Lindsey Prather

SUPPORT: The bipartisan Reorganization and Economic Development Act will remove government red tape that prevents nonprofit hospital service corporations from using their resources to improve care and lower costs. Currently, these nonprofit organizations cannot use their resources to act in the best interests of healthcare consumers without first getting permission from government regulators. They are the only organizations regulated in this manner. Removing this layer of bureaucracy will allow for organizations to invest more resources into increasing access and improving quality, which will generate downward pressure on costs. Actions related to the legislation will be factored into a member’s Affordable Healthcare Grade at the close of the legislative session.

House Bill 76 expands Medicaid coverage and makes important reforms to the state's CON laws. Medicaid expansion would provide coverage to about 500,000 new individuals. Covering uninsured individuals will lessen the burden on businesses and workers to subsidize the cost on uncompensated care, and thus drive down premiums. CON reform will increase competition among healthcare providers, thus driving down costs and incentivizing new, innovative care options. Actions related to this bill will be factored into a member’s Affordable Healthcare Grade at the close of the legislative session.

SUPPORT: The bipartisan SAVE Act will increase healthcare access and lower costs by removing outdated government regulations to allow high-skilled nurses to practice at the full level of their education and training. Removing this barrier could greatly expand access to care while saving up to $4.3 billion in healthcare costs, without any sacrifice in quality. Importantly, the legislation would not allow Advanced Practice Registered Nurses to do anything they are not already doing. It would simply remove an outdated and burdensome government regulation that requires these nurses to meet with a “supervising” physician every six months and pay the physician a fee. Actions related to the SAVE Act in the Senate and House will be factored into a member’s Affordable Healthcare Grade at the close of the legislative session.

SUPPORT: Senate Bill 156 and HB 340 will improve the way children and families in foster care get healthcare. The bill authorizes the state to move forward with a single, statewide healthcare plan for families and children in the foster care system. The current system leads to disrupted and inefficient care as children move across difference service regions. Rural regions often lack services available in urban areas. A statewide system will help ensure that children and families, have access to a continuous, broad range of physical and behavioral health services regardless of where in the state they live.

House Bill 107 would repeal our state’s outdated Certificate of Need (CON) laws. CON limits the number of medical facilities that can operate in any given area. For a new clinic to enter the market, it must petition the government and demonstrate a “need” for another facility of its type. This limits the kind of competition that can drive costs down and increase access to important care. While targeted CON reforms may be preferable, removing the laws from the books is a far better outcome for consumers than the status quo. Actions related to this bill will be factored into a member’s Affordable Healthcare Grade at the close of the legislative session.

Senate Bill 48 would repeal our state’s outdated Certificate of Need (CON) laws. CON limits the number of medical facilities that can operate in any given area. For a new clinic to enter the market, it must petition the government and demonstrate a “need” for another facility of its type. This limits the kind of competition that can drive costs down and increase access to important care. While targeted CON reforms may be preferable, removing the laws from the books is a far better outcome for consumers than the status quo. Actions related to this bill will be factored into a member’s Affordable Healthcare Grade at the close of the legislative session.

Senate Bill 46 helps protect consumers from surprise medical bills by ensuring they are notified if anyone caring for them at an in-network facility is out-of-network. Specifically, the bill requires that patients at in-network facilities are notified before a procedure if a provider caring for them is out-of-network. An estimate of the out-of-network costs must also be provided. The transparency provided through Senate Bill 46 will give patients the opportunity to find other, in-network alternatives if a provider on their care team is out-of-network. Actions related to this bill will be factored into a member’s Affordable Healthcare Grade at the close of the legislative session.

House Bill 76 expands Medicaid coverage and allows rural and safety-net hospitals to access federal funding so they can continue providing care to patients. Medicaid expansion would provide coverage to about 500,000 new individuals. Covering uninsured individuals will lessen the burden on businesses and workers to subsidize the cost on uncompensated care, and thus drive down premiums. Expansion also has the potential to help the working poor get health coverage, ease medical debt, and save struggling rural hospitals. Actions related to this bill will be factored into a member’s Affordable Healthcare Grade at the close of the legislative session.

The House PCS of Senate Bill 408 will keep the ball moving forward on Medicaid expansion. It directs the North Carolina Department of Health and Human Services (DHHS) to develop a Medicaid expansion plan that will be presented to the General Assembly for a possible vote later this year. The bill also gives DHHS the authority to work with the federal government to ensure there is no net cost to the state. Actions related to this bill will be factored into a member’s Affordable Healthcare Grade at the close of the legislative session.

The Coalition SUPPORTS to this legislation. Specifically, House Bill 1039: Requires that hospital and healthcare facilities disclose charges for all services. Sets standards for the provision of charity and discounted care. Prohibits collecting on medical debt though arrest, home foreclosures and wage garnishment. Institutes financial assistance guidelines and parameters for patients who cannot pay medical bills. Places fair limits on interests for medical debt. A study by the National Academy of State Health Policy and the North Carolina State Health Plan found that hospitals are encouraging patients who can’t pay to open medical credit cards that charge interest rates as high as 18 percent. HB 1039 is a strong consumer protection bill that will help address the medical debt crisis and ensure family finances are not ruined by the inability to afford healthcare. Actions related to this bill will be factored into a member’s Affordable Healthcare Grade at the close of the legislative session.

House Bill 144 authorizes a critical step in fixing the state’s fractured foster care system. The Coalition SUPPORTS to this legislation. Specifically, House Bill 144 authorizes the North Carolina Department of Health and Human Services to move forward with a single, statewide healthcare plan for families and children in the foster care system. This will provide children and families, regardless of their geographic location, with access to a “broad range of physical health, behavioral health, pharmacy, long-term services and supports, Intellectual/Developmental Disability services, and resources to address unmet health-related needs.” The goal of this change is “aimed at preserving families and supporting reunification and permanency.” Currently, children and families in foster care are subject to a regional system. These children and families, however, often move across regions, causing services and care to be disrupted, duplicated or both. Many rural regions also lack the care and support needed to serve families in foster care. A statewide plan with access to a broad network of experts and providers will mean better care for children and families, a more efficient use of tax dollars, and will erase the urban-rural divide that right now plagues the system. Actions related to this bill will be factored into a member’s Affordable Healthcare Grade at the close of the legislative session.

A North Carolina General Assembly proposal (House Bill 149) will increase access and lower healthcare costs. The Coalition SUPPORTS to this legislation. Specifically, House Bill 149 will: 1) Remove outdated government regulations that restrict highly skilled nurses from practicing at the full level of their education and training, thereby helping increase access and lower the cost to care. 2) Make multiple reforms to the state’s “Certificate of Need” laws, most of which are good and will go a long way in improving affordability and access. 3) Increase consumer protections against surprise medical billing. 4) Expand Medicaid. Unfortunately, the bill also includes a mandate that requires families and businesses, through their insurance premiums, cover (i.e., pay for) any healthcare service provided virtually if it’s covered in-person. Thankfully consumer protections have been added that guard against very real abuse, fraud, and quality of care concerns. It is essential that these consumer protections remain in the bill as it works its way through the legislative process. Actions related to this bill will be factored into a member’s Affordable Healthcare Grade at the close of the legislative session.

As amended, the House’s version of the legislation would cause consumer drug prices to rise, while providing a windfall for pharmaceutical companies and major hospital systems. The House’s amended legislation also undermines important patient safety measures. Specifically, the bill: -- Mandates patients, through their insurer’s PBM, pay no less for their medicine than what it costs the pharmacies to obtain it. This will allow pharmaceutical companies to drastically increase the prices of their drugs for consumers. -- Removes the ability to negotiate lower 340b drug costs for patients with major hospital systems. Hospitals already make tens of millions of dollars in profits off the sale of federally discounted 340b drugs. As written, the House’s amended bill would exacerbate the problem and cause patients to pay even more for the medicine they need. -- Removes strict accreditation standards that ensure safety and quality for consumers. As amended, the Coalition opposes the bill.

HB 703 would mandate that millions of dollars be added to the healthcare system and encourage misuse and overuse. Specifically, the bill mandates that individuals and businesses, through their insurance premiums, pay for advanced diagnostic imaging tests such as MRIs and breast ultrasounds at the same level as a preventive screening mammography. Screening mammograms are considered a preventative service with no cost share under the ACA, whereas diagnostic tests are not considered preventive. The US Preventive Services Task Force recommends conventional mammography for screening. Mandating zero cost share for diagnostic tests would cause more than $7 million in estimated premium escalation. It could also encourage overuse and misuse as tests such as MRIs and diagnostic breast ultrasounds more expensive for patients – and more profitable for providers.

HB 896 would impose a costly and unworkable mandate requiring that pharmacists be reimbursed at the same rate as doctors for performing equivalent healthcare services. Under this legislation, big pharmacies would see a windfall but costs for patients would skyrocket. One of the primary benefits of expanding a pharmacist’s scope of care, as the Coalition supports, is that it would provide people with a less expensive source of care. Mandating that a pharmacist is paid the same as a doctor would undermine those cost-saving objectives.

SB575 would expand access to affordable care by letting trained, qualified pharmacists prescribe, dispense and administer certain medications. Specifically, it would allow pharmacists to administer treatments such as an opioid antagonist in the event of an overdose, EpiPen’s for allergic reactions, glucagon for diabetics with low blood sugar, short-acting inhalers for asthma an prenatal vitamins. Pharmacists must document any administered care and notify the patient’s doctor within 72 hours. By allowing qualified pharmacists to administer medications such as these, along with FDA-approved vaccines for things like the flu, we would expand access to important care and reduce costs.

HB524 would mandate that consumers cover, or pay for, oral chemotherapy drugs the same as they do IV chemotherapy drugs through their insurance premiums. Oral chemotherapy drugs are already some of the most expensive on the market and many are priced significantly higher than IV chemo drugs. In a 14 year span, Big Pharma increased the cost of these drugs by more than 500 percent to an average total of $11,325 a month. The mandate will cause health insurance premiums to soar, while doing nothing to protect patients from the high costs of their lifesaving drugs, rein in excessive prices set by Big Pharma, or help those on chemotherapy save money.

Senate Bill 462 will allow for more competition in the healthcare industry, which lowers costs and improves access for consumers. Specifically, the legislation would update the state's Certificate of Need (CON) laws. CON limits the number of medical facilities that can operate in any given area. For a new clinic to enter the market, it must petition and demonstrate a “need” for another facility of its type. This limits the kind of competition that can drive costs down and increase access to important care. Senate Bill 462 increases the dollar threshold for needing a CON from $2 million to $4 million and ensures construction on projects awarded a CON begin in a timely manner. Raising the dollar threshold will creates additional flexibility for new facilities to be built and existing facilities to be improved without government approval. Establishing a construction timeline will eliminate the ability of a CON winner from holding the approval, with no intention to act, to prevent competition from entering the market.

HB93 would create a costly, new prescription drug mandate that inflates the profits of Big Pharma and undermines the doctor-patient relationship. Specifically, House Bill 93, would mandate that naloxone be co-prescribed with opioids whenever certain conditions exist. It’s costly. It’s unnecessary. And it sets a dangerous precedent. The cost of this mandate could total nearly $3 million a year. That’s $3 million that goes straight to Big Pharma’s bottom-line. Moreover, North Carolina already has laws in place that make this mandate unnecessary and redundant. In 2016, a state law was passed that allows pharmacists to provide naloxone without a prescription from your doctor. Finally, we should not be setting a precedent where lawmakers get to tell doctors what they must and must not prescribe their patients. That is a job for medical professionals, not state legislators. House Bill 93 is, at best, redundant.At worst it is another costly mandate that boosts Big Pharma’s profits and puts politicians between patients and their doctors.

SB228 and HB373 would allow Exclusive Provider Organization (EPO) insurance plans to be offered to fully insured small business and individuals. Currently, because of North Carolina regulations, EPOs are only available to large businesses who can self-fund and pay their own insurance claims. Senate Bill 228 would fix this by making sure these same, more affordable plans are also available to our state’s small businesses, workers and their families.

HB149 would institute a costly and dangerous government mandate requiring that families and businesses, through their insurance premiums, cover (i.e., pay for) any healthcare service provided virtually if it’s covered in-person. This would dramatically increase costs and undermine the quality of care that patients receive. Telehealth, when done right, has the potential to vastly improve healthcare by expanding access and lowering costs. However, government mandates, like those in House Bill 149, pose a serious threat to telehealth’s long-term viability, while letting multibillion-dollar healthcare systems bill you for emails, texts, chats and “remote monitoring.”

SB257 would increase prescription drug pricing transparency, establish important consumer protections, and help people save at the pharmacy. Specifically, it would: Allow pharmacists to share cost information about prescription drugs with patients and sell patients a lower costs drug if one is available. This can help patients save money on their medicine.Require pharmacists to disclose any shipping and handling fees that will be charged to patients for any mailed or delivered prescriptions. Consumers have a right to know the full price up front, including any fees they may have to pay. Require that Pharmacy Benefit Managers (PBMs) are licensed by the State of North Carolina. Licensing will help ensure that PBMs are operating in the best interest of the consumer and working to keep drug costs down. 23 other states require PBMs to be licensed.

The SAVE Act would increase healthcare access and lower costs by removing outdated government regulations to allow high-skilled nurses to practice at the full level of their education and training. Specifically, the legislation would remove a requirement that Advanced Practice Registered Nurses get an agreement from a physician to supervise their work – a requirement that was already waived to expand access to care during COVID-19. Importantly, the legislation would not allow Advanced Practice Registered Nurses to do anything they are not already doing. It would simply remove an outdated and burdensome government regulation that requires these nurses to meet with a “supervising” physician every six months and pay the physician a fee. Permanently removing this barrier could greatly expand access to care while saving up to $4.3 billion in healthcare costs, without any sacrifice in quality.

SB505 will help protect consumers from surprise medical bills by ensuring they are notified if anyone caring for them at an in-network facility is out-of-network.Surprise billing is the biggest issue facing healthcare consumers today. 1 in ten Americans have been a victim of a surprise medical bill received from an out-of-network provider. And it drives up costs by roughly $40 billion a year. Senate Bill 505 helps mitigate this problem though transparency. Specifically, the bill requires that patients at in-network facilities are notified before a procedure if any provider caring for them is out-of-network. An estimate of the out-of-network costs must also be provided. In emergencies where notification is not possible, Senate Bill 505 requires notification as quickly as possible. The transparency provided through Senate Bill 505 will give patients the opportunity to find other, in-network alternatives if a provider on their care team is out-of-network.

SB415 will protect patients from surprise medical bills received in emergency situations and from out-of-network providers at in-network facilities. Surprise billing is the biggest issue facing healthcare consumers today. 1 in ten Americans have been a victim of a surprise medical bill received from an out-of-network provider. And it drives up costs by roughly $40 billion a year. Senate Bill 415 addresses this problem by setting a fair and reasonable benchmark payment for out-of-network care received at an in-network facility or an emergency room. Research shows benchmarking is the best solution to surprise billing. Under this legislation, the patient’s insurer must pay the out-of-network provider the lesser of three options: The same amount the insurer would pay for the service if the patient was on Medicare. The provider’s actual charges. The median contracted rate in the insurer’s network for the same or similar services. The provider gets to accept that amount as payment in full. The insurer pays. The provider accepts. The patient is protected.

Senate Bill 411 holds Big Pharma drug manufactures accountable by making them notify and justify any major Rx price hikes.Under this bill, drug manufacturers would be required to notify consumers and regulators prior to any substantial price increase for a drug. They would also be required to justify their proposed price increase. Nearly a quarter of every healthcare dollar spent goes toward prescription drugs. Consumers have a right to know when prices will be significantly hiked and why.