In an emailed statement to Carolina Journal on Friday, Duke Health said it is “actively engaged in good faith negotiations” with health insurance company Aetna, in response to a story that many patients, including over 750,000 state employees covered under the State Health Plan (SHP), will lose in-network coverage to Duke’s doctors, hospitals, clinics, and services on Oct. 20.
Aetna is the administrator of the SHP, which is the company’s largest customer in the state and is responsible for half of its member base in North Carolina.
Duke’s demands don’t sit well with State Treasurer Brad Briner, whose office oversees the SHP.
After the State Health Plan Board of Trustees voted unanimously last month to approve premium increases for 2026 due to a budget shortfall, he told Carolina Journal in a phone interview on Sept. 17 that the State Health Plan simply doesn’t have the money for another increase.
However, Duke Health says only a small percentage of State Health Plan members would be affected.
“In 2024, Duke Health served fewer than 6-10% of its participants,” Duke Health officials told CJ. “This small percentage means a minimal potential impact on premiums for State Health Plan members.”
Briner said in the interview on Wednesday that he encourages everyone to go to Duke’s website and pull their financial statements. He notes that you don’t need an accounting degree to see that the profitability of their nonprofit system is extraordinary.
“Duke is very good at many things, and so they’re a provider we absolutely want in network,” he said. “They provide amazing cancer care and cardiac care and a number of other things. And so, yes, we would love to have them in the network. The $600 million and change [in profit] last year tells me that they’re enjoying that and that apparently is not enough.”
Duke Health said they are asking for a modest increase below inflation.
“Despite escalating costs in pharmaceuticals, supplies, and labor, Duke Health has not received a rate adjustment from Aetna in four years, according to Aetna’s own data,” the email stated. “As a nonprofit academic health system, Duke Health is driven not by margin but by mission. Every decision we make is rooted in our commitment to hope, health, and healing for every patient we serve.”
In an emailed statement to Carolina Journal on Wednesday, Shelly Bendit, senior manager of corporate communications for CVS Health, which owns Aetna, said the company is committed to providing access to affordable, quality health care for its 1.5 million members in North Carolina.
“We are negotiating in good faith with Duke Health — a partner for several decades — to enable members to continue receiving in-network care at all of their locations,” she said. “We have a responsibility to offer a cost effective, quality provider network to our customers. Payment to providers participating in our networks directly impacts health care costs, and we have an established track record of working collaboratively with health systems in North Carolina toward fair and market-competitive reimbursement.”
Duke Health officials said that last year alone, Duke Health invested $1.021 billion in community benefit, including $175 million in financial assistance to patients, 97% of whom are North Carolinians who are either underinsured or cannot pay for care, and their physicians routinely provide donated care and absorb cost gaps when government programs fall short.
Briner told CJ he doesn’t know what else the State Health Plan can offer and expects Duke to accept the reality that the public pressure advertising campaign of constant ads is simply not going to work. A similar situation happened last year between Duke and UnitedHealthcare.
“They do this over and over again, and they do it over and over again because it works,” the treasurer said. “But I’ve been very clear with anyone who wants to talk about that, including people from Duke, from Aetna, etc., that it’s not going to work because we can’t afford it. We literally don’t have the money. So, I would ask them to look harder at their cost structure, to dig deep into their many billions of investments, and figure out a better way than charging state employees more.”
Duke Health officials said, “These negotiations are not about profit but instead about ensuring that Aetna patients continue to receive the exceptional care they deserve, without disruption.”