State Sen. Benton Sawrey, R-Johnston, said health care reforms, including hospital price transparency, Medicaid, and Certificate of Need (CON) laws, are among the issues the Senate plans to tackle during the upcoming short session.

“I think everybody here is aware that we have some of the highest health care premiums in the nation because we don’t really know what’s going on behind the curtain of the health care system,” he said in comments to the John Locke Foundation’s recent Carolina Liberty Conference.

Sawrey said that SB 316, Lower Healthcare Costs; and SB 315, More Transparency/Efficiency in Utiliz. Rev., both went to great lengths to peel back the layers of the marketplace regarding pricing transparency for hospitals, but were unable to pass. In the short session, the Senate plans to follow up on those efforts, including providing good-faith estimates and banning hospital fees, and providing patient-friendly prior authorization, all of which they hope will result in the savings of billions of dollars in care costs for employers and lower costs for employees through lower premiums.

The lawmaker said that what will drive fiscal policy in the state over the next 10 years is the Medicaid program, adding that it has a billion-dollar increase in cost year over year.

One of the factors driving cost increases is not adequately managing Medicaid service utilization among enrolled individuals. He said they are seeing nearly 100% year-over-year cost increases in certain programs, and they need to do a better job of understanding what’s happening, allowing companies to manage utilization of those programs, and ensuring the services are actually delivering the outcomes they expect.

“Because we spend $30 billion, almost $40 billion on health care costs in Medicaid on an annual basis, I think it’s fair to ask the question, do we get the outcomes that we deserve for that distinction?” Sawrey asked. “We are spending that significant sum of money from our state coffers, including federal receipts. I think we deserve to know exactly what we’re getting.”

He quoted fellow state Sen. Jim Burgin, R-Harnett, in saying that “Medicaid shouldn’t be a safety net but a safety trampoline,” and only be there when someone truly needs it, not as a long-term fix.

“It should not be a permanent solution for health care for anybody in North Carolina,” Sawrey told the audience. “We need to identify those people. We need to figure out a way to get them off the program, get them a job, get them into an employer-sponsored plan or some form of private insurance because that’s a better result for them, for the taxpayers, and it’s a better result for the people of North Carolina.”

President Donald Trump’s “One Big Beautiful Bill Act” also created new work requirements of at least 80 hours a month for those receiving Medicaid, as well as redeterminations for the program, something the lawmaker said they will be working on over the next year or so, adding that each of the state’s 100 counties department of social services need to work on those new requirements as well.

“Does it make sense for us as North Carolina to reimagine the 100-county model, bring it back in-house rather than the county-administered model?” he asked. “We actually have a state-supervised model using regional hubs where we save on efficiencies and administrative costs, where we can bundle programs for workforce development, jobs, and job training, so that we’re interacting with people. Going back to what I talked about earlier, it not being a safety net, but a safety trampoline, and trying to figure out how do we get these people back in the workforce, get off these welfare programs that cost the taxpayers millions and millions of dollars on an annual basis.”

Sawrey said the One Big Beautiful Bill Act gave them a tremendous opportunity to reimagine how things are done at the state level.

“I think it’s going to take creative thinking from efficiencies and administrative costs, and looking at ways that we can really make it that ‘trampoline concept’ and give people the resources they need to be productive,” he said.

On the subject of Certificate of Need (CON) laws, Sawrey commented that it was “one of the last vestiges of centralized planning that you see in communist nations that exists in North Carolina.”

“We have a system in place where you want to open a new facility offering a new service and you have to go to submit an application to a centralized planning committee that nobody knows who is on it. And it is one of the most powerful committees that people really don’t know exists, and that committee then turns around and makes the determination whether your certificate is in fact granted, whether the need does exist,” he told the audience. “The system doesn’t work. The system is slow, and it causes delays.”

He talked about his home county, the third-fastest-growing county in the state, which has two hospital systems, one in Smithfield and the other in Clayton, and how they are always full, with people in the hallways, and long waits in emergency departments.

“You would think that UNC in Johnson County could make a decision about whether they need new beds,” Sawrey said. “And they need new beds, and they asked the state for beds back in 2020. And the state said, wait, we don’t think there’s a need for them. That’s nonsensical. Why does a group of bureaucrats in Health and Human Services get to make a determination on what’s best for Johnston County?”

Over the next five years, the county continued to wait until 2025, when the state told UNC Health that it could have 12 beds.

“So, our hospital CEO, Tommy Williams, who is a big proponent of doing away with CON in North Carolina, is taking those 12 new beds, and he’s actually building two additional floors in his hospital that will be empty, and they will wait until the state determines that there’s additional need,” he said. “That’s wasted money. That’s wasted investment. That’s wasted space.”

Sawrey said that people across the state, not just in Johnston County, are not getting the services that they need, including the state ranking at the bottom in the nation for emergency room wait times, all because North Carolina is a CON state.

He gave an example of how the state determined years ago that there was a need for a linear accelerator, which is used in radiation oncology, in Wake County. WakeMed applied for it, but Duke Health and UNC Health sued because they didn’t want WakeMed to get it first. The case is now tied up in the court system.

“It shows how backward and convoluted the system is,” the lawmaker stated. “There’s clearly a need. WakeMed is smart enough to make a determination it needs that linear accelerator. Johnston County is smart enough to determine whether or not it needs new beds. We do not need a central committee making these determinations.”

He also added that there is a licensing regime to ensure linear accelerator rooms are safe and that operators are protected.

Sawrey said the system is anti-competitive and the worst in the nation in terms of certificate-of-need requirements, which are reflected in costs, health care access, and patient outcomes.

He added that the single biggest thing that North Carolina can do is reimagine how hospital facilities and procedures can operate without CON.

“People will often say, well, if we do away with certificate of need, then the cost will go up,” Sawrey said. “We’ll have duplicative services. That and Medicaid are separate topics. You can manage Medicaid costs without restricting who can and cannot build facilities, and that’s on the supposition that there isn’t a private marketplace that would do anything less.”

Sawrey also touted other health care reform wins last year, including the Script Act,