Democrats expect North Carolinians will make the GOP pay for cuts they made last year that have cost 200,000 residents their health insurance.
Republicans think they’ll be rewarded for President Donald Trump’s push to create good-paying pharma factory jobs in decaying tobacco and textile towns.
How North Carolina voters assess Republicans’ weighty health care moves could determine who replaces retiring Republican Thom Tillis in the Senate and controls the chamber. But in a recent swing through the Tar Heel State, POLITICO found voters, even ones directly affected by federal policy, are reluctant to switch sides. Party loyalties across America, stronger than ever in the age of Trump, are narrowing the path to victory by making it harder for candidates to find voters willing to consider the other side.
“When [Trump] says he loves America and the people in it, I truly believe that,” said Amy Davis, 57, a skin cancer survivor who lost her health insurance this year. Davis’ Obamacare premiums more than doubled to $1,200 a month following Republicans’ rejection of Democrats' bids to renew expiring subsidies.
An independent who leans conservative, Davis said she’s “not a Roy Cooper fan,” even though the Democratic Senate candidate is campaigning on restoring the Obamacare subsidies. Davis cites Cooper's policies to mitigate Covid-19 when he was governor that hurt her business, Amy Jo’s Country Restaurant.
Amy Jo’s serves up Southern comfort food — specializing in fluffy biscuits — a 15-minute drive from the site of a planned Johnson & Johnson factory in the sleepy town of Wilson, east of Raleigh. It once was home to the largest tobacco market in the world.
Republicans are hoping Trump’s tax cuts and manufacturing push will generate enough jobs and economic growth to wash over the increased Obamacare rates and coming reductions to Medicaid, the federal-state insurance program for low-income people, that the GOP enacted last year.
This strategy is playing out most clearly in North Carolina, which has become the epicenter for Trump’s plans on the economy and health care. In addition to Johnson & Johnson, Biogen, Genentech and Novartis have all committed hundreds of millions of dollars to expand their manufacturing footprint in the state in the past year. But North Carolina is also bracing for a $50 billion Medicaid cut from Trump’s One Big Beautiful Bill Act and has seen the steepest drop in Obamacare enrollment of any state, some 200,000 people. Its Research Triangle, home to top universities and the main attraction for the pharmaceutical industry, has also been hit hard by cuts to federal funding.
The high cost of health care has contributed to economic malaise, undercutting optimism around new pharmaceutical jobs and posing a challenge to the GOP’s prospects.
“I'm choosing between what to pay and what not to pay,” said Kayla Suttles, 30, a single mother of three and a waitress at Jones Cafe, the oldest restaurant in Clayton, North Carolina. It’s the same town where Novo Nordisk, the Danish manufacturer of popular weight-loss drugs, announced a $4 billion expansion in 2024. The company’s chief executive touted the investment in its deal with Trump in November.
Suttles has failed to land jobs at Novo Nordisk and Grifols, another major pharmaceutical manufacturer in the area, despite taking classes at the community college tailored to the industry. Uninsured, Suttles’ Medicaid application was denied, and she found Obamacare premiums unaffordable on her $32,000 income.
“If you live here and you work at one of those places, everybody's like, ‘Oh, you work at Novo, you’re good. You got money,’” Suttles said.
She hasn’t decided who she’s voting for.
In the race to replace Tillis, Cooper figures to be a strong candidate. He has never lost an election, winning races for governor in 2016 and 2020, the same years the state backed Trump, and was attorney general and state Senate majority leader before that. Sixty-eight years old, he began serving in the state legislature in 1987.
He is facing off against ex-Republican National Committee Chair Michael Whatley. Tillis announced in June he wouldn’t seek a third term after challenging Trump on the Medicaid cuts.
The race, projected to be the most expensive Senate contest in history, is likely to hinge on how voters see Trump’s handling of the economy. It could determine whether Democrats secure a majority, and shape Trump’s remaining years in office.
“At some point we will hit an inflection point that North Carolina will become a reliably blue state,” said Morgan Jackson, co-founder of political consultancy Nexus Strategies and an adviser on Cooper’s campaign. “This election is critical for that.”
Cooper is focusing on affordability in his campaign and has offered a health care plan to restore the Obamacare subsidies and reverse Medicaid cuts. Whatley is highlighting Trump’s enthusiasm for his campaign in a state that backed the president in each of his presidential runs. The state hasn’t elected a Democratic senator since Kay Hagan 18 years ago.
“If you look at 2026, it’s going to be driven by voter sentiment about the economy and…their sentiment about the White House,” said Paul Shumaker, who has worked on several GOP Senate races in North Carolina and co-owns political consultancy Strategic Partners Solutions.
“Health care is one of many anchors that are dragging behind those families who are trying to push their boats upstream,” he added.
Farm to pharma
The town where Johnson & Johnson plans to build, Wilson, is best known for its whirligig park, an array of colorful ornaments that spin in the wind beside old tobacco warehouses that once drove the town’s economy.
In January, the drugmaker struck a deal with Trump, joining the list of 16 pharma companies that have negotiated agreements with the White House for tariff relief. In its deal, Johnson & Johnson promised to lower prices for some drugs and committed to building a second multibillion-dollar factory in Wilson, on top of a $2 billion commitment it made in 2024. Salaries will average $108,823 at the factories — double the average in the county, where one in five residents lives below the poverty line. Rodger Lentz, Wilson’s city manager, called the project a “game-changer.”
“You can only watch things spin around for so long,” said Giovanna Danese, a Wilson resident and mother of four. She hopes the Johnson & Johnson factory will bring other businesses to the area and stave off some of the brain drain.
“Unless you’re going to be working at the hospital or the fast food place or some little country store that doesn’t really have much in it, you’re not going to grow much here,” she added.
The transition to pharmaceutical manufacturing in Wilson mirrors a transformation underway in old farming and textile towns across North Carolina as drug companies, under pressure from the White House to manufacture domestically, commit to building new facilities.
Members of the Pharmaceutical Research and Manufacturers of America, the trade group for branded drugmakers, committed $500 billion to building new manufacturing and infrastructure projects last year, citing Trump’s tax cuts and deregulation efforts as tailwinds.
No state has benefitted more than North Carolina, which secured six of PhRMA’s manufacturing commitments, more than any other state. The investments are the fruits of decades of state efforts to recruit the industry, ranging from company grants and shovel-ready industrial sites to tailored community college programs and career fairs that start as early as eighth grade.
“All I do is pharma,” said Josh Guss, 34, a construction worker at Johnson & Johnson’s factory. A former nurse, Guss pivoted to construction during the pandemic and has worked on several pharmaceutical construction sites in North Carolina.
“If they had told me in school how much I would make in the trades, I would not have gotten a nursing degree,” Guss, who makes $65 an hour, added.
State business partners, along with local officials, credited Trump’s policies for securing recent investments and helping reverse industrial decline. Doug Edgeton, chief executive of North Carolina’s Biotechnology Center, a state-sponsored organization to support industry, said Trump’s pressure on drug companies has had a “profoundly positive impact.” The center is working with more than two dozen companies interested in locating in North Carolina. Most of them are in manufacturing.
“What do you think would have happened if tariffs had been in place back then? Do you think all the textiles would have left North Carolina and went overseas?” said Patrick Harris, commissioner of Johnston County, where Novo Nordisk is located. For decades, Champion Products, which makes activewear, was the town’s largest employer before offshoring in the early 2000s.
Local business owners are also anticipating a boost. “It brings a good population of people to live here that could spend money in the businesses and be part of the community,” said Amy Read, owner of Leaf, a plant shop in Clayton. Novo Nordisk employees are regular customers, and she has been hired to teach succulent classes at the factory.
In a statement to POLITICO, White House spokesperson Kush Desai said the drug pricing deals and manufacturing investments were “just the beginning” of the president’s health care affordability push. “The administration is closely working with Congress to pass the Great Healthcare Plan,” he wrote, referring to Trump’s agenda, released in January, which included demands for greater price transparency and shifting funds from insurers to health savings accounts.
Still, even as Trump has succeeded in getting pharma companies to build factories, other administration policies have worked at cross purposes.
For years, North Carolina has attracted investment by leveraging its cluster of top-tier universities and college-educated talent, an ecosystem industry leaders warn is now at risk from Trump’s cuts to research funding. Tariff threats and Trump’s most-favored-nation approach to drug pricing, which ties U.S. drug prices to the lowest price paid in wealthy nations abroad, have also worried companies.
“There is some concern around science and around investment,” said Laura Gunter, president of the North Carolina Life Sciences Organization, which counts large drugmakers along with PhRMA and the Biotechnology Innovation Organization, the biotech trade group, as members.
“A lot of companies that are here have a piece of NIH-funded technology that is the basis of the company,” she said, referencing the National Institutes of Health, the $49 billion federal agency that funds health research. Trump last year sought unsuccessfully to cut the NIH budget by 40 percent.
For many residents, the promise of high-paying pharmaceutical jobs is also overshadowed by broader cost-of-living concerns.
“Trump is a great businessman…I’m hoping that him bringing these pharmaceutical companies will start to make an impact for us here in America, but I think he’s too distracted with everything else,” said Danese, who typically votes Democrat.
“We're still struggling to pay for everything.”
A health care engine
While North Carolina is reaping the rewards of its decades-long effort to attract pharmaceutical manufacturing, it is also vulnerable because of its reliance on jobs providing health care to patients.
The cuts in the One Big Beautiful Bill Act to Medicaid, which will cost the state an estimated $50 billion, will pose big challenges for the state’s hospitals and health care providers.
Six of North Carolina’s 20 largest employers last year were health care providers, compared to only one in 1990, according to data from the North Carolina Department of Commerce. Manufacturing, meanwhile, has gone the opposite direction: In 1990, 25 percent of the state’s top 20 employers were manufacturers. Today, none are.
The state’s growing reliance on health care as an economic engine is even clearer at the county level. In 1990, manufacturing was the top private employer in 75 percent of North Carolina’s counties; today, that has fallen to 32 percent. Meanwhile, health care is the top employer in 25 percent of counties, up from 9 percent in 1990.
The deep GOP cuts to Medicaid, which include reduced payments to hospitals and new requirements that people using the program work, volunteer or go to school 80 hours a month, could result in hospital closures and leave hundreds of thousands of residents uninsured.
“There's real headwinds associated with cuts to Medicaid,” said Lee Lilley, North Carolina’s secretary of Commerce. “The decline of investment at the federal level in workforce, in Medicaid, in health care delivery, frankly, and in research will have demonstrable impacts on our economy.”
The state legislature is gridlocked over how to pay its share of Medicaid costs — the program is jointly funded by the federal and state governments — and could drop coverage for the 720,000 residents who gained it in an expansion Cooper led three years ago.
“Rural eastern North Carolina is going to become a medical services wasteland,” said Randy Lansing, the town manager of Nashville, where Cooper grew up.
Nashville, a 45-minute drive east of Raleigh, is the county seat of Nash County. The county is where Vice President JD Vance and Whatley held a recent rally, and the location of Trump’s most recent North Carolina visit. Its congressional district, represented by second-term Democrat Don Davis, is the only competitive House race in the state this year following a GOP redistricting push in October. Nash’s hospital system is the county’s second-largest employer, behind the drugmaker Pfizer.
Jonathan Felts, a spokesperson for Whatley’s campaign, told POLITICO that Whatley supported the One Big Beautiful Bill Act's Medicaid provisions. “Michael Whatley supports cutting illegal aliens from getting taxpayer-funded Medicaid, cutting weasels who were fraudulently filing for Medicaid in multiple states, and adding a work requirement for able-bodied adults,” he wrote in a statement that also praised the law’s $50 billion rural health care fund and attributed high health care costs to Cooper’s leadership as governor.
Cooper, meanwhile, has leveraged the high cost of health care against Whatley, hosting roundtables on the issue and portraying his opponent on social media as opposed to lowering health care costs. Earlier this month, in Greensboro, a city of 300,000 that’s 75 miles west of Raleigh, Cooper unveiled a nine-point plan on health care, promising to reverse Medicaid cuts and revive the Obamacare subsidies if elected. The extension of the Biden-era subsidies were at the center of Democrats’ demands in the record-long government shutdown last year.
Subsidies have now reverted to the levels Democrats set when they created Obamacare in 2010. Insurance premiums have more than doubled for the average buyer of an Obamacare plan, and have risen significantly more for middle-income people who no longer qualify for any federal help.
A recent health care poll of 800 North Carolina voters conducted by Healthier United, a group that has opposed Republicans’ health care moves, found more than two-thirds supported extending the Obamacare subsidies. Republican voters were split equally on the issue. The poll was conducted from March 8-9 and supported by Strategic Partners Solutions and Nexus Strategies.
“Affordable health care continues to move further out of reach for North Carolinians thanks to D.C. insiders like Michael Whatley,” said Sam Chan, a spokesperson for Cooper’s campaign, adding that Cooper will work with Republicans in the Senate to make health care more affordable and accessible.
Some Republican strategists are raising alarm at the GOP’s messaging on health care. “I might not agree with the Democrats’ plan, but they have a plan. The Republicans, in either Raleigh or Washington, do not seem to be focused on anything that's going to have a practical effect between now and Election Day to address voters’ concerns,” said Carlton Huffman, a GOP strategist in North Carolina.
Health care has long been a political weakness for Republicans and the risk in favoring tax relief over the social safety net has grown as the party tent includes more working class voters reliant on federal programs. Hours after announcing his retirement, Tillis slammed Republicans for supporting Medicaid cuts in Trump’s megabill, warning they were making a “mistake on health care.”
“I respect President Trump. I support the majority of his agenda, but I don’t bow to anybody when the people of North Carolina are at risk, and this puts them at risk,” he told reporters. Tillis was one of three Republican senators, with Susan Collins of Maine and Rand Paul of Kentucky, to vote no.
Other Republican lawmakers in North Carolina have defended the cuts. Sen. Ted Budd called the Medicaid changes “responsible reforms” to slow cost increases and limit coverage to qualified individuals. He introduced a plan in December with Sen. Ted Cruz (R-Texas) to extend the maximum duration of private short-term insurance plans as an alternative to extending the Obamacare subsidies.
Josh Dobson, chief executive of the North Carolina Healthcare Association and a former GOP state lawmaker, cautioned against blaming any party for the Medicaid cuts, saying “Congress had no good options.”
“There's no question that the hospitals are economic anchors…We're mindful of the challenges,” said Dobson. The NCHA, which represents hospitals and health systems, last year had warned Medicaid cuts would impose "significant financial burdens” and be “catastrophic” to the state Medicaid expansion and rural hospitals.
In Trump’s manufacturing towns, voters are reckoning with those changes.
Back in Johnston County, Christina Sullivan, 23, a self-employed contractor who makes around $20,000 a year, is worried she could lose her Medicaid coverage next year when new work rules take effect. She takes daily antidepressants and mood stabilizers, and even a brief medication lapse can trigger sleep paralysis, a condition in which a person loses their ability to move while falling asleep or waking up.
“It's very scary to think that at some point I might not be able to afford them,” said Sullivan of her prescriptions. An independent, she voted for the Democrat, Kamala Harris, in the last presidential election and is planning to vote for Cooper this year.
Others are cheering the GOP’s Medicaid reforms, which in addition to the new work requirements included a crackdown on state budget gimmicks that drew more federal funding.
“There's people abusing the system everywhere,” said Jeremy Blackman, 41, a truck driver from Clayton, lounging at a gas station casino on a Thursday afternoon. Like Sullivan, Blackman grew up in Johnston County, which backed Trump in all three of his elections.
While Blackman supports Trump and Whatley, he too feels Republicans have dropped the ball on the economy. “Let's get back to making money,” he said, hitting the spin button on a slot machine.
Later, he counted his losses: “I came in with $100, and I’m probably going to leave with about $5.”
from Politics, Policy, Political News Top Stories https://ift.tt/pIgQwv2
https://ift.tt/KVhFg16
0 Comments