Senate Advancing Trio of Pro-Consumer Health Care Reforms

Reforms addressing access, cost, and transparency to be voted on this afternoon

Measures continue Republican commitment to pro-consumer reforms to the health care system

Raleigh, N.C. — The North Carolina Senate will vote today on a trio of pro-consumer health care reform bills: Senate Bill 505, Senate Bill 462, and Senate Bill 228. Taken together, these bills fit into Senate Republicans’ long-term goals of improving access, lowering costs, and increasing transparency for consumers.

Senate Bill 505 (Sponsored by Sens. Joyce Krawiec, Jim Burgin, Jim Perry)

This bill requires healthcare facilities to notify patients if a provider within that facility is out-of-network.

Legislators have heard many stories of patients doing their due diligence to identify an in-network hospital, going into that hospital for a procedure, and then getting a surprise bill four months later for some part of the procedure that was performed by an out-of-network provider. The idea is that disclosure will prompt questions from a patient so he or she can learn ahead of time what to expect and act accordingly.

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 462 (Sponsored by Sens. Joyce Krawiec, Jim Burgin, Jim Perry)

This bill makes reforms to Certificate of Need (CON) laws.

In North Carolina, providers must get government approval before offering a particular service. For example, if a hospital wants to open more beds, it has to get a CON from the state government before being allowed to build new beds. The CON has nothing to do with whether the provider is operating safely — that’s another regulatory matter. A CON is all about whether the government agrees that there’s not enough of a supply of hospital beds in the area.

The system is rife with protectionism, which keeps down supply and therefore drives up costs.

This bill would eliminate the practice of “hoarding” CONs. For example, right now, a hospital system could apply for and receive a CON to build a new hospital in a particular county. There is no time limit for when that hospital must be built. So the system could just hoard that CON for years and years, never building a new hospital while also preventing anybody else from building a new hospital.

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 228 (Sponsored by Sens. Chuck Edwards, Joyce Krawiec, Jim Burgin)

This bill deals with EPO benefit plans. An EPO benefit plan is like a PPO health insurance plan, except they do not include an out-of-network option. The trade-off for not offering consumers out-of-network providers is that EPO plans cost 15–20 percent less than PPO health insurance plans.

Large self-insured employers already have the ability to offer employees EPO plans, and some in the state do. However, North Carolina law currently does not allow small businesses to offer EPO plans to employees.

One of the top concerns from business owners is the escalating cost of healthcare. This bill gives small businesses a lower-cost option.

Likewise, families and individuals who desperately need more affordable health insurance can take advantage of EPOs.

Sen. Edwards (R-Henerson) 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.”

The bills will be voted on the Senate floor this afternoon.