A HUGE Day for Pro-Consumer Healthcare Reforms at NCGA

May 06, 2021

May 5th will go down as one of the year’s biggest days for pro-consumer healthcare reforms at the North Carolina General Assembly. 

With three overwhelmingly bipartisan votes, the Senate passed legislation that will protect patients from surprise billing, lower costs and improve access to care. 

The champions of these bills were Senators Joyce Krawiec, Chuck Edwards and Jim Burgin.

Senate Bill 505 – Protect Patients from Surprise Medical Bills 

Surprise billing is one of the biggest issues facing healthcare consumers today. 1 in ten Americans have been a victim of a surprise medical bill received from an out-of-network provider. 

And while private equity backed providers and their Wall Street investors make millions, it drives up consumer costs by roughly $40 billion a year.

Senate Bill 505 takes on this problem through transparency.  

It requires that patients be notified prior to a procedure if anyone caring for them at an in-network facility is out-of-network. It also says patients must be told the expected cost for the out-of-network service.

Sen. Krawiec (R-Forsyth) said, "Even a sophisticated consumer would assume that an 'in-network' hospital means the services provided within that hospital are also in network. It really is outrageous. This bill will help patients make more informed decisions about their care and who is providing it."

Senate Bill 228 – A More Affordable Insurance Choice

Choices are important, especially when you’re deciding on something as expensive and important as health insurance. 

Right now, North Carolina’s laws and regulations prevent premium-paying small businesses and individuals from being offered the full menu of health insurance choices. 

Under current law, only large corporations who pay their own medical claims can buy what’s called and Exclusive Provider Organization (EPO) insurance plan.

Senate Bill 228 would give small businesses and individuals the same option.

EPO plans, by some estimates, could save small businesses, workers and their families, close to 20 percent on their premiums while also improving the quality of care-coordination.

The plans are subject to the same consumer protections, pre-existing condition coverage requirements, and network adequacy standards as other ACA health insurance plans.

Sen. Edwards (R-Henderson) said, "To put this in simple terms, this bill lets small employers offer their employees the same type of health insurance plan as large employers do. Thirty-nine other states currently allow this type of plan offering, so if our bill becomes law then North Carolina would be the 40th state."  

Senate Bill 462 – Lower Costs and Greater Access 

When there is competition in the marketplace it helps drive costs down. 

But right now, outdated state laws stifle competition when it comes to healthcare. 

North Carolina requires most new healthcare facilities in any given area to obtain a government permission slip to open. 

These permission slips, or “Certificates of Need” prevent new clinics from entering the market, unless it can demonstrate a “need” for another facility of its type. 

For example, a new value-driven in-home dialysis practice may want to open in a given area, but it can’t get a CON because the mega-dialysis providers own the CON and service all the current residents of the area. Or, even worse, have a CON but don’t actually use it.

Because of this, the residents are blocked from getting what could be far better and less expensive care. 

Sen. Burgin (R-Harnett) said, "This bill fixes the CON hoarding problem by requiring construction of a facility to begin within two or four years of CON issuance, depending on the size of the project. This will bring an end to CON hoarding, which will increase health care supply and lower costs."

Senate Bill 462 makes commonsense changes to the outdated CON laws. The changes will help more facilities open without a CON and help prevent CON-holders from blocking out competition.

Each of the bills will now go to the North Carolina House where your grassroots efforts will continue to be strongly needed to ensure each of these pro-consumer reforms takes the next step to becoming law.


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