Concerns Grow Over Rising Health Care Costs for North Carolina State Employees
Teachers and state employees in North Carolina have traditionally relied on solid health benefits to compensate for lower salaries in government jobs. However, many are now worried that this crucial advantage is diminishing.
In a recent development, newly elected State Treasurer Brad Briner highlighted that increasing health care costs might lead to higher premiums for the State Health Plan by 2026. His office announced that a decision will be made soon about implementing salary-based premiums, which means that those with higher incomes could face steeper health care costs.
This comes on the heels of complications arising from the plan’s recent switch from its long-time administrator, Blue Cross Blue Shield of North Carolina, to Aetna. Many users are already feeling the pressure from increased out-of-pocket expenses. For example, one teacher reported that her copay for visits to a specialist jumped from $40 to $80. Complaints about rising costs for various medical services, including mental health and physical therapy, have been flooding social media among educators.
Amanda Thompson, president of the Charlotte-Mecklenburg Association of Educators, stated that many educators were unprepared for these increased copays, especially when they were assured that minimal changes would come with Aetna’s transition. “These higher costs are unfortunate, especially since our salaries aren’t keeping up with inflation,” she added.
The State Health Plan, which serves approximately 750,000 individuals in North Carolina—around 8% of the state’s insured population—faces similar challenges to those seen in private health plans, struggling to manage surging health care costs. According to a recent study from Forbes Advisor, North Carolina has the highest health care costs in the nation, with the average family premium through employers reaching $7,180 annually.
A survey by the nonprofit United States of Care revealed that 80% of residents believe health care costs in North Carolina are excessive. Nearly 75% of respondents reported taking measures to lower their medical expenses, like postponing doctor visits or skipping tests, despite the potential risks to their health.
Bryan Proffitt, vice president of the North Carolina Association of Educators, shared that he received numerous negative responses from teachers about the Aetna transition within just hours of seeking feedback. “They’re discovering that many services that used to be affordable are now costly. This has significant implications for their lives,” he noted.
The rising copays are attributed to a dwindling number of health care providers participating in the Clear Pricing Project—a program meant to keep costs down for state employees. However, the State Health Plan also faces a daunting projected deficit of $507 million in 2026, which could balloon to $1.4 billion by the following year.
At an upcoming board meeting, discussions will commence on how to bridge this financial gap. Treasurer Briner has acknowledged that difficult decisions are necessary and has floated the idea of potentially switching to generic drugs or reducing benefits for retirees. "Everything will be considered," he remarked.
As the debate continues, Ardis Watkins, executive director of the State Employees Association of North Carolina, advocates for more transparency regarding contracts between the State Health Plan and health care providers. Some hospitals, she claims, charge up to eight times the Medicare reimbursement rates, with such pricing hidden from public view. Increased transparency, she argues, could lead to lower costs for patients.
Briner agrees with the need for transparency but emphasizes the importance of collaboration among all involved parties—health care providers, state lawmakers, and the health plan itself—if meaningful changes are to be achieved.
Experts, including Ciara Zachary from the UNC Gillings School, suggest that the lack of competition among providers, partly due to recent health care mergers, is exacerbating cost issues. Large hospitals often wield greater negotiating power over insurers, making it difficult for smaller practices to compete.
In North Carolina, previous efforts aimed at controlling costs, like the Clear Pricing Project initiated by former treasurer Dale Folwell, have not gained enough legislative backing to make significant changes mandatory.
The recent transition to Aetna, which began on January 1st, has also led to many providers dropping out of the Clear Pricing Project. This shift has left many state employees with fewer affordable options for care, further complicating an already challenging landscape.
Looking ahead, Treasurer Briner has not committed to continuing the Clear Pricing Project beyond this year due to its financial impact on the State Health Plan. He remarked, “While the intent behind the project was good, its implementation hasn’t provided the anticipated savings.”
Meanwhile, educators and state employees remain concerned about how these changes will affect their health care access and finances. Proffitt stated that the health board should explore alternative budget-balancing measures that do not shift costs onto working families. He warned that continued benefit erosion could lead to higher attrition rates among teachers and public employees.
