Back in July, Gov. Roy Cooper and the Department of Health and Human Services announced a for North Carolinians. In exchange for federal funding, North Carolina hospitals would agree to forgive eligible medical debt, set new standards for charity care, and limit the impact of future debt.
The plan comes at an important time for North Carolina. Out of the 50 states, North Carolina ranks fifth highest in the amount of medical debt in collections, according to the .
NCDHHS Secretary Kody Kinsley described the plan as 鈥渁 win, win, win for North Carolina.鈥�
鈥淚t's a win for our hospitals to be able to get enhanced payments for more investments in their health care and their work,鈥� he said. 鈥淚t's a win for individuals who will finally have the relief from this burden, and it is a win for the health and the economy of North Carolina to be able to clear this bad and rarely ever paid debt off the books.鈥�
A month later, all 99 of the state's eligible hospitals signed on. The plan will begin implementation in January 2025 鈥� with taking action now.
But, Governor Cooper's office isn't the only one tackling medical debt.
Treasurer Dale Folwell is a long-standing critic of the state's healthcare system鈥攐r, as he refers to it, a 鈥�cartel.鈥�
"We're talking about a product that no one consumes,鈥� he said, speaking to 瓜神app. 鈥淚t consumes them. It's the only thing in your life that you don't know the price and the value of even after you've consumed it. When you get a bill from a health care provider, especially a hospital, you can't tell if you had an appendectomy or tonsillectomy."
Folwell said Governor Cooper鈥檚 plan is not a sustainable solution to medical debt.
"Why don't we actually fix the problem instead of bailing out these multi-billion dollar corporations who disguise themselves as nonprofits?" he said.
Instead of focusing on a one-time solution, Folwell said he wants to look at the root of the issue. In his role as the head of the State Health Plan, Folwell has released investigating the financial practices of N.C. hospitals.
Folwell鈥檚 reports focus on three main topics: charity care, overcharging, and executive pay. He has also covered medical debt. found that almost 7,600 patients were sued over outstanding medical debt between 2017 and 2022, with interest and other charges accounting for 35.4% of the $57.3 million in total judgments.
Folwell said the idea came while looking for ways to keep the State Health Plan solvent. It covers about 750,000 state employees, retirees, and dependents.
Folwell said hospitals told him they couldn't lower prices due to programs like charity care and Medicaid.
"Those reports that we produce, which are all peer-reviewed by outside sources, show that every reason that they gave us for why they couldn't do something was basically false,鈥� he said.
Meanwhile, a spokesperson for the North Carolina Healthcare Association said the state's hospitals don't set prices independently. They collaborate with insurance companies to negotiate costs for care.
Folwell is leaving office after eight years in the role. Treasurer-elect Brad Briner has been meeting with him to prepare for the transition.
During his campaign, Briner focused on the underperformance of the state's pension plan. Now, he said his top priority has shifted to the State Health Plan.
"It can only be so much of the state budget,鈥� he told 瓜神app. 鈥淪o we've got to figure out, again, in the short run, how we balance the books in '26 but in the long run, how do we set up a system that doesn't naturally increase costs."
A problem both Folwell and Briner share concerns over is hospital consolidation.
According to the , almost 59% of physician practices are now owned by hospitals or corporations. Research shows this consolidation can decrease patient choice and .
While Folwell has been vocal about the issue, Briner wants to take a different approach.
"I have often known and learned and seen that you attract more flies with honey than vinegar, so to speak,鈥� he said.
By working with healthcare providers, Briner hopes to get the State Health Plan back on track. He's also not as focused on the compensation of healthcare executives as .
"I do not blame anyone for being a capitalist or for making money,鈥� he said. 鈥淚 blame them if they're what economists call rent seeking, which is taking money without providing value."
When Governor Cooper announced his medical debt relief plan, Folwell by voicing support for the . It would require hospitals to set transparent prices and regulate debt collection practices, among other protections.
N.C. currently in legislation that protects consumers from medical debt, but Folwell said he believes the bill would propel the state to second in the country.
It passed the state Senate unanimously in 2023 but has not received action in the House.
Meanwhile, Briner said the General Assembly has denied the bill multiple times.
Briner also sees the Treasurer's office in a tangential role when it comes to medical debt.
鈥淚 think we can be helpful, but that is not for us to lead,鈥� he said. 鈥淚t is for us to support whoever is going to lead it.鈥�
