In his office, State Treasurer Brad Briner has a copy of a healthcare affordability task force report signed by Governor Jim Hunt in 1977.
Now, along with N.C. Department Health and Human Services Secretary Dev Sangvai, Briner will co-chair the Health Care Affordability Commission, a similar effort almost 50 years later. Long-standing concerns about healthcare costs are reaching a tipping point, Briner said.
"People are fed up, and rightly so. It's opaque, it's not particularly helpful. A lot of people are trying really hard to do the right thing, but it doesn't add up. So the question is, can we help to figure out a way to make it add up in a context of everybody desperately wanting it to?" Briner said.
Gov. Josh Stein created the new commission with an executive order signed Tuesday at Advance Community Health in Raleigh. The full committee has 25 people, but there are seven voting members.
In introducing the commission, Stein recounted a story he'd recently heard from a Johnston County doctor whose patients included a couple that ended up in the emergency room on a weekly basis. The reason, the doctor discovered, was that they both had chronic illnesses and could only afford the medication for one person at a time.
So they took turns, Stein said, trading off weeks for who bought their medication and who sought treatment in the emergency room.
"Healthcare is too expensive for people to get the care they need, and we ignore this problem of rising healthcare costs at our peril," Stein said Tuesday.
In addition to Briner and Sangvai, the committee's voting members include:
- Sen. Gale Adcock, D-Wake;
- Rep. Allen Buansi, D-Orange;
- Sen. Benton Sawrey, R-Johnston;
- Rep. Timothy Reeder, R-Pitt;
- And Kristin Walker, the director of North Carolina's Office of Management and Budget.
There will also be 18 non-voting members on the commission, made up of high-profile healthcare lobbyists, researchers and leaders from hospitals and insurance groups.
Forbes Advisor infamously declared North Carolina the most expensive state for healthcare in 2024, a study that has often been cited by politicians and industry groups.
Federal estimates on healthcare spending are only available through 2020. But researchers at healthcare nonprofit Altarum estimated that per capita healthcare spending in North Carolina increased 12.9% between 2019 and 2022, tied for the 15th-highest in the country. They also estimated that the state's per capita healthcare spending was about $9,730 in 2022, the 11th-lowest in the country.
Sangvai said that when he was a practicing physician, he frequently heard patients ask if cheaper options were available or what would happen if they couldn't afford medication or care.
"Affordability is not a single problem with a single cause. It reflects how care is paid for, how prices are set, how services are delivered, how primary care and prevention are supported, as well as how well our system meets the people's needs," Sangvai said.
Stein has created a similar bipartisan task force on energy policy, asking it to find and advance policy recommendations that help keep prices down while meeting spikes in North Carolina's demand for power.
Goals of healthcare commission
On healthcare, Stein is asking the commission to focus on improving transparency to help consumers shop more effectively for healthcare, improve data to help policymakers, find ways to address healthcare workforce shortages and both expand access to primary care and how much people use it.
"We want a specific, targeted list of interventions that have the real potential to make a difference in containing healthcare costs. This is a sensitive, complicated topic. This is an issue that is fundamental to our lives and well being, and we all have our own ideas about why costs are rising so fast. But the goal of this commission is to listen to the data, do the research and make recommendations," Stein said.
Rural healthcare is a focus of Stein's effort, with a directive to explore "unique solutions" to increase affordability in the state's rural areas.
Stein is also asking the commission to look at ways to inject competition into a marketplace that is rapidly heading towards consolidation. That steady process is the driving force behind WakeMed's effort to partner with Atrium Health and its parent company, nonprofit Advocate Health.
Briner, a Republican, oversees the State Health Plan as Treasurer. In that role, he has found himself grappling with ways to control rapidly escalating healthcare costs.
"Unfortunately, healthcare costs do rise faster than inflation and faster than the resources that people have to pay for them. We simply accept the status quo. We're asking taxpayers and state employees to shoulder a burden that is truly unsustainable," Briner said.
The state budget bill introduced Tuesday includes nearly $4 billion in state money for the State Health Plan. Without increased contributions from the state, Briner said, the State Health Plan would have needed to increase monthly premiums by $38 per member.
The budget also includes a provision that directs the N.C. Collaboratory to study rising healthcare costs and how they could be mitigated, including by looking at changes Indiana made to its Medicaid program.
Asked about the provision, Stein said that he welcomes other scrutiny of healthcare costs, in part to keep it from further dominating state spending that could instead go to public safety, infrastructure or schools.
"Every extra dollar that's just an inflationary dollar that doesn't actually go to improve someone's health is a dollar less that we can spend on those other things," Stein said.
In an effort to control healthcare spending, State Health Plan officials have increasingly tried to inject more competition into the plan, trying to find ways to lower their own costs and those of customers by asking providers to compete against each other for the business of their roughly 750,000 members.
The commission will start meeting in July, Briner said. Stein's order directs it to issue a report by January 1, 2027.
"This problem's not getting better if we wait," Briner said, adding that it would be ideal to make any policy recommendations to the General Assembly ahead of next year's legislative long session.
