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NCGA to consider health provider and insurance reforms

My last blog post described what I believe are two bad pieces of health care policy that were introduced recently in the North Carolina General Assembly. The blog detailed two insurance mandates dealing with telehealth coverage and chiropractic services. The main problem with insurance mandates is they result in diffused costs and concentrated benefits. Put another way, mandates usually benefit the few at the expense of everyone.

In this blog, I’ll highlight two good pieces of health care policy set to be heard in committee soon. The two pieces of legislation are SB 228/HB 373, Allow Employers to Offer EPO Benefit Plans, and S345 Physician Assistant (PA) Team-Based Practice.

SB 228/HB 373 would allow for the sale of exclusive provider organization (EPO) plans to North Carolina’s small businesses. Under current law, only large employers have the opportunity to buy these plans. EPO plans are essentially a managed care plan where the insurer only offers in-network coverage from a narrow network of providers. Furthermore, the insurer will not pay for any out-of-network care, except for emergency services. Similar to HMOs, EPO plans sometimes require the insured to pick a primary care provider (PCP). But unlike HMOs, EPOs typically do not require that you get referrals from your PCP to see a specialist.

Allowing small businesses to purchase EPO plans will create another affordable insurance option for employers in North Carolina. In exchange for a narrower network of providers, insurers can offer reduced premium rates to employers because the exclusivity of the plan guarantees a certain patient volume for the provider groups that agree to take these plans. As small employers look for more ways to provide insurance to their employees, EPOs could offer another option.

The next bill is SB345, PA – Team-Based Practice. This bill updates and loosens some of the regulations concerning physician assistants. Similar to some advanced practice nurses, PAs are required by current law to have a supervisory arrangement with a physician. While well-intended, these supervisory requirements can hinder well-trained health professionals from offering their full range of medical services.

SB345 amends the requirement for supervisory agreements between physician assistants and physicians. Under the changes proposed in the bill, a PA would not be required to enter into a supervisory agreement if the PA practices in a team-based setting and has more than 4,000 hours of practice experience and more than 1,000 hours of practice experience with a physician in a particular medical specialty. The bill furthermore sets standards for how PAs who operate without a supervisory agreement can practice.

The John Locke Foundation supports health care legislation that removes unnecessary barriers and fosters a more functional health care market. Each of these bills discussed accomplishes those goals. By allowing EPOs to be sold to small businesses, North Carolina employers and employees will have more insurance options. By allowing PAs to practice independently of a supervisory requirement, we can expand the use of the health care capital we already have in this state, empowering health care workers to offer their full range of services. The General Assembly should pass both of these bills.

Jordan Roberts / Government Affairs Associate

Jordan joined the Locke Foundation in the summer of 2018 as Health Care Policy Analyst. He analyzes state and national health policy issues with an eye toward removing governm...