The Problem

1. Healthcare Costs Are Pricing Families Out of Care

• A statewide survey of more than 1,400 North Carolina adults found that healthcare affordability is a widespread and growing concern (Healthcare Value Hub, October 2023).
  • Over 2 in 3 (68%) experienced at least one health care affordability burden in the past year;
  • Over 4 in 5 (85%) worry about affording health care in the future;
  • Over 3 in 5 (61%) of all respondents delayed or went without health care due to cost in the last twelve months;
  • Low-income respondents and those with disabilities had higher rates of going without care due to cost and incurring medical debt, depleting savings, and/or sacrificing basic needs due to medical bills; and
  • Across party lines, respondents express strong support for government-led solutions.
• High healthcare costs, billing errors, and surprise charges are creating ongoing financial strain for North Carolinians, discouraging care and increasing household financial hardship (CHIP50, November 2024).
  • 61% of North Carolinians said that it was somewhat or very difficult to afford healthcare costs.
  • 43% of respondents indicated they had ever received a medical bill with an error in it.
  • About one-third (32%) of survey respondents in North Carolina said they had had to resort to using a credit card in order to cover medical costs they did not have enough money to cover.
  • Near three-quarters (74%) of respondents said they were somewhat or very concerned about surprise medical bills.
• A survey of more than 800 residents of North Carolina conducted in November and December of 2024 found that the costs of health care lead many North Carolinians to delay medical treatment and struggle financially (United States of Care, January 2025).
  • 80% believe the costs of health care in North Carolina are higher than they need to be;
  • 52% have accrued debt as a result of a hospital bill within the past two years;
  • 74% have recently taken an action that could impact their health in order to avoid the costs of health care, while another 43% say the costs of health care have impacted their ability to take medications as prescribed;
  • 88% agree that legislators in the state should take action to reduce the cost of hospital care, with almost half strongly agreeing legislators should do so;
  • 70% say health care consolidation has caused them to experience a financial or logistical challenge in accessing health care, and there is broad support for policies and elected officials that limit the impact of consolidation;
  • 46% of all surveyed North Carolinians say they are less likely to seek non-emergency treatment because of hospital facility fees, and 72% support placing limits on hospital facility fees in the state.

2. Inaction on Public Investment Impacting Community Well-Being

• More than 2.5 million North Carolinians are enrolled in Medicaid (Elon University, October 2025).
• Nearly 350,000 are enrolled in the Children’s Health Insurance Program (CHIP) (Elon University, October 2025).
• Combined, Medicaid and CHIP cover about 26% of North Carolina’s population (out of just over 11 million residents) (Elon University, October 2025).
• Medicaid and healthcare rank among the top two funding priorities for North Carolinians, with nearly half (44.6%) selecting it as a top area for increased state investment (Carolina Journal Poll, September 2025).
• Healthcare is a near-universal priority, with 93% of registered voters saying it is important for elected officials in Raleigh to address, including 70% who say it is very important (High Point University, September 2025).
  • 88% of registered voters say Medicaid is at least somewhat important, with 65% calling it very important, underscoring strong support for public funding and coverage stability.
  • Addressing opioids is viewed as a major public-health issue, with 86% of registered voters saying it is important and 58% rating it as very important.
  • While more polarized than other healthcare issues, abortion remains a significant concern, with 74% of registered voters saying it is at least somewhat important for state leaders to address, including 48% who say it is very important.
• 78% of North Carolina voters support Medicaid expansion (ACS CAN Poll, January 2023).
  • 96% of Democrats are in favor, with 71% of unaffiliated voters and 64% of Republicans as well. 
• 71% of North Carolinians support expanding mobile medical clinics in rural and underserved areas (High Point University, December 2025).
  • 70% believe mobile medical clinics can positively impact overall population health in North Carolina.
  • 67% say they would use a mobile medical clinic if they needed care and one was available.
  • 65% agree that mobile medical clinics are an important resource for improving healthcare access in the state.
  • 66% of North Carolinians trust the quality of care provided by mobile medical clinic staff.
• A majority (59%) report little or no concern about being able to access the vaccines they want (Elon University, October 2025).
  • 58% say North Carolina’s COVID-19 rules and restrictions were “about right.”
  • 30% say the state was too restrictive.

3. A Growing Mental Health Crisis

• As of July 2023, approximately 1 in 18 adults in North Carolina live with a serious mental illness (NCIOM, September 2025).
  • Behavioral and substance use disorders often co-occur, and nearly 1 in 6 NC adults has a substance use disorder alongside a mental health condition.
• In 2023, about 4 in 10 North Carolina high school students reported persistent feelings of sadness or hopelessness to the point that it disrupted their normal day-to-day life for two weeks or more at a time (NC Child).
  • The percentage of young people diagnosed with anxiety and depression more than doubled since 2016.
• 58% say caring for their mental health is extremely important (High Point University, May 2025).
  • 81% of North Carolinians either strongly or somewhat agree that more mental health resources should be dedicated to youth.
  • Nearly 60% say they are not content with the status of mental health treatment in the U.S.
  • 72% of North Carolinians agree social media has a noticeable impact on mental health and anxiety.
  • Only 15% of North Carolinians say they are very familiar with the state’s mental health system.
  • Only 13% of North Carolinians view the mental health system very favorably.
  • 45% of North Carolina adults say significant improvements are needed.
• A large percentage of the population (69%) responded that they are unaware of the 988 suicide and crisis line, highlighting the need to be more intentional about getting the word out about it to communities across the state (High Point University, September 2025).

Voter Consensus

Recent polling indicates strong public support for reform across key areas:

• 88% agree that legislators in the state should take action to reduce the cost of hospital care.
• 81% of North Carolinians agree that more mental health resources should be dedicated to youth.
• 78% of North Carolina voters support Medicaid expansion.
• 72% of North Carolinians agree social media has a noticeable impact on mental health and anxiety.
• 71% of North Carolinians support expanding mobile medical clinics in rural and underserved areas.

Policy Recommendations

Grounded in community consensus (defined as 68%+ support), the following solutions are proposed:

A. Affordability, Transparency, and Patient Protection

• Universal Price and Quality Transparency: Launch a statewide healthcare comparison platform and price tracker showing procedure costs, network coverage, quality metrics, and complaint rates so patients can make informed decisions.
• Plain-Language Billing and Surprise Bill Prevention: Require advance cost estimates, itemized bills, clear coverage explanations, and easy dispute processes, with strong enforcement of the No Surprises Act and state affordability laws.
• Patient Navigation and Insurance Literacy: Fund appropriate health navigators and voluntary community programs to help residents understand insurance, billing, appeals, and patient rights, particularly for Medicaid enrollees, rural residents, and the uninsured.

B. Mental Health Access and Integrated Care

• Mental Health as Core Healthcare: Expand billing and payment models that reimburse integrated physical and behavioral health visits, treating mental health like any other chronic condition.
• Rapid and Mobile Behavioral Health Access: Scale NC-STeP statewide and deploy rural mobile behavioral health units to provide rapid psychiatric consultations and reduce emergency room overuse.
• Early Intervention for Children and Youth: Provide stable funding for school-based mental health providers and require coordinated crisis protocols with local health systems to prevent escalation into emergency care or juvenile justice.

C. Public Investment, Workforce Capacity, and Community Health

• Healthcare Workforce Recruitment, Retention, and Well-Being: Invest in loan repayment, competitive pay, expanded training slots, safe staffing standards, and burnout mitigation to stabilize today’s workforce and build tomorrow’s pipeline.
• Rural Hospital and System Stability: Pilot voluntary global budget models for rural hospitals and offer performance-based grants tied to staff retention, patient outcomes, and community health impact.
• Prevention and Community Health Investment: Incentivize prevention through grants and tax credits for employers and community groups, paired with an annual public report comparing prevention vs. treatment spending and return on investment.
• Stabilizing and Strengthening Medicaid Expansion: Stabilize and strengthen Medicaid expansion by protecting coverage, increasing provider participation, and ensuring access to timely physical and mental health care statewide.

Policy Guardrails

While we do not impose a litmus test on our candidates, our policy recommendations are designed to serve as a resource—providing accessible, consensus-driven solutions that candidates can reference throughout their campaigns. These recommendations reflect strong membership support and are intended to streamline alignment around practical solutions. If candidates choose not to adopt a recommended policy in full or in part, they are still expected to advance solutions that fall within our established guardrails. This ensures that their platforms remain solution-focused and do not contribute to divisive or polarizing narratives that hinder progress and public trust.

All policy proposals have been verified through a consensus threshold of 68% or higher among our membership.