Senate passes bill capping medical insurance coverage

Health insurers operating in North Carolina are required under several laws enacted over decades to provide a variety of medical benefits and coverages.

Since 2001, a state law has required the coverage of colorectal cancer screening for every covered individual over 50 and all those under 50 who are determined to be a high risk for the disease. Another law dating back to 1997 requires coverage for emergency care. Others require coverage for things like post-mastectomy care, coverage for ovarian cancer screenings, HIV/AIDS treatment, and coverage for adopted children.

The sponsor of Senate Bill 24, Sen. Jim Burgin, R-Harnett, told colleagues last week there are 58 such mandates in state law and it's time to enact a cap. The legislation would bar the addition of any new mandates unless an existing one is repealed.

It would also require any new benefits mandated by state law to also apply to the State Health Plan — which covers more than 750,000 state workers — and require the legislature to appropriate funds to the Plan to cover the cost.

The changes in the bill would impact a wide swath of insured North Carolinians, including those on individual policies through the Affordable Care Act and some private plans. Those on self-funded, large employer plans (approximately half of the state's insured workers) would not be impacted.

Burgin and other Republican sponsors of the bill, as well as proponents within the business world, say it offers a response to rising health care costs. The more procedures that insurance companies have to provide, they argue, the higher costs will go.

"We filed SB 24 to ensure that we were fully aware of the costs of our health care system," said Burgin. He pointed to a 2024 Forbes survey that found North Carolina had the highest costs in the U.S.

The bill's Democratic opponents said it would hurt efforts to add important — even lifesaving — procedures, such as breast cancer screenings, by requiring other patients to lose coverages they need.

"While we agree that health care costs are too high, this bill pits patients and providers against each other rather than seeking a comprehensive solution," said Sen. Jay Chaudhuri, D-Wake.

Chaudhuri proposed adding a study committee to the bill to investigate health care costs and outcomes. It was voted down after Burgin argued that it would incur unnecessary costs.

The bill passed the Senate on a 30-15 vote and now heads to the House of Representatives for consideration. Three Democrats (Senators Blue, Lowe, and Robinson) voted in support alongside all Republicans in attendance.

The legislation could also have significant implications for attempts to reform the "prior authorization" process, whereby insurance companies will only pay for certain treatments or tests if a patient first goes through a specific process, such as other treatments or procedures.

As NC Health News reported in January, many patients, advocates and health care providers have long argued that prior authorization requirements can be burdensome and become dangerous by delaying necessary care. If Senate Bill 24 becomes law, it's likely that any new efforts to restrict or reform prior authorization would be treated as a new insurance company mandate and thereby force the elimination of another benefit.

Senate Bill 24 now goes to the House of Representatives, where Republican members have introduced a companion bill — House Bill 46.