Healthcare solutions for North Carolina

Published July 23, 2020

By Leah Byers


The vision for A Better Carolina would not be complete without addressing the on-going problems of healthcare in our state. Previous articles demonstrate how government contributes to high healthcare costs; how a proposed government intervention (Medicaid Expansion) would harm access to care for the most vulnerable populations; and how a current North Carolina regulation made the state’s healthcare system less prepared for the COVID-19 pandemic.

For decades, the U.S. approach to healthcare policy has been to layer intervention upon regulation upon mandate, hoping that the next bit of government will be the tipping point to fix all the problems caused by government intervention in the first place. Perhaps it is time to try a different approach.

Federal reform is certainly needed. Ten years after the passage of the Affordable Care Act, the legislation has not delivered on its name. In the meantime, there are plenty of state-level reforms that could have a substantive impact on healthcare access and affordability in North Carolina.

A good scorecard for state healthcare policy comes from the Mercatus Center of George Mason University. The Healthcare Openness and Access Project of 2020 grades states on metrics of “flexibility and discretion that patients and providers have in managing health and healthcare.” North Carolina ranks 46th in this grading system. (Note: As of July 16 2020, the study is available on non-peer-reviewed prerelease only).

Reviewing the Mercatus metrics is a good place to start. In addition, Civitas has advocated for healthcare reforms for years. With these factors in mind, the following free market reforms are some of the most viable or needed for improving healthcare in North Carolina.

Expand scope of practice

Expanding access to healthcare – especially in rural areas of the state – starts with increasing scope of practice for Advanced Practice Registered Nurses (APRN). APRNs are currently limited by government regulations from practicing within the full scope of their training and experience. The supervisory physician requirements are overly burdensome and can prevent qualified healthcare professionals from even volunteering during times of crisis.

In North Carolina, the proposal for expanding APRN scope of practice is known as the SAVE Act. In 2019, the bill enjoyed bi-partisan support in both chambers of the legislature, but it was unable to gain traction. It failed to even get a committee hearing. Legislative leadership should allow the bill to be considered in future sessions.

For a more detailed explanation of the need for the SAVE Act, and how it could expand access to healthcare in rural areas, read more about the subject here.

Encourage price transparency 

Lack of price transparency is perhaps one of the biggest obstacles in U.S. healthcare today. John Hopkins School of Medicine professor Dr. Marty Makary put it this way in a Newsweek piece:

“For years, hospitals have been focused on other priorities such as hiring staff and meeting regulatory requirements. Itemizing their true costs has never been required by the market. But given our current cost crisis and its toll on American families, transparency’s time has come.”

Some healthcare providers are circumventing the system of their own volition. Take Winston-Salem based surgeon Dr. Gajendra Singh (Sound familiar? He’s the doctor at the center of the on-going lawsuit against the state’s Certificate of Need laws). Dr. Singh offers a full list of his prices on his website, along with a comparison of the typical price for the same procedure in the U.S. This type of entrepreneurship and patient-friendly approach is a beacon of what the future of healthcare could look like in our state.

Where possible, North Carolina law should encourage price transparency in healthcare. Recently, some at the legislature have gone so far as to fight against transparency efforts by the state treasurer. Industry protectionism fuels such efforts, and they are antithetical to improving healthcare costs in our state.

Don’t hinder telemedicine growth

An early version of the North Carolina House’s coronavirus response legislation included a provision to require insurance companies to reimburse healthcare providers the same rate for telemedicine services as they do for in-person services. This provision did not make it into the final version of the bill, and it was time-limited, but represents a dangerous sentiment.

Telemedicine is a vehicle for providers and patients to connect in a more cost-effective way. Over-regulation of the practice through a parity law, like the one proposed by the House, is almost guaranteed to squash the positive benefits of telehealth innovation on healthcare prices.

Other healthcare reforms

The elephant in the healthcare room is the repeal of the state’s Certificate of Need laws. This is arguably the reform that is the biggest lift, but it could have a proportionately large impact on the healthcare landscape of North Carolina. For more information on CON reform, view the previous A Better Carolina article on the subject.

Other reforms from the Mercatus scorecard for which North Carolina scored low include:

Allow medical licensure reciprocity across state lines
Allow oral contraceptives without a physician prescription
Allow insurers from other states to sell health insurance in the state (Note: U.S. territories should also be included, since they are exemptfrom burdensome ACA insurance mandates)
These are just a few areas in which North Carolina could improve healthcare access. The full Mercatus scorecard for North Carolina can be found here.


It is worth noting that the state has taken positive steps in the free market direction in recent legislative sessions. The legislature approved creation of Association Health Plans in the state and protected Direct Primary Care agreements from burdensome insurance regulations. State leaders should be commended for their efforts in these areas and encouraged to continue to promote free market healthcare reforms in the months and years to come.