Democrat Senate Candidate Roy Cooper's Pay-to-Play Healthcare Push Made Him Rich

North Carolina Democrat Senate candidate Roy Cooper benefited substantially from healthcare companies while serving eight years as the state’s governor. Records show state-awarded contracts went to companies who made donations to entities connected to Cooper while he also owned stocks in investment funds featuring those same companies.

The state of North Carolina transitioned from a fee-for-service model to managed care for its Medicaid program in legislation passed in 2015. Under the fee-for-service model, the state’s health department reimbursed physicians and healthcare providers based on the number of services they provided. The managed care model gives contracts directly to health insurance companies.

Cooper was elected governor in 2016, meaning his administration would select the winners of the contracts when the transition took effect.

One company, United Healthcare, received one of the coveted contracts from Cooper’s administration in 2019 as he took in $142,184 in contributions.

Cooper prodded the state legislature for years to expand Medicaid in the state, which finally occurred in 2023 and extended coverage to over 600,000 North Carolinians. Medicaid expansion succeeded in growing the enrollment base flowing through that same United Healthcare contract, boosting Cooper’s stock portfolio.

His relationship with healthcare giant Centene links millions in donations directly to his time as governor.

Centene’s North Carolina-based subsidiary also won regional Medicaid contracts from Cooper’s administration in 2019, and the company later acquired WellCare, which held one of the four statewide contracts awarded in that same round.

Cooper chaired the Democratic Governor’s Association (DGA) in 2021-22 when Centene gave $1.45 million to the group — also timed with his continued push to expand Medicaid in North Carolina.

In January, it was reported that Cooper has taken more than $160,000 from big insurance throughout his political career in North Carolina. By July, that number has swelled to nearly $400,000 from the industry.

Another entity receiving donations is Moving NC Forward, a dark money nonprofit managed by Cooper allies. PhRMA, a trade association representing drug companies, gave $50,000 to the group in 2023 — the same year Cooper signed Medicaid expansion into law.

Local news outlets in 2019 reported on the group “selling access to Cooper” in meetings at a lavish resort.

Additionally, U.S. Senate Financial disclosures confirm Cooper owns stock in Centene through investment vehicles and nearly $500,000 just in the healthcare sector.

While Cooper was soliciting healthcare companies for donations, the state suffered from the highest healthcare costs in the nation.

Forbes detailed its criteria for the ranking, outlining that the state featured the highest average premium for “plus-one” health insurance coverage through an employer, the second-highest average premium for family coverage through an employer, and the fifth-highest average deductible for residents.

Cooper also opposes the $50 billion in additional rural healthcare funding in the Working Families Tax Cuts and oversaw the closing of rural hospitals in the state.