Rep. Addison McDowell worked as a lobbyist for Blue Cross Blue Shield of North Carolina until the day he announced his congressional campaign in December 2023, and since arriving in Washington he has voted to slash Medicaid by $1 trillion — putting more than 670,000 North Carolinians who gained coverage under Medicaid expansion at risk of losing it — while refusing to join the bipartisan effort to extend ACA subsidies whose expiration caused a 29% premium spike for his former employer's own customers. When NC Health News asked McDowell to share his positions on Medicare, prescription drug costs, Medicaid work requirements, rural hospital support, and other health care issues during the 2024 campaign, his campaign did not respond.
McDowell Worked As A Lobbyist For Blue Cross Blue Shield Of North Carolina Until The Day He Launched His Congressional Campaign. According to NC Newsline, "McDowell was registered with the state as a lobbyist for Blue Cross Blue Shield of North Carolina until he resigned in 2023. [He] was only registered to lobby for the insurance company when he filed to run for Congress." McDowell resigned his lobbying registration on December 13, 2023 — the same day he announced his candidacy with a Trump endorsement. [NC Newsline, 3/14/24]
McDowell's First Major Fundraiser Drew Questions About His Ties To "Big Insurance." According to Yahoo News, McDowell's January 2024 fundraiser in Raleigh featured prominent state legislators including Senate President Pro Tempore Phil Berger. An opponent's consultant challenged McDowell's allegiances, saying, "'It appears safe to say Addison McDowell has chosen his allegiance and who he wants to represent.'" [Yahoo News, 1/30/24]
McDowell Voted For The "One Big Beautiful Bill," Which Cuts $1 Trillion From Medicaid Over The Next Decade. According to WFAE, the law requires that "many Medicaid participants must prove they are working, volunteering or attending school for at least 80 hours a month in order to maintain benefits." The bill passed the House 218-214 on July 3, 2025, with only two Republicans voting against it. [WFAE, 1/17/26]
An Estimated 255,000 North Carolinians Could Lose Coverage Under The New Work Requirements. According to WFAE, "213,000 expansion enrollees face potential coverage loss from administrative or documentation barriers." County officials warned that "counties cannot absorb that without cutting services, delaying investments, or raising property taxes." [WFAE, 1/17/26]
Arkansas Precedent Showed That Roughly 25% Of People Subject To Work Requirements Lost Coverage Despite Most Being Eligible. According to WFAE, in Arkansas — the first state to implement Medicaid work requirements — "approximately 25% of work-requirement subjects lost coverage, despite 95%+ meeting requirements or qualifying for exemptions." [WFAE, 1/17/26]
McDowell's Vote Could Trigger An Automatic Rollback Of North Carolina's Medicaid Expansion, Threatening Coverage For More Than 670,000 People. According to WFAE, North Carolina's 2023 expansion law "included a contingency: if federal funding drops below certain levels, the expansion automatically terminates." The One Big Beautiful Bill's provider tax cap and funding cuts could trigger this mechanism, potentially unwinding coverage that nearly 700,000 North Carolinians gained in less than two years. [WFAE, 1/17/26]
McDowell Did Not Join The Bipartisan Effort To Extend ACA Subsidies That Expired On December 31, 2025. According to NBC News, only four House Republicans — Reps. Brian Fitzpatrick, Mike Lawler, Rob Bresnahan, and Ryan Mackenzie — signed a discharge petition forcing a vote on a three-year extension of the ACA subsidies. McDowell was not among them. The subsidies had helped nearly 900,000 North Carolinians afford health coverage. [NBC News, 12/17/25]
After Subsidies Expired, ACA Premiums In North Carolina Rose By Up To 29%. According to NC Health News, Blue Cross Blue Shield of North Carolina — McDowell's former employer — announced a 29% increase for 2026 ACA plans, driven primarily by the expiring tax credits. [NC Health News, 8/15/25]
ACA Enrollment In North Carolina Dropped 22%, With 220,000 Fewer Residents Signing Up. According to the NC Department of Insurance, the loss of subsidies contributed to a dramatic plunge in ACA sign-ups, leaving hundreds of thousands without affordable coverage options. [NC DOI, 10/29/25]
Nine Republicans Voted To Extend ACA Subsidies In January 2026 — McDowell Was Not Among Them. According to ABC News, the House passed a procedural motion 221-205 to force a vote on a clean three-year ACA subsidy extension, with nine Republicans joining Democrats. McDowell voted against the motion. [ABC News, 1/8/26]
McDowell's Campaign Did Not Respond To NC Health News' Health Care Questionnaire During The 2024 Campaign. According to NC Health News, when the outlet reached out to McDowell's campaign "for answers to their healthcare questions, they received no response." The questionnaire covered Medicare, pharmaceutical costs, Medicaid work requirements, rural hospital support, child care access, and pandemic preparedness. [NC Health News, Viewed 2/16/26]
A North Carolina Man's Monthly Health Insurance Premium Nearly Tripled After ACA Subsidies Expired. According to Carolina Public Press, Adrian Pitts of Hendersonville saw his monthly premium rise from approximately $1,000 to $2,670. Pitts said, "'I have had to re-engineer things that I'm doing in terms of how I'm saving for retirement.'" [Carolina Public Press, 1/15/26]
A North Carolina Family's Out-Of-Pocket Health Costs Rose From $650 To $1,690 Per Month. According to Carolina Public Press, Michael Kimsal of Franklin County said, "'This is really the limit as to what's manageable for us.'" His family has been forced to cut spending to absorb the increase. [Carolina Public Press, 1/15/26]
A Charlotte-Area Couple Nearing Retirement Could See Annual Premiums Rise From $7,225 To $31,446. According to a Center for American Progress analysis cited by Carolina Public Press, a 62-year-old couple in Charlotte faces a potential $24,221 annual premium increase due to the subsidy expiration. [Carolina Public Press, 1/15/26]