Can North Carolina lower health care costs? New bipartisan commission gets to work

Family health insurance premiums have increased more than 50% from 2013 to 2024, and North Carolina ranks in the bottom half of states in overall health system performance, access and affordability.

That’s the message that state leaders and members of the North Carolina Health Care Affordability Commission heard during Tuesday’s initial meeting. 

The panel, created by Gov. Josh Stein, through an executive order, includes lawmakers, state officials and representatives from hospitals, physician groups, insurers, employers and patient advocacy organizations. It is co-chaired by Brad Briner, North Carolina’s Republican state treasurer, and Dev Sangvai, the state’s Democratic Secretary of Health and Human Services.

“When you're thinking about what this really means, let's not forget that at the end of the day, it's 11 million people who are trying to stay healthy in our state," Sangvai said. "Our goal is to develop practical, data-driven strategies that will improve affordability without compromising quality or access."

Much of Tuesday's meeting focused on defining the affordability problem. Barak D. Richman, a George Washington law professor serving as the commission’s facilitator, delivered the statistics on costs and North Carolina’s ranking. He said the United States spends about 18% of its gross domestic product on health care — more than any other industrialized nation — while one in six adults delay care because of cost and more than two in five carry medical debt.

“We’re spending too much and not getting enough in return,” Richman said.

Briner said North Carolina has spent years studying health care costs without producing lasting reforms. The State Health Plan recently approved a tiered provider network, an example, Briner said, of the difficult decisions needed to address rising costs. Negotiations with several hospital systems failed.

“We cannot just produce another binder full of recommendations that gathers dust," Briner said.

The Commission will meet again in the fall before voting on final recommendations in January 2027, ahead of the General Assembly’s session. Each of the 170 seats in the legislature is on the November ballot.

The commissioners discussed a variety of topics.

Commissioners discussed expanding preventive care and addressing social factors such as housing, food insecurity and transportation, arguing those investments could reduce costly emergency room visits and improve long-term health outcomes. Others called for simpler, more meaningful price transparency, saying patients often cannot determine what care will cost even under existing federal requirements. 

Commissioners also discussed expanding value-based payment models, preserving independent physician practices to increase competition, reducing unnecessary tests and procedures, improving health literacy and using artificial intelligence to reduce administrative work and make the health care system easier for patients to navigate. Several members emphasized that recommendations should focus on measurable improvements in affordability, quality and access rather than simply producing another report.

Sen. Benton Sawrey, a Johnston County Republican, said rising costs are driven not only by more people receiving care but by how much care each patient receives. He said state data in several Medicaid service areas showed spending per enrollee increased by nearly 1,800% over about four and a half years. 

Sawrey said the state should give Medicaid managed care plans and insurers better tools to manage utilization and expand value-based payment models that reward appropriate care instead of higher volumes of services. 

North Carolina can look to Indiana for a success story. In Indiana, a legislative task force sparked bipartisan legislation, executive actions and new oversight aimed at increasing transparency and competition.

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