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Bill > H434


NC H434

NC H434
Lower Healthcare Costs


summary

Introduced
03/18/2025
In Committee
06/09/2025
Crossed Over
05/01/2025
Passed
Dead

Introduced Session

2025-2026 Session

Bill Summary

AN ACT LOWERING HEALTHCARE COSTS AND INCREASING PRICE TRANSPARENCY. Whereas, rising healthcare costs place a significant financial burden on individuals, families, employers, and taxpayers, greatly contribute to inflation, and make it increasingly difficult for residents to access essential healthcare services; and Whereas, North Carolina has intolerably high healthcare costs, with recent studies ranking the State 50th out of 50 in the United States; and Whereas, skyrocketing healthcare costs have resulted in over 40 percent of Americans reporting some type of healthcare debt, according to one study; and Whereas, many patients face unexpected medical bills due to a lack of disclosure about out-of-network providers and a general lack of transparency in healthcare pricing, resulting in financial strain and hardship; and Whereas, employers are burdened with the increasing costs of providing health insurance for employees, leading to higher premiums, deductibles, and out-of-pocket expenses; and Whereas, patients and employers are often unable to compare the costs of medical services due to a lack of clear and accessible pricing information, hindering their ability to make informed decisions; and Whereas, the absence of price transparency in the healthcare system leads to market inefficiencies, less awareness of price difference, less competition, and higher prices, with consumers often unable to identify the most cost-effective providers; and Whereas, transparency in healthcare pricing allows consumers to shop for affordable healthcare services and encourages competition among healthcare providers to offer more competitive pricing; and Whereas, providing consumers with clear, understandable, and accessible information about the costs of healthcare services will foster a more competitive and patient-centered healthcare market; and Whereas, requiring healthcare providers and insurers to disclose their prices in advance, including all providers and services a patient may need, both in-network and out-of-network, will enable consumers to make more informed choices about their care, leading to better healthcare outcomes at lower costs; and Whereas, price transparency will incentivize hospitals and healthcare providers to improve the quality of care while reducing prices, to the benefit of patients and employers; and Whereas, clear pricing and competition among healthcare providers will encourage innovation in healthcare delivery and improve overall efficiency within the system; and Whereas, empowering patients and employers with pricing information will help create a healthcare system that prioritizes affordability, access, and choice; and Whereas, President Trump recently signed an Executive Order to make healthcare prices transparent, "empower[ing] patients with clear, accurate, and actionable healthcare pricing information," also "ensur[ing] hospitals and insurers disclose actual prices, not estimates, and take action to make prices comparable across hospitals and insurers, including prescription drug prices"; Now, therefore,

AI Summary

This bill aims to lower healthcare costs and increase price transparency in North Carolina by implementing several key provisions across multiple areas of healthcare regulation. The bill requires hospitals and ambulatory surgical facilities to provide quarterly reports on their most frequently reported medical procedures, including detailed pricing information such as full charges, average negotiated settlements, Medicare and Medicaid reimbursement rates, and insurance payments. Healthcare providers must now provide patients with good-faith estimates for scheduled medical services, and these estimates cannot exceed the final bill by more than 5%. The bill also introduces new requirements for healthcare facilities to disclose potential out-of-network providers and associated fees before treatment, limits facility fees for certain outpatient services, and mandates that hospitals and health systems submit annual reports detailing their facility fee revenues and most expensive procedures. Additionally, the bill updates prior authorization processes for health insurers, requiring faster review times for urgent and non-urgent healthcare services, and prohibits the use of artificial intelligence as the sole basis for denying utilization review determinations. The legislation is designed to empower patients with more information about healthcare costs, encourage competition among healthcare providers, and reduce unexpected medical billing surprises.

Committee Categories

Business and Industry, Government Affairs, Health and Social Services

Sponsors (60)

John Bell (R)* Grant Campbell (R)* Patricia Cotham (R)* Tim Reeder (R)* Eric Ager (D),  Jonathan Almond (R),  Dean Arp (R),  Amber Baker (D),  Mary Belk (D),  Brian Biggs (R),  Cecil Brockman (D),  Gloristine Brown (D),  Kanika Brown (D),  Allen Buansi (D),  Laura Budd (D),  Jennifer Capps Balkcom (R),  Becky Carney (D),  Richard Carver (R),  Maria Cervania (D),  Allen Chesser (R),  Mike Clampitt (R),  Tracy Clark (D),  Bryan Cohn (D),  Mike Colvin (D),  Allison Dahle (D),  Aisha Dew (D),  Jimmy Dixon (R),  Julia Greenfield (D),  Pricey Harrison (D),  Zack Hawkins (D),  Chris Humphrey (R),  Cody Huneycutt (R),  Neal Jackson (R),  Ray Jeffers (D),  Jake Johnson (R),  Donny Lambeth (R),  Donnie Loftis (R),  Brandon Lofton (D),  Tim Longest (D),  Jarrod Lowery (R),  Jeff McNeely (R),  Ray Pickett (R),  Larry Potts (R),  Lindsey Prather (D),  Heather Rhyne (R),  Stephen Ross (R),  Phil Rubin (D),  Mike Schietzelt (R),  Paul Scott (R),  Mitchell Setzer (R),  Charles Smith (D),  Larry Strickland (R),  Brian Turner (D),  Steve Tyson (R),  Bill Ward (R),  Harry Warren (R),  Diane Wheatley (R),  Donna White (R),  Shelly Willingham (D),  Jeff Zenger (R), 

Last Action

Conf Com Appointed (on 06/24/2025)

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