Lawmakers: Bridge partisan divide to make better health policy

By Rose Hoban

The drumbeat of polarized partisan rancor can be so deafening that messages of people working together in politics can easily get lost.

But it’s happening, here in North Carolina — a purple state where Republicans have run the statehouse for more than a decade and voters have elected a Democratic governor for two consecutive four-year terms.

Sen. Gale Adcock (D-Cary) and Rep. Wayne Sasser (R-Albemarle) are prime examples of lawmakers who have come together from opposite sides of the aisle to fight together for key health care initiatives that they think will benefit the state — with Medicaid expansion being a big one.

Last month the lawmakers, together, shared some of their wisdom with an overflow crowd at the Eshelman School of Pharmacy at UNC Chapel Hill. They encouraged their audience of health care workers and pharmacy and nursing students to get involved in the political process and build coalitions across parties.

Adcock, a nurse practitioner, and Sasser, a pharmacist, made the argument that their partnership on health care policy across the political divide has been a productive one. 

“I don’t believe we’re unique in our … bipartisan relationship and regard for each other,” Adcock said. “It’s not across the board, but we’re not exactly unicorns either.”

Angela Kashuba, the pharmacy school dean, invited the lawmakers to campus after meeting them in Raleigh earlier this year.

“I was so impressed, individually, with what they were doing and how they talked about each other,” Kashuba said. “And when we talk about working across the aisle, or having civil discourse, even when we come from different places, the work that they were doing together for the health of North Carolinians impressed me so much that I wanted them to tell their story to our students.” 

In addition to telling stories of legislative victories, Adcock and Sasser gave students a road map, of sorts, for how to advocate for their priorities, build coalitions and get laws passed that help patients.

Lawmakers Sen. Gale Adcock (D-Cary) and Rep. Wayne Sasser (R-Albemarle) became friends while serving on health care committees when they were still both serving in the North Carolina House of Representatives. They bonded over a shared experience of caring for patients. Credit: Rose Hoban

Getting to know you

One of the main points Adcock and Sasser homed in on was that they’ve been able to join forces on certain issues because of their shared experiences working with patients.

Adcock started as a lawmaker in the House of Representatives before her election to the state Senate. She had been in the House a few years when Sasser arrived. 

Their common interests led to a friendship that extended beyond the health-related committees they served on in the General Assembly.

“We’ve spent time breaking bread with each other and doing other activities with each other, to actually get to know each other, to understand the areas of intersecting interests that we have that go beyond the professional but into the person,” Adcock said. “We don’t agree on everything. And that doesn’t bother us at all. But what we do have is a huge amount of things that we do agree on. And we agree on what many of the problems are, and we certainly agree on many of the solutions.”

Their ability to work together started from a place of mutual respect, Adcock and Sasser said.

“We’ve worked together on all kinds of collaborative practice bills, we’ve worked together and accomplished Medicaid expansion, which is one of the biggest bills that I’ll look back and say that I was able to work on and get passed,” Sasser said, referring to a policy passed this year allowing more than 600,000 low-income North Carolinians to become eligible for Medicaid coverage.

The expansion deal was sweetened by a financial inducement from the federal government that will bring an additional $1.6 billion to the state. The state spending plan for the next two years allocates more than $800 million of that incentive to beef up the state’s mental health system. 

“We have common goals. And our major common goal should be the same thing with the pharmacists and the nurses that’s in this room. And that’s looking after patients,” Sasser said.  

The two also emphasized how slow the lawmaking process can be. Patience is needed, they added, to achieve legislative goals, especially in an area as specialized as health care policy.

“You just don’t do those things overnight,” Sasser said. “Gale and I got it… but the other 160 non-medical people in the legislature, none of them got it.

“It was a no-brainer, but it wasn’t quite as simple as us health care professionals understood it. And still some people don’t understand it.” 

That took many educational sessions with fellow lawmakers, Adcock said, drawing a parallel to educating a patient to better manage their health.

“It was not one visit I have with my patient, it’s a series of visits,” she added. “Well, that was what Medicaid expansion took. It took a decade of continued conversation.”

“We had to convince the people who actually are the power gatekeepers at the legislature, to make it their idea,” Adcock said. “And when it became their idea, and they had the messaging and the math to back it up, by gosh, it happened.”

Advocacy moves the needle

Beyond Medicaid expansion, Adcock and Sasser said they have found common ground in the seemingly endless battles among health care professionals about how much autonomy certain practitioners can have.

These scope of practice debates have often pitted physicians looking to protect their turf against other professionals.

Advanced practice nurses have spent years lobbying for more independence through the SAVE Act. Pharmacists have sought better compensation for managing patient medications or administering vaccinations in a collaborative practice bill that’s gone nowhere so far. 

“We as pharmacists have to monitor and make sure our patients are healthy with things like blood pressure and diabetes,” Sasser said. “The doctors can’t continue to do the [lower-level] care for patients because we’ve got too many people in this world … and somebody has to look after them.” 

“Somebody in this class has to take my place, be the next pharmacist in the legislature,” Sasser added, “and somebody has to take Gale’s place because we’ve still got to get the SAVE Act passed, we’ve still got to get the collaborative practice bill passed.”

At least one student said he’s interested in this kind of outside work. Graduate student Dominic Tecza has already gotten involved with national organizations representing pharmacists. 

“I just think it’s really important for us as pharmacists, but not just pharmacists, health care workers in general, to advocate for the profession and see what’s on the books legislature-wise, and see where we can play a role in getting what we want passed for betterment of our professions,” Tecza said. 

“Now that we’re in such a, I would say, heated political climate … I feel like people are kind of more piqued and want to learn more about how they can play a role.” 

Both lawmakers encouraged the students to become advocates for their professions and their patients, even as they’re still building mastery in their subject areas.

That could take the form of conversations that Adcock modeled: “‘Hi, my name is Gale Adcock. I’m a family nurse practitioner who takes care of families in your district. My biggest concern right now is…’ maybe it’s paying for medication, maybe it’s access to care, maybe it’s behavioral health,” she said. “‘What can I do to help? I know you’re interested in this too. I’ve looked at the bills that you’ve introduced and that you cosponsored. How can I help you? How can I be a resource to you?’”

Adcock and Sasser added that getting on lawmakers’ radar might require repeated letters, phone calls or in-person meetings. 

“You have to make the effort outside your day job, to get to know us, to meet with us, whether that’s downtown in our offices, whether that’s in the district, where you live, whether that’s at events like town halls and things like that, to actually tell your story,” Adcock said. “You have to tell it more than once, you have to tell it more than one way, you have to bring different kinds of backup materials to help me understand, just like you do with your patients.”

“It’s a lot about repetition,” Sasser said. “Don’t assume that people know everything.”