Patients deserve transparency and accountability in North Carolina’s hospital system

North Carolina families shouldn’t have to guess what their healthcare will cost or whether they’re getting a fair deal. But too often, that’s exactly where people find themselves: navigating a system where prices vary widely, transparency is limited and accountability can feel just out of reach.

At the center of this challenge is a trend that has quietly reshaped healthcare across the country: hospital consolidation.

Over the past two decades, hospitals have steadily joined larger systems, often with the goal of improving coordination and expanding access to care. Those are important goals. But the reality for many patients, especially those in rural communities, has been more complicated. Research continues to show that when markets become more concentrated, prices often rise and choices become more limited. New consolidation efforts in North Carolina raise real questions about what this means for patients, taxpayers and local communities.

When competition declines, patients lose. And too often, families and employers end up paying the price.

We’re seeing the effects here in North Carolina. Wide differences in hospital prices and real gaps in price transparency make it harder for patients and employers to plan ahead or even know if they’ve been treated fairly.

And it’s not just about confusion. It’s about trust — trust that the system is working as intended and that patients are benefiting from it.

One clear example is the 340B Drug Pricing Program. This federal program was created in 1992 to help ensure low-income and rural patients have access to affordable medicines. Eligible hospitals and clinics can buy outpatient medicines at steep discounts with the understanding that those savings should support patient care and community needs.

That goal and the 340B program are worth preserving. But over time, the program has expanded dramatically without consistent transparency or clear requirements for reporting how those savings are used. In too many cases, patients have no way to know whether discounted medicines are actually lowering their costs or improving access to care.

In North Carolina, data shows that some hospitals participating in 340B have charged far more than the discounted price they paid for certain medications. At the same time, there is no consistent requirement that those savings be passed directly to patients or clearly tied to improving patient access or affordability. When that’s combined with continued hospital consolidation, it raises serious questions about whether the program is serving patients as Congress intended.

This highlights something else worth paying attention to: incentives matter. As hospitals grow larger and acquire new facilities, they can expand their use of programs like 340B. Over time, that dynamic can reward consolidation, reduce competition and make an already complicated healthcare system harder for families to understand.

Supporting hospitals and standing up for patients should not be in conflict. We can, and should, do both.

That starts with greater transparency so patients can understand prices before they receive care. It means clearer standards and accountability so programs designed to help vulnerable populations actually deliver on that promise. It also means practical federal reforms that protect legitimate safety-net providers while closing loopholes that allow the program to drift away from patients.

The Trump administration is taking one encouraging step by continuing to pursue the recent federal 340B rebate pilot, which offers a measured way to add verification and accountability before discounts are finalized. Done correctly, that approach can help confirm that a prescription is eligible, reduce duplicate discounts, create a clearer data trail and bring more discipline to the program without changing which hospitals or clinics qualify for 340B. Just as important, it focuses on solving problems up front rather than relying on slower, after-the-fact efforts to untangle errors once the money has already moved.

That is the kind of commonsense reform conservatives should support: limited, practical, focused on accountability and respectful of both taxpayers and patients.

Just as importantly, we have to recognize where responsibility for reform truly sits. Programs like 340B are federal by design, and Congress should lead. A patchwork of state-level fixes risks creating more inconsistency and less accountability, failing to provide the clarity and consistency patients deserve.

North Carolina has always valued fairness, personal responsibility, competition and looking out for one another. Bringing more transparency and accountability to our healthcare system is simply an extension of those values.

At the end of the day, patients should come first, and families should be able to trust the healthcare system they rely on. Congress should act now to strengthen 340B through clear federal reforms that restore transparency, protect taxpayers, preserve the safety net and ensure the program finally works the way it was intended: for patients.

Dennis Berwyn is vice chair of the Wake Republican Men and vice president of the Central Region of the North Carolina Federation of Republican Men.