Make Healthcare Affordable.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 1
HOUSE BILL 46

Short Title: Make Healthcare Affordable. (Public)
Sponsors: Representatives K. Hall, Lambeth, Paré, and Chesser (Primary Sponsors).
For a complete list of sponsors, refer to the North Carolina General Assembly web site.
Referred to: Rules, Calendar, and Operations of the House
February 5, 2025
*H46-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO DISCLOSE T HE COST OF STATE GOV ERNMENT HEALTH INSUR ANCE 2
MANDATES ON NORTH CAROLINA'S EMPLOYERS AND TAXPAYERS. 3
Whereas, the rising healthcare costs in North Carolina place a significant financial 4
burden on individuals, families, employers, and taxpayers, greatly contribute to inflation, and 5
make it increasingly difficult for residents to access essential healthcare services; and 6
Whereas, North Carolina has intolerably high healthcare costs, with recent studies 7
ranking the state 50th out of 50 in the United States; and 8
Whereas, government -mandated health insurance requirements for employers in 9
North Carolina lead to higher premiums, placing undue financial strain on employers, 10
particularly small businesses; and 11
Whereas, he alth insurance mandates on the North Carolina State Health Plan for 12
Teachers and State Employees carry a cost that is ultimately paid for by taxpayers and divert 13
resources away from other critical public services and economic investments; and 14
Whereas, many consumers in North Carolina are forced to pay for health insurance 15
coverage they neither need nor use as a result of government-mandated benefits that do not align 16
with their personal healthcare needs or preference; and 17
Whereas, the continued escalation of healthcare costs driven by government mandates 18
exacerbates the rising cost of living, as individuals and families struggle to afford both premiums 19
and out-of-pocket expenses for necessary care, and the rising cost of doing business, as employers 20
struggle to continue offering health insurance to employees; Now, therefore, 21
The General Assembly of North Carolina enacts: 22
23
PART I. HEALTH BENEFIT MANDATE LEGISLATION 24
SECTION 1. Article 31 of Chapter 120 of the General Statutes is amended by adding 25
a new section to read: 26
"§ 120-272. Legislation containing health benefit mandates. 27
(a) Definitions. – The following definitions apply in this section: 28
(1) Health benefit mandate. – A regulation impacting a health benefit plan or the 29
State Health Plan that meets any of the following criteria: 30
a. Mandates that a health benefit plan or the State Health Plan provide 31
coverage of any healthcare service, any specific treatment or set of 32
treatments, or any prescription drug used for the treatment of any 33
health, physical, mental, or behavioral condition. 34
General Assembly Of North Carolina Session 2025
Page 2 House Bill 46-First Edition
b. Requires that a health benefit plan or the State Health Plan include 1
coverage for any healthcare service or treatment by a provider or group 2
of providers other than a physician licensed in this State. 3
c. Places requirements on any cost -sharing mechanism utilized by a 4
health benefit plan or the State Health Plan , such as a copayment or 5
deductible. 6
d. Regulates any health benefit plan or the State Health Plan cost-control 7
process, including those that necessitate a healthcare provider obtain 8
advance approval from an insurer before a specific service, treatment, 9
or prescription benefit is delivered to the patient or utilized by the 10
patient in order to qualify for coverage under the applicable plan. 11
e. Places a limit or requirement on a pharmacy benefit s manager under 12
Article 56A of Chapter 58 of the General Statutes. 13
f. Regulates the manner in which a health benefit plan or the State Health 14
Plan provides coverage for a healthcare service, treatment, or 15
prescription drug, regardless of whether the regulation is imposed 16
upon a covered service that is provided by a healthcare provider that 17
participates in the provider network of the health benefit plan. 18
(2) Health benefit plan. – As defined in G.S. 58-3-167. 19
(3) Piece of legislation. – Any introduced bill, any bill or proposed committee 20
substitute considered by a committee, or any bill, conference committee 21
report, or proposed conference committee substitute considered by either 22
chamber of the General Assembly. 23
(4) State Health Plan. – The North Carolina State Health Plan for Teachers and 24
State Employees. 25
(b) Required Additional Statutory Repeals. – Any piece of legislation containing one or 26
more new health benefit mandates is required to also contain at least one provision that repeals 27
at least the same number of health benefit mandates that are already in effect as of the date of the 28
consideration of that piece of legislation prior to ratification of that legislation. 29
(c) Appropriation Required. – Any piece of legislation containing one or more health 30
benefit mandates is required to also contain a provision appropriating recurring funds in the 31
amount of the cost of that mandate to the Department of the State Treasurer and the State Health 32
Plan or to any other relevant State agency prior to ratification. If any repeal of an existing health 33
benefit mandate required to be contained in the legislation under subsection (b) of this section 34
results in cost -savings to the State, then that cost-savings shall have no impact on the amount 35
required to be appropriated under this subsection." 36
37
PART II. IMPACT ON NORTH CAROLINA STATE HEALTH PLAN FOR TEACHERS 38
AND STATE EMPLOYEES 39
SECTION 2. G.S. 135-48.51 reads as rewritten: 40
"§ 135-48.51. Coverage and operational mandates related to Chapter 58 of the General 41
Statutes. 42
(a) The following provisions of Chapter 58 of the General Statutes apply to the State 43
Health Plan: 44
(1) G.S. 58-3-191, Managed care reporting and disclosure requirements. 45
(2) G.S. 58-3-221, Access to n onformulary and restricted access prescription 46
drugs. 47
(3) G.S. 58-3-223, Managed care access to specialist care. 48
(4) G.S. 58-3-225, Prompt claim payments under health benefit plans. 49
(5) G.S. 58-3-235, Selection of specialist as primary care provider. 50
(6) G.S. 58-3-240, Direct access to pediatrician for minors. 51
General Assembly Of North Carolina Session 2025
House Bill 46-First Edition Page 3
(7) G.S. 58-3-245, Provider directories. 1
(7a) G.S. 58-3-247, Insurance identification card. 2
(8) G.S. 58-3-250, Payment obligations for covered services. 3
(9) G.S. 58-3-265, Prohibition on managed care provider incentives. 4
(10) G.S. 58-3-280, Coverage for the diagnosis and treatment of lymphedema. 5
(11) G.S. 58-3-285, Coverage for hearing aids. 6
(12) G.S. 58-50-30, Right to choose services of certain providers. 7
(13) G.S. 58-67-88, Continuity of care. 8
(b) A provision of Chapter 58 of the General Statutes containing a health benefit mandate, 9
as defined in G.S. 120-272, that first becomes effective on or after July 1, 2025, shall apply to 10
the State Health Plan as of the start of the next Plan year following the effective date of the health 11
benefit mandate." 12
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PART III. EFFECTIVE DATE 14
SECTION 3. This act is effective 30 days after it becomes law and applies to pieces 15
of legislation considered by the General Assembly on or after that date. 16