North Carolina
How looming NC health policy decisions could change what you pay for care
Language in the state budget that lawmakers are hammering out now would help some of the state’s largest hospital systems grow, fueling concerns of monopoly.
One would grant UNC Health, as well as ECU Health in eastern North Carolina, antitrust exemptions that some lawmakers say the systems need to partner with struggling rural medical facilities.
One expert on the industry calls the proposal “idiotic.”
The Federal Trade Commission, which reviews hospital mergers to preserve competition in the sector, has weighed in against the change, saying it would likely increase health care costs and lower the quality of care as competition is reduced.
Another proposal — essentially one sentence in nearly 400 pages of budget text — would end a long-standing rule that limits in-state expansion for Charlotte-based Atrium Health, a 40-hospital system that’s part of one of the biggest hospital companies in the country.
Atrium is forbidden most expansion in North Carolina outside its home in Mecklenburg County because it’s organized as a local hospital authority, a throwback to its earlier days that comes with limitations but also with quasi-government powers, including eminent domain and its own antitrust protections.
The hospital’s competitors have opposed the changes, fearing a massive expansion. They say these changes would give UNC Health and Atrium unfair advantages in the marketplace and a legal edge that would make it extremely difficult for other hospital groups to compete.
Spokespeople for Atrium didn’t respond to multiple interview requests about the proposal. UNC Health officials say they need the antitrust change to thrive in an industry marked by hospital systems gobbling up private physician practices and growing ever larger, including through out-of-state partnerships that are unavailable to a university hospital.
They also promised an ongoing commitment to healthcare in rural North Carolina.
“We’ve run to the rural parts of the state when no one else has,” UNC Health spokesman Alan Wolf said. “Name one other health care system outside of ECU that is serving rural North Carolina. There are none.”
Lawmakers who are supporting the effort say the changes will strengthen the systems’ role as a provider of last resort, particularly in rural areas. In addition to the antitrust language and other regulatory shifts, the state Senate’s budget proposal includes hundreds of millions of dollars for new facilities where UNC Health and ECU Health would partner.
“I’m trying to create more options out there across the state for individuals to receive their healthcare,” said Sen. Ralph Hise, R-Mitchell, who is a Senate budget-writer.
ECU Health leaders declined an interview request and didn’t respond to specific questions about the legislation.
“In general, ECU Health is grateful for legislators’ commitment to exploring ways to strengthen rural health care,” spokeswoman Ashlin Elliott said in an email.
FTC criticism
After the UNC antitrust language emerged at the statehouse, Federal Trade Commission officials sent Hise and other key health care leaders a letter blasting the proposal.
The regulator said UNC Health doesn’t need an antitrust carve out to collaborate with other entities and that the measure’s main effect “would be to shield mergers and conduct that would violate the antitrust laws by depriving patients and workers of the benefits of competition.”
The change would likely increase healthcare costs and could reduce wages and benefits for healthcare workers as UNC colludes with one-time competitors, the letter states.
“Experience has taught us that antitrust exemptions threaten broad harm to many while benefiting only a select few,” it states.
UNC Health said it has never had an expansion blocked by FTC review. But every major transaction goes through that review, they said, and in some cases the system has made decisions meant to avoid federal roadblocks. In some cases, they said, the system might want to own a location, but it ends up simply managing it to avoid antitrust concerns, which limits its ability to make capital investments.
The changes would make UNC Health a more unified system, as opposed to a federation, system executives said. It also changes the way UNC Health and entities that it owns, including UNC Rex, a separate private nonprofit hospital owned by UNC Health, issue debt, saving the system money, they said.
Outside experts say antitrust exemptions are dangerous. Barak Richman, a Duke Law professor who researches healthcare policy and antitrust issues, said it would be “idiotic” to give a large system antitrust immunity.
“The whole health policy world is demanding more antitrust enforcement against hospitals,” Richman said in an email. “Hospital consolidation is the primary cause of price inflation, and it’s one of the biggest problems with the current U.S. healthcare system. It’s just an incredibly foolish policy.”
As for the Atrium language, Richman said the company is “all about expansion.”
“And expansion isn’t a bad thing, per se,” he said. “It’s just a problem when it creates market concentration, which is exactly what they want to do.”
Eastern merger concerns
Before the Senate budget emerged with antitrust exemptions for UNC Health and ECU Health, a standalone bill just dealing with UNC Health passed the state Senate.
Some of that support has faded since the vote, and long-standing worries in eastern North Carolina that UNC Health might one day absorb ECU Health fuel some of the opposition.
The Senate budget also includes hundreds of millions of dollars for new facilities that UNC Health and ECU Health would operate together, as well as an edict that they collaborate in rural North Carolina in a project called “NC Care.”
The money, combined with the antitrust language and some of ECU Health’s recent financial struggles, have some thinking a forced merger would be next. The hospital in January announced the closure of several ambulatory clinics following a $46 million loss in the 2022 fiscal year.
“In my humblest opinion, it’s a set up,” Sen. Kandie Smith, D-Pitt, said.
“It looks like it’s almost preparing for a larger takeover,” Smith said. “Wouldn’t you want to get things right before you take over?”
UNC Health officials say that’s not their plan at all, and top lawmakers say nothing like it would be forced.
“Anything that happens between UNC and ECU will be as a result of collaboration, of partnership, of those entities,” Speaker of the House Tim Moore said. “Nothing that is forced from this General Assembly.”
Senate Republican Leader Phil Berger said he doesn’t see a merger in the offing, just “more cooperation, working together, maybe some combination of some back office stuff.”
Berger, and other Senate Republicans, have repeatedly said they want the two hospital systems to have the tools they need to be the state’s provider of last resort, and to step in in rural areas when community hospitals have financial trouble.
Richman, the Duke University professor, said the issue isn’t whether the two merge, it’s that the antitrust language is bad policy, period.
“A monopolist with a light blue color on its front will not be much different from a monopolist with a purple color on its front,” he said, referring to the UNC and ECU hospital groups’ logos.
High level talks
Key health policy and budget writers in the House said in recent weeks that they didn’t know much about the UNC antitrust provision or the Atrium expansion language, and that these issues would likely be decided by the legislature’s “corner offices.”
That means Moore and Berger, the General Assembly’s top leaders who handle the final big-picture budget negotiations each year. That process is ongoing now, and both men have indicated the UNC and Atrium language will likely be among the last issues decided in a budget process that also includes fights over tax rates, teacher salaries and a wealth of other issues.
Berger said last week that he and Moore hadn’t even discussed these issues yet.
Both changes are Senate priorities, embedded in the Senate budget proposal and not the House’s. Moore was non-committal when asked about them recently.
Those talks, which lawmakers once hoped to conclude in June, have extended into July.
Moore also noted the FTC letter as a strike against UNC’s antitrust exemption.
“I have, certainly, concerns with it,” he said. “I think if there’s a way to allow a greater partnership between ECU and UNC on the hospital side, that’s something certainly to look at, but there’s a lot of discussion to look at.”
Healthcare session
The cumulative impact of these proposed changes and others working their way through the North Carolina General Assembly is wide-ranging. Even lawmakers typically involved in health policy, and hospital executives themselves, struggle to describe the overall vision of a legislative session unusually focused on foundational health care policy.
Medicaid expansion could bring the biggest immediate impact, but with the Atrium language, the antitrust language and a potential second rollback on certificate-of-need competition limits, lawmakers are mulling changes that would shift the playing field for hospital mergers and operations for decades to come.
“I think this session will have dealt with health policy in a substantive way that we’ve not seen for a very long time,” Berger said.
As
North Carolina positions itself as a leader in clean energy, federal spending
cuts are raising concerns about the future of renewable energy investments and
jobs in the state. At a press event Thursday, climate and economic policy
experts warned that reductions in federal funding threaten progress made under
the Inflation Reduction Act, while some conservatives argue that market forces
will sustain clean energy growth regardless.
Concerns over federal cuts
Since
the Inflation Reduction Act was signed into law in 2022, North Carolina has
seen more than $20.44 billion in clean energy investments—the fifth-highest in
the nation—and more than 17,000 new jobs, particularly in rural areas,
according to Climate Power. But panelists at the event, including State House
Democratic Leader Robert Reives, warned that recent federal spending cuts could
jeopardize that progress.
“This
does nothing but set us back,” Reives said. “It takes away jobs, it takes away
people’s ability to have choices on energy, and ultimately, it takes away North
Carolina’s ability—and the United States’ ability—to stay competitive in what
is clearly a growing market.”
Panelists
emphasized that incentives from the Inflation Reduction Act have driven clean
energy investments, with consumer tax credits and rebates helping more than
85,000 North Carolina families afford home energy upgrades in 2023 alone.
“Federal
cuts will make it harder for the people of our state to make ends meet and for
us to meet our climate goals,” said Alex Campbell of the NC Budget and Tax
Center. “Without these programs, families in North Carolina are going to face
higher costs—not just from reduced public services, but from ripple effects
throughout our economy.”
Business impact
Much
of the debate centers around North Carolina’s booming electric vehicle and
battery manufacturing industry, which has attracted billions in private
investment.
“In
the past two years, North Carolina has become a leading hub for electric
vehicle and battery production,” said Stan Cross of the Southern Alliance for
Clean Energy. “As of June 2024, our state ranked third in the country for EV
and battery manufacturing investments, at $20.2 billion, creating over 16,000
jobs—many of them in rural communities.”
Cross
argued that federal incentives have played a critical role in attracting these
companies. “If these tax credits are eliminated, we risk losing our competitive
edge,” Cross said.
But
not everyone sees it that way.
Mark
Fleming, president and CEO of Conservatives for Clean Energy, said he isn’t
concerned that federal cuts will slow the state’s progress.
“North
Carolina has been a leader for years in the clean energy economy, a leader in
the Southeast and in the country,” Fleming said. “And we believe that the clean
energy economy will continue to grow in North Carolina due to private
investment.”
Fleming
said technological advancements have made clean energy increasingly
cost-competitive and expects the industry to keep expanding without federal
mandates.
“We
believe in free markets,” Fleming said. “Technology is leading to rapid
decreases in the cost of solar and wind, and we believe that will continue.
Clean energy technologies can compete on their own.”
State
vs. federal policy
Fleming
pointed to support across the aisle for clean energy at the state level as a key
reason why North Carolina will remain a leader in the sector.
“There
has been bipartisan leadership in North Carolina on clean energy going back a
decade plus,” Fleming said. “Clean energy has provided jobs, and it has
provided revenue for our state’s counties that, quite frankly, are struggling
and need that revenue.”
While
Fleming believes North Carolina’s clean energy future is secure without federal
intervention, Reives warned that even the perception of reduced federal support
could discourage further investment.
“If
businesses are getting the signal that the U.S. is deciding to pull out of the
clean energy space, they’re not going to be as anxious to locate here,” Reives
said. “We spent years recruiting companies like Toyota to build in North
Carolina. If we stop supporting clean energy, we could lose that momentum.”
What’s next?
The
North Carolina General Assembly is expected to debate energy-related
legislation in the coming months, and stakeholders on both sides will be
watching to see whether state lawmakers move to reinforce or roll back clean
energy initiatives. Meanwhile, businesses and workers in the clean energy
sector wait to see how federal policy shifts will impact their industries, which make take years to play out.
Gov.
Josh Stein, a Democrat, has expressed strong support for clean energy and is
expected to continue advancing the North Carolina Clean Energy Plan, which aims
to cut greenhouse gas emissions, modernize the grid and expand renewable
energy across the state.
INDIAN TRAIL, N.C. (WBTV) – A tornado sounded like “a roar” as it passed through a Union County community on Wednesday morning, one resident said.
The twister touched down at 8:34 a.m. in the area of Friendly Baptist Church Road in Indian Trail, right near Porter Ridge High School, according to the National Weather Service (NWS).
NWS officials said the tornado was only on the ground for about three minutes, but had peak winds of 90 mph, making it an EF-1 tornado. The twister was an estimated 75 yards wide and traced a path 2.24 miles long.
The tornado left about 1,000 people in the area without power and toppled trees throughout the area.
Peggy Allen had a massive tree come down in her yard, but said she felt lucky for that to have been the only damage.
“The wind was blowing real hard and all of a sudden the power went out and we heard this big noise,” Allen said. “I can’t explain it. A roar! And then it was gone.”
The NWS said nobody was hurt by the quick-moving tornado, but said that a fence and shed was damaged in addition to the downed trees and power outages. Some debris was also blown across roads.
A tornado warning had been issued just moments before the twister touched down. NWS officials said the warning was given at 8:31 a.m., which was just three minutes before it was on the ground.
Based on times given by the NWS, the tornado touched down shortly after students at Porter Ridge High went to their first class of the day. However, at the middle school — which is right next door — students do not start their day until 9:05 a.m. A soccer net at the schools’ campus was reportedly flipped into parked cars, but nobody was hurt.
Another tornado warning was issued in Chester County on Wednesday, but it expired within a half hour and nothing came of it.
Previous Coverage: EF-1 tornado likely touched down in Union County amid storms, officials say
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CHAPEL HILL, N.C. — Bill Belichick has seen North Carolina run through only two practices this spring — players in shorts and jerseys without names or numbers — so he’s not making any grand pronouncements about the caliber of team he’s working with.
But the one thing he says he feels confident in is the Tar Heels will be built his way and without compromise.
“I don’t really have any expectations,” Belichick said. “It’s going to be up to each individual. I know we’ve got a good plan, I know we can do the right things to put a good product on the field. Everybody that buys into it and wants to be a part of it, will be a part of it. And if they don’t, they can go somewhere else. That’s their decision.”
Belichick said he has been encouraged by the team’s progress since he arrived, though he said the early days of spring practice haven’t offered many insights.
But unlike his time in the NFL, the 72-year-old Belichick said he expected to use the spring as an opportunity to develop players through contact and physicality — particularly in the run game and along the line of scrimmage, something that was difficult to do during minicamps and OTAs in the pros.
“We didn’t have pads to do things like that,” Belichick said. “Contact is very limited in the NFL in the spring. There really isn’t any.”
One group that won’t have much contact is the quarterbacks. UNC’s depth chart at the position is thin, with Purdue transfer Ryan Browne and true freshman Bryce Baker. Last season’s Week 1 starter, Max Johnson, remains as well, but he’s recovering from a broken leg sustained in the opener.
Belichick said Johnson was “getting better,” and UNC was adjusting his workload each day based on how he responded to the previous day’s efforts.
Beyond that, Belichick said the first few practices at UNC have been as much an onboarding for players as a chance for the staff to evaluate what it has.
“It’s kind of similar to what a rookie minicamp would be and time with the rookies,” Belichick said. “… We’re starting to put everything together — here’s how we do things, here’s what our expectations are, this is what you need to do to be successful. They’ve embraced that and tried to do it.
“We haven’t accomplished anything, but we’re a lot further along than we were five weeks ago. We’re getting there.”
It’s also a chance for Belichick to get back to doing what he does best.
“That’s the great thing about being a head coach — I can coach anybody I want,” Belichick said. “I can coach the line, I can yell at the tight ends, I can yell at the DBs, I can yell at the kickers.
“I can go to any group I want and coach them. And honestly, that’s the fun part.”
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