North Carolinians pay more than many Americans for healthcare. The state ranks 38th nationally in healthcare access and affordability, according to a 2025 scorecard by the Commonwealth Fund.
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A separate study by RAND found North Carolina had the 15th highest overall hospital prices in the country.
Gov. Josh Stein announced the formation of the North Carolina Health Care Affordability Commission earlier this summer to develop practical recommendations to reduce healthcare costs and make care more affordable. When the bipartisan commission held its first meeting this week, they learned just how daunting their mission would be.
Professor Barak Richman, co-director of the Health Law Program at the George Washington University Law School, told the commission that affordability is a national problem. He said America spends substantially more on healthcare than other wealthy countries – $5.3 trillion in 2024.
“It’s important to say that we are no healthier. In fact, we are actually less healthy than those [other] industrial nations,” Richman said.
About 1 in 6 U.S. adults go without healthcare due to the cost, according to an analysis by KFF.
Richman said businesses increasingly cannot afford to offer health insurance benefits. And for people who do obtain health insurance through work, premiums have been rising faster than inflation since 2013.
The result is a state of constant worry about whether a person can afford to see a doctor when they are sick. One in five North Carolinians struggling to pay their medical bills will be contacted by a collection agency.
“In 2023, 8% of North Carolinians had medical debt in collections. It’s not just that they had medical debt, but that they were contacted by a court saying that they were being sued for a collection,” Richman said. “And that was the fourth highest in the nation.”
What’s driving costs higher: lessons from the Hoosier state
If you look at what is driving health care costs higher, Richman said, hospital care and physicians account for 65 cents of every health care dollar spent. And costs tend to rise when there is a lack of price transparency.
“You don’t have price competition if patients can’t compare prices,” said Richman.
Others on the commission pointed to private equity firms buying health care physician practices and facilities. Private-equity ownership can result in higher prices for patients and a consolidation of practices as the focus turns to profit over patient care.
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Members of the commission are taking a closer look at efforts in Indiana, which has moved quickly over the past three years to rein in costs.
Last year, Indiana’s legislature passed bills that would codify into state law the federal hospital price transparency rule and require third party administrators and pharmacy benefit managers to act as fiduciaries.
To further control costs, lawmakers in the Hoosier state passed bills to ban excess hospital fees and prohibit non-compete clauses for primary care. Mergers must now be reported to the state attorney general.
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An signed by Governor Mike Braun denies tax exemptions to hospitals that provide less charity care than the amount they receive in state tax breaks.
The promise and pitfalls of technology
Beyond passing more legislation, Mark McClellan, the director of the Duke-Margolis Center for Health Policy, said controlling costs may also require becoming more comfortable with technology and telehealth.
“It’s going to be hard to get to where we want to go, given trends in the population and workforce, without new kinds of digital supports,” said McClellan. “It really enables primary care planning and primary care practices to not just survive, but maybe thrive more effectively in the future when delivering care.”
Panel member Sen. Gale Adcock, D-Wake, a family nurse practitioner, told her colleagues that while consumers want lower healthcare costs, a huge percentage of the population doesn’t use technology or doesn’t want to when faced with a personal health problem.
“My mom is just an example of a whole section of people who don’t want to talk to a machine. They don’t want to talk to AI,” said Adcock. “They want to call their provider that they know and trust.”
Adcock says in many cases, a costly trip to the emergency department can be avoided if the patient can simply talk to a reassuring person at their primary care provider’s practice.
“What they really need to do is talk to their physician, their nurse practitioner, their P.A. and say, “Can this wait until tomorrow? I’m scared,’” Adcock said.
The Health Care Affordability Commission holds its next meeting in October when it decides which specific areas and unique ideas will have the greatest impact in reducing healthcare costs. The group is slated to deliver its recommendations to Gov. Stein in January 2027.
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