Cary, NC – June 2, 2022 – The North Carolina Healthcare Association thanks the North Carolina Senate for advancing a bill that includes Medicaid expansion to improve access to health care coverage for approximately half a million North Carolinians currently in the coverage gap. These hard-working individuals include farmers, fishermen, veterans, clergy and service industry workers, among others. Healthy workers are essential for our state to enjoy a healthy economy.  

Individuals without health insurance often wind up in the emergency department with preventable and costly medical conditions – expanding Medicaid is an opportunity to change that. North Carolina hospitals would see a reduction in uncompensated care by closing the coverage gap, which would have a particular impact on our struggling rural hospitals. When hospitals provide care without adequate reimbursement, costs rise for everyone, including for those with insurance. 

In addition, the Healthcare Access and Stabilization Program (HASP) could give the state an opportunity to bring in billions of dollars in federal funds to help stabilize rural hospitals and add to the state’s General Fund to address issues such as the growing mental health crisis. This federally funded program comes at no cost to the state and could provide additional dollars to the general fund. It would also have the effect of improving provider participation in the Medicaid program, improving network adequacy and access to care. 

At the same time, House Bill 149 contains troubling language that will erode hospitals’ ability to care for their community and negatively impact the relationship between patients and their providers.   

North Carolina’s health systems and hospitals remain deeply concerned about proposed modifications to the current Certificate of Need law included in the bill. The ultimate goal of Certificate of Need programs is to use data-driven need methodologies to equitably distribute healthcare services across the state while ensuring quality services. Hospitals do not operate in a traditional free market environment; they have a moral and legal obligation to care for all regardless of the patient’s ability to pay. Modifying the current CON law would hurt the stability of rural hospitals by carving out elective and outpatient procedures which are the lifeblood of community hospitals, while allowing niche medical organizations without such federal regulation to cater to commercially insured patients. The CON process has right-sized healthcare resources in our state, keeping costs contained and care accessible in communities. 

Further, the bill ignores common sense telehealth modernization measures in favor of another insurance industry drafted bureaucracy to make it harder for providers to care for patients through modern technology.  

In addition to the harmful CON and telehealth policies that will ultimately impact patients, the bill includes yet another tax on hospitals making hospitals one of the highest taxed businesses in the state.  Most of our state’s hospitals are charitable, not-for-profit organizations that reinvest in people, programs, and services.  Like other not-for-profit organizations, hospitals have a duty to fulfill their charitable purpose. In an environment where half of all NC hospitals have negative operating margins, this won’t stop the bleeding. North Carolinians not only depend on their hospitals being there when they need help in their most vulnerable time of need, but also thousands of North Carolinians and their loved ones depend on the jobs hospitals provide.   

NCHA applauds the effort to expand coverage and pass the Healthcare Access and Stabilization Program but urges the General Assembly to decouple those provisions from the remaining harmful provisions. 


About NCHA 

Founded in 1918, North Carolina Healthcare Association (NCHA) is the united voice of the North Carolina healthcare community. Representing more than 130 hospitals, health systems, physician groups and other healthcare organizations, NCHA works with our members to improve the health of North Carolina communities by advocating for sound public policies and collaborative partnerships and by providing insights, services, support and education to expand access to high quality, efficient, affordable and integrated health care for all North Carolinians.  

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