help people with chronic illness.

Mental Health

Mental health care is difficult to find for all North Carolinians. We must work to increase the availability of counselors, psychologists, psychiatrists, and mental health facilities.

MCOs (Managed Care Organizations) were created to provide Medicaid benefits to people in exchange for a monthly payment from the state. They have become a maze of bureaucracy making it difficult for the people who need services to understand. [5]

Drug/Alcohol/Opioid Crisis

Alcohol and drug abuse is the #1 health problem in Ashe and Watauga Counties (mental health is the second biggest health problem, diet is third). Yes, the drug crisis affects more people than cancer, diabetes, heart disease and stroke, aging, etc. [6]

In North Carolina, 1,505 opioid-related deaths occurred during 2016. The rate of opioid deaths has almost doubled since 2010. Between 2010 and 2016 in North Carolina, heroin-related deaths rose from 39 to 544 and the number of deaths related to synthetic opioids increased from 170 to 601. The increase in drug related deaths is especially seen among middle-aged males. [7]

Addressing this epidemic demands immediate attention and courageous leadership. Solutions will involve the following:

  • More judicious prescription writing of opioids
  • Community-based prevention efforts and integrated healthcare (medical, mental health, etc.)
  • Broader availability of Narcan
  • Law enforcement increasing efforts to stop drug trafficking
  • Harm reduction efforts like safe syringe programs
  • Expanding access to treatment and recovery services
  • Affordable health insurance for individuals with substance use problems

Increased access to health care via Medicaid Expansion is vitally important for many individuals to recover from substance abuse problems.

Local Health Services are Underfunded

Local state health services offices struggle to find resources to match the challenges they are required to address. Here’s just one example of dozens that could be cited… The rate of communicable diseases is rising rapidly in Ashe and Watauga Counties; however, state funding to fight these diseases last year was $30,000; the actual cost to our local health departments was $366,000.[8] Funding for community health has not kept up with the increased need for public health.


As your House Representative, I pledge to stand up to anyone who wants to make healthcare more expensive, and will work tirelessly to protect coverage and access to rural health care for Ashe and Watauga Counties.



[1] ncjustice.org/sites/default/files/Understanding%20Medicaid%20And%20Its%20Impact%20in%20North%20Carolina.PDF

[2] conehealthfoundation.com/foundation/initiatives/nc-medicaid-expansion/

[3] www.northcarolinahealthnews.org/2017/09/29/21325/

[4] npr.org/sections/health-shots/2018/08/21/640636316/ohio-gov-kasich-stumps-again-in-support-of-medicaid-expansion

[5] newsobserver.com/opinion/op-ed/article189644714.html

[6] Our Community’s Health: Result of the 2017 Watauga and Ashe County Community Health Assessments, AppHealthCare

[7] drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/north-carolina-opioid-summary

[8] How does AppHealthCare Respond to Communicable Disease Occurrences Locally, AppHealthCare