The North Carolina Senate, concerned about rising health care costs, plans to soon vote on a bill that would ban any further expansion of the list of procedures that health insurance must pay for.
The rules wouldn’t apply to many of those who get health insurance through their employers, if they work in the private sector for large companies. But the rules would apply to people on other insurance plans — including from the individual marketplace or some private group plans, as well as the 750,000 government workers, retirees and family members on the State Health Plan.
In total about half of everyone in North Carolina would be affected if the bill becomes law, state legislators said Tuesday.
North Carolina mandates 58 types of medical coverage that insurance must pay for — broad topics such as emergency room visits or mental health care, as well as more specific issues such as hearing tests for newborn babies.
Senate Bill 24 would require that the list of procedures can never grow larger than it is now. If any new procedures are going to be mandated in the future, they could only be added if something that’s currently required gets taken off the list.
It passed its final committee hurdle Tuesday morning and is planned to be voted on by the full Senate Wednesday, after which it would go to the state House of Representatives.
The proposal is backed by the leaders of the Senate Health Committee, including Sen. Jim Burgin, R-Harnett. He said the list of several dozen required procedures seems far too large.
“There’s 58 mandated coverages,” Burgin said. “You know, I tell people all the time, God only had to have 10 commandments.”
Other politicians think there should be more types of required coverage. For instance Sen. Julie Mayfield, D-Buncombe, said her mother and grandmother had breast cancer. Since that makes her a high cancer risk, she gets MRIs to check. But her insurance won’t cover those cancer screenings, she said, so she pays for it herself.
Mayfield said she’s been working with advocates and might sponsor a bill this year to require coverage for breast cancer screenings. She expressed concern that, if Burgin’s bill passes, she would be forced to pick some other medical issue to eliminate coverage for.
“We would have to go through the list of existing mandates and pick some other group of people to say, ‘They no longer get that,’” Mayfield said. “So, for instance, hearing tests for babies. So in order to improve the health outcomes for one group of people, this bill mandates that we reduce the health outcomes for another group of people?”
Burgin said that’s correct, but that he would rather focus on the fact that if insurance companies have to cover more procedures, all they’ll do is keep hiking prices for insurance. The line has to be drawn somewhere, he said.
“If we don’t do something about insurance, nobody’s going to be able to afford it,” said Burgin, an insurance agent. “And we’ve got a crisis coming up with the State Health Plan right now that I’m really concerned about.”
The State Health Plan is run by the State Treasurer. Last week, new State Treasurer Brad Briner, a Republican, announced one of his first actions will be to raise premiums for the State Health Plan, using a sliding scale that will charge workers with higher salaries a higher premium.
For the previous eight years the Treasurer had been Dale Folwell, a former high-ranking Republican state lawmaker. He spent years trying to keep State Health Plan premiums frozen, instead asking the legislature to increase spending on the program to cover the higher costs that have come with an aging population and higher prescription drug costs.
But GOP legislative leaders repeatedly shot down Folwell’s requests, which would’ve run into the hundreds of millions.
Republican lawmakers have focused in recent years on cutting taxes, including a plan to fully eliminate corporate income taxes by 2030. On top of that, natural disasters such as Hurricane Helene have also led to unexpected pressures on the state budget. Burgin said Tuesday the government simply can’t afford to take on additional costs — including for the State Health Plan.
The best way to avoid paying for health expenses, Burgin added, is to ensure they never happen in the first place.
“With all the other budget constraints and things that we have going on, if we don’t deal with it on a cost side, we’re going to be dealing with it on the expense side,” he said.
While some Democratic senators expressed concerns about the proposal and its potential to pit people with different medical ailments against one another in future fights for coverage, Burgin said his plan is fiscally responsible. The U.S. has higher health care costs than any other nation, and he said he’s seen recent studies claiming North Carolina has the highest health care costs in the U.S.
Last year Forbes conducted a study of all 50 states that found North Carolina was the most expensive state for people who insure themselves and one other person through their employer’s benefits, the second-most expensive state for people who insure their entire family through an employer’s plan, and the fifth-most most expensive state for people to insure only themselves.
No other state was more expensive, on average, in that Forbes study. Other studies in previous years have reached similar findings about the high costs of health care specifically in North Carolina.
“We’re the most expensive place in the world for health insurance,” Burgin said. “This is unacceptable.”
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