- Affordability is a major concern for North Carolinians, and health care is a leading contributor to the rising cost of living
- Lip service is not enough; politicians need to deliver results
- There are four policies North Carolina legislators can approve this session that will make health care more affordable
People of all political stripes agree that health care is unaffordable for too many. A major campaign buzzword this year is the “unaffordability crisis,” with health care being a foremost factor driving up the cost of living.
In the September 2025 Carolina Journal poll, when respondents were asked what issues mattered most to them, cost of living was the top response. Health care specifically finished in the top five.
With health care costs being at the forefront of voters’ minds, candidates who can demonstrate actions they’ve taken to address the problem would likely have a great advantage.
In that context, here are four policies that state legislators can advance this session that would ease cost pressures on health care and show that lawmakers are serious about making health care more affordable.
Repeal Certificate of Need (CON) laws
CON laws require medical care providers to get permission to expand facilities or add medical equipment such as MRI machines. The approval process can often be long and expensive, with no guarantee of being granted permission.
A government committee with the power to restrict the supply of medical care is reminiscent of Soviet-style planning committees. This archaic law reduces the availability of care, limits competition, and drives up prices.
A 2021 research paper published by the John Locke Foundation found that “CON is associated with 30% fewer hospitals per capita, 13% fewer hospital beds, 14% longer emergency room wait times, and 3% higher spending.”
The March 2026 Carolina Journal poll found that 42 percent of respondents supported CON repeal, while 38 percent were opposed. Of the 20 percent who were unsure, most would likely support repeal if they were better informed about the restrictive nature of the law.
Last year’s Senate budget proposal included a provision to repeal North Carolina’s CON laws. Legislators from both chambers should get behind the elimination of this harmful policy.
Allow the purchase of insurance from the U.S. territories
In 2014, the Obama administration clarified that many of Obamacare’s most costly regulations would not apply to the U.S. territories, such as American Samoa, Puerto Rico, and the U.S. Virgin Islands.
The ability to offer health insurance products that can avoid these costly mandates enables insurers in U.S. territories to offer more affordable options for consumers. Moreover, according to Cato Institute Michael Cannon, director of health policy studies at the Cato Institute, “Consumers and employers could enforce their insurance contracts in their home states with help from their home-state regulators,” so that consumers who are wronged wouldn’t have to seek relief from faraway islands.
Cannon adds, “Many of the largest health insurers in the country already operate in US territories and have provider networks in the states. Consumers and employers could purchase coverage from the same insurer they do now with lower premiums and broader provider networks.”
The infrastructure is already largely in place; it’s just up to state legislators to act.
Legislators in Florida (in 2023) and Kentucky (earlier this year) have already introduced legislation to allow their residents access to these more affordable insurance plans, so bill drafters in North Carolina can borrow language from those examples.
Reduce coverage mandates on insurance
Health benefit mandates are laws that force insurance companies to cover specific health care services, ensure access to desired providers, or expand the level of benefits offered to certain employers and people who purchase insurance policies on their own.
The federal government imposes a list of coverage mandates required for insurers in all states, but states still have a broad amount of discretion as to which and how many mandates they impose. At last count, North Carolina had 58 coverage mandates, including services such as treatment for HIV/AIDS, treatments for narcotics abuse, and screenings for prostate cancer. Insurance consumers must pay for these coverages regardless of any potential need.
State legislators can repeal some, most, or all of such coverage mandates and allow for greater competition in the insurance market to provide more affordable coverage tailored to the specific needs and preferences of consumers. For example, insurance plans with less coverage can provide affordable and sensible options, especially for younger, healthier customers who need only basic catastrophic coverage.
One study concluded that state health insurance mandates were responsible for between 9 percent and 23 percent of all premium increases between 1996 and 2011. North Carolina can escape this upward spiral of insurance prices by eliminating coverage mandates.
Grant nurse practitioners full scope of practice
If nurse practitioners (NPs) want to practice in North Carolina, they must establish a collaborative practice agreement with a physician. The agreement outlines patient management and describes how the providers will interact. Interestingly, NPs are not required to be in the same geographic location as the overseeing physician, and they are required to meet only twice a year. The lack of oversight, then, demands asking why the contracts are even necessary.
These requirements can be expensive and create uncertainty for nurses, resulting in fewer nurses choosing to practice. Fewer nurses place greater strain on the time of doctors, who in turn are able to see fewer patients. The result is less access to care for patients.
Ending the requirement for nurse practitioners to contract with a physician would create opportunities for NPs to deliver patient care, especially in more rural and underserved areas. Arizona, for example, granted NPs full practice authority in 2002. Five years later, the state reported a 73 percent increase in the number of NPs serving rural counties.
As of 2025, 27 states and Washington, D.C., have granted full practice authority to nurse practitioners. North Carolina should join them.
Current and future North Carolina legislators have a chance to do more than just pay lip service to addressing the rising cost of health care. Passing these four policies will go a long way toward delivering results.
