Can NC lawmakers fix our health care headaches?
Plus: Humanities nonprofit sees big funding cut; Lovin' Life Music Fest grooves despite weather hiccup; Toppman reviews Charlotte Ballet's 'Carmen'; city budget to be presented tonight
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A series of bills introduced in the General Assembly this session are intended to lower health care costs and make the health care system less painful to navigate
by Michelle Crouch
If you’ve ever been hit with a slew of confusing bills after a hospital stay, had a long wait for an insurance approval or struggled to pay an unexpectedly high medical bill, you know how frustrating health care in North Carolina can be.
In fact, by at least one measure, it’s the worst in the nation: A 2024 Forbes Advisor analysis found that the state had the highest health care costs in the nation.
Now, under growing pressure from patients and health care providers, lawmakers in Raleigh are considering a series of bills designed to trim costs.
Advocates say they are cautiously optimistic.
“There seems to be more of an appetite than ever before to try and address some of the pain points,” said Rebecca Cerese, health policy advocate for the North Carolina Justice Center. “It is heartening that they are looking at different mechanisms and trying to figure out some solutions.”
The Ledger/NC Health News has highlighted many of the issues that the General Assembly proposals address. Here’s a look at what’s on the table:
Prior authorization reform
Legislation approved by both chambers would make changes to prior authorization — the process insurers use to decide whether to pay for specific treatments ordered by providers. Doctors say prior authorization can delay essential care, sometimes leading to serious health consequences or even death. Insurers say the process is necessary because sometimes doctors “upcode,” or ask for more expensive treatments so that they can earn more reimbursement.
Bills originating from each chamber would require insurers to respond to urgent care requests within 24 hours, up from the current three business days. They would both also require the doctor reviewing a case for the insurer to be in the same specialty as the care, so a dermatologist, say, can’t deny care related to a knee injury.
House Bill 434 bill goes further, requiring the insurer’s doctor to be licensed to practice in North Carolina. And it says that if a provider has been approved for a specific treatment 80 % of the time, insurers could no longer require prior authorization.
Senate Bill 316 includes a provision that artificial intelligence can’t be the “sole basis” for a denial.
Because the House and Senate approved different versions, members will try to hash out their differences in a conference committee.
Facility fee crackdown
As hospital systems buy medical practices and clinics, more North Carolinians are being hit with surprise hospital facility fees, even if their care didn’t take place on a hospital campus.
A Ledger/NC Health News story last year dug into the trend and told the story of a Charlotte breast cancer survivor whose regular $75 checkup jumped to $400 after her clinic was acquired by Novant Health.
North Carolina Senate members approved, by a bipartisan vote of 44-2, a bill that would ban facility fees for care delivered at places that aren’t on a hospital campus — such as your doctor’s office or outpatient clinic — unless it's at a remote location of a hospital, a facility that includes an emergency department or at an ambulatory surgical facility.
The North Carolina House of Representatives hasn’t approved a similar bill, but the topic will likely come up when the two chambers meet to negotiate differences in their health care bills.
More billing transparency
Medical bills are confusing, and part of the problem is that patients have no idea what the charges will be until they arrive.
Even then, billing statements are often hard to understand and contain errors. A 2024 Ledger/NC Health News story highlighted the case of a leukemia patient whose credit score was ruined due to a series of billing mistakes, miscommunication and delays in billing.
A provision in a bill from the North Carolina Senate would require health care systems to provide a plain-language, good-faith estimate of what your care will cost before a non-urgent procedure — and the final invoice couldn’t be more than 5% higher.
The bill also requires hospitals and ambulatory surgical facilities to send you an itemized list of charges “in language comprehensible to an ordinary layperson” before sending an unpaid bill to collections.
Other health-care related reforms
Other changes being considered in Raleigh would have a less direct impact on patients but could potentially help lower the cost of care and improve access. They include:
Certificate of need law changes: Legislation in both chambers would repeal the system that requires health care providers to get state approval before opening certain types of health care facilities. Proponents say that would allow for more competition and lower prices. Hospitals argue that removing those guardrails mean they’d be left holding the bag for less well-reimbursed, but necessary, services like emergency care and labor and delivery.
More independence for certain nurses: Bills in both chambers would expand the authority of advanced practice registered nurses such as nurse practitioners, nurse anesthetists and certified nurse midwives, allowing them to practice without physician supervision, which the nurses argue is superficial. Physicians’ groups say it’s a safety issue, even as dozens of other states have allowed for greater nurse autonomy.
Limit on health insurance mandates: Among other provisions, Senate Bill 24 requires any new mandate for health benefit plans to be offset by the repeal of an existing one. Lawmakers said the bill would help control rising health care costs because they would have to consider the financial impact before expanding benefits.
It’s hard to say how much — if any — of this legislation will make it through both chambers and land on the governor’s desk. Similar proposals have stalled in the past.
Cerese says she’s hopeful, noting that her organization, which is left-leaning, and the conservative John Locke Foundation both support some of the proposals.
Ultimately, she says, as hospital systems continue to grow and consolidate, the state’s leaders will need to have “a much deeper conversation … because it's the system itself that puts profit at the center — rather than patient care — that is really the problem.”
(If you want to have a say in these bills or others, you can reach out to your reps by entering your address into the General Assembly's “Find Your Legislators” tool.)
Michelle Crouch covers health care. Reach her at mcrouch@northcarolinahealthnews.org. This article is part of a partnership between The Ledger and North Carolina Health News to produce original health care reporting focused on the Charlotte area.
Today’s supporting sponsor is Landon A. Dunn, attorney-at-law in Matthews:
North Carolina Humanities grapples with 90% funding cut due to DOGE budget reductions; foundation will provide some funding but more help is needed, director says
North Carolina Humanities, a nonprofit that brings programs related to culture, literature and history to communities across North Carolina, has lost more than 90% of its funding due to cuts by the Trump administration’s Department of Governmental Efficiency, or DOGE.
NC Humanities is a state affiliate of the National Endowment for the Humanities (NEH). Last month, DOGE announced that it aimed to cut 80% of NEH staff and terminate a majority of the agency’s grants.
The cuts mean a loss of $1.6M for NC Humanities, or more than 90% of its budget, said Sherry Paula Watkins, executive director of NC Humanities, in an interview Friday with The Ledger.
One of the organization’s flagship programs is North Carolina Reads, a statewide book club that features monthly virtual discussions with authors and experts and free books for some participants.
NC Humanities also provides grants for public humanities projects such as lecture series, exhibitions, and workshops. The grants often support teachers, veterans, and underserved communities.
In 2023, for example, NC Humanities awarded a $20,000 grant to the Charlotte Museum of History for its exhibit “Open Wide the Door: The Story of Mary Cardwell Dawson and the National Negro Opera Company.” The exhibit, which ran until February 2025, explored Dawson’s impact and the legacy of her opera company, which was founded in 1941.
NC Humanities also has a collaboration with the Smithsonian Institution Traveling Exhibition called Museum on Main Street to bring exhibitions and programs to museums in small-town communities across North Carolina.
To make up for the DOGE cuts, the Mellon Foundation has given $15M to U.S. humanities organizations in 50 states, some $200,000 of which will go to NC Humanities, which has a staff of four employees and has operated for 50 years, Watkins said. The Mellon Foundation is also offering a $50,000 challenge grant to NC Humanities if the nonprofit is able to raise that much from donors. (Donors can give through the NC Humanities website.)
Watkins said NC Humanities remains open and functioning thanks to the Mellon Foundation funding as it seeks new donors and aims to advocate for federal funding in 2026.
She said she fears what would happen across the state, and especially in rural areas, if the work that NC Humanities does to “weave together our fabric” goes away.
“I'm afraid that the isolation that we are already suffering, that these programs are designed to eliminate, would grow more, and that people would feel disconnected from each other and not understand each other,” she said. “Without this work … you would have a gap in stories and connection in North Carolina.” —Cristina Bolling
Despite rain, Charlotte showed up for Lovin’ Life music fest; third-annual event is scheduled for May 1-3, 2026
R&B singer Teddy Swims performed on the main stage Sunday night ahead of the final festival performance from Dave Matthews Band. (Photo by Lindsey Banks)
Back for its second year, Lovin’ Life Music Fest once again delivered a packed three-day weekend of live music, food and Charlotte pride — even if the weather didn’t always cooperate.
Crowds estimated at about 20,000 people per day turned out for performances by Gwen Stefani, Benson Boone, Pitbull, Weezer, Dave Matthews Band, Teddy Swims and others. This year’s lineup didn’t pack quite the same A-list punch as 2024’s (which included Post Malone, Stevie Nicks and Noah Kahan), but festival-goers still showed up in force.
Some of the details that worked well last year returned: The festival layout stayed the same, which made it easy to navigate for returning attendees. Picking up wristbands early made getting through the gates quick and seamless, and the entrance gate’s proximity to the 7th Street Station light rail stop was convenient for those using public transit. While themed dress-up days were once again promoted, most people stuck to regular festival attire.
There were some differences, though. The central part of the festival grounds felt more open this year, making it easier to move around and a little less congested. And the food scene was stronger, with over a dozen food vendors and multiple bars throughout the grounds.
Saturday afternoon and evening brought lightning and heavy rain, which caused some delays. Festival goers had to seek shelter in a parking deck while the storm passed, but the weather lightened up around 6 p.m. and held off until late that night. Friday and Sunday brought perfect weather, though: sunny skies, comfortable temps and an occasional breeze.
Benson Boone’s set on Friday night was the highlight of the weekend for me. (He performed on Saturday Night Live the following night, so it felt like Charlotte got a sneak peek.) I didn't attend Saturday night's Lovin’ Life shows with Pitbull and Weezer because I was at Kendrick Lamar and SZA’s Grand National Tour at Bank of America Stadium, but from what I saw on social media, attendees had a great time jamming out, especially to Mr. 305.
Road traffic was a little nightmarish uptown after the festival and the show, which was about the time the rain started pouring again.
Festival officials on Sunday announced the dates for the third year of the event: May 1-3, 2026. (No word yet on who the performers will be.)
Overall, the weekend brought back the spirit of last year’s inaugural event, and fans are already looking ahead to what next year might bring — hopefully with fewer weather hiccups, a few more well-known artists and no major concert overlap across the street. —Lindsey Banks
🎥Check out recap videos from Day 1 and Day 3 on The Ledger’s Instagram
Review: Charlotte Ballet’s ‘Carmen’ has plenty of excitement but no soul; strong corps de ballet and live orchestra are highlights
Charlotte Ballet’s “Carmen” — a world premiere choreographed by Andrea Schermoly — is set in Las Vegas in 1973. (Photo by Taylor Jones courtesy of Charlotte Ballet)
Ledger arts critic Lawrence Toppman took in Friday’s opening night performance of Charlotte Ballet’s “Carmen,” a world premiere choreographed by Andrea Schermoly that runs through May 11 at the Knight Theatre.
In his review for the Toppman on the Arts newsletter, Toppman writes:
The 90-minute world premiere choreographed by Andrea Schermoly offers frantic energy, blunt broad humor, superficial glamor without real sensuousness, and crowd-pleasing if often repetitive physical pyrotechnics. But as Gertrude Stein said of her hometown of Oakland, “There’s no there there:” no sense of hearts broken, danger looming, people rushing toward self-destruction. Watching it is like meeting a beautifully dressed, handsome blind date who, after 15 minutes, has nothing left to say.
Schermoly sets this, for no reason I can see, in Las Vegas in 1973. Perhaps she chose that time because Elvis Presley was still working there: Her Escamillo, Don José’s rival for Carmen’s favors, is a pompadoured, puffed-up pop singer who draws snickers from the audience. That means, of course, we don’t see why Carmen immediately feels drawn to him: Who wants this no-charisma buffoon, however rich he is?
Read the full review:
You might be interested in these Charlotte events
Events submitted by readers to The Ledger’s events board:
THURSDAY: The Charlotte Ledger’s 40 Over 40 Awards presented by U.S. Bank, 6-9 p.m. at Heist Brewery and Barrel Arts, 1030 Woodward Ave., Charlotte. In its 6th year, the 40 Over 40 Awards presented by U.S. Bank has become a beacon of recognition for those over the age of 40 who continue to shape the future of Charlotte. Join us for a fun night out of networking, dinner, drinks, live music from Uptown Dueling Pianos, award ceremony, and more. $95.
THURSDAY: “Conclave” Movie & Talkback, 7 p.m. at the Independent Picture House. Join IPH after the screening of “Conclave” for a conversation with Peter Judge, Professor Emeritus of Religious Studies at Winthrop University and Tim Funk, former faith & values reporter for the Charlotte Observer.
➡️ List your event on the Ledger events board.
In brief:
Dilworth arson: A fire and explosion that leveled a Dilworth home and injured two on Friday was set intentionally, officials said. No one was inside the home at the time. (Observer)
City budget reveal: Charlotte City Manager Marcus Jones will present his proposed fiscal year 2026 budget at 6 p.m. tonight. The city council will take a final vote in June after adjustments and straw votes.
Courting Cooper: Democrats’ hopes of retaking the Senate majority in 2026 hinge on a handful of undecided candidates, including former N.C. Gov. Roy Cooper. One person close to the governor put the odds that he runs at 50 percent. Cooper is teaching at Harvard University this spring. (NOTUS/he Assembly, subscriber only)
Not Animal House: Lake Norman neighbors are protesting a Cornelius family’s plan to add a 6,000sf facility for weddings and other events to their two-mansion waterfront property. A member of the family told Cornelius commissioners the venue would cater to upscale clientele. “No ‘Animal House’-type events,” he stressed. (Observer)
Office building purchase: Tennessee-based real estate firm Highland Ventures has purchased an aging 19-story office building at 525 North Tryon St. in uptown for $24M. The high-rise was valued at $97.2M in the county's last assessment and was last purchased in December 2014 for $60M. It’s about 46% occupied. (Biz Journal)
Rea Road closure: A section of Rea Road south of Providence Lane West will close starting today through May 30 so crews can replace underground pipes. Detours will also affect NC 51 and Providence Road. (Observer)
Armed ref: A referee was arrested in Union County after firing a concealed weapon inside an Indian Trail athletic facility, according to the Union County Sheriff’s Office. (WSOC-TV)
The chicken Caesar guy: Mark Engels tried 45 chicken Caesar wraps in Charlotte and ranked the top five on his TikTok channel. Next up: chicken fingers. (Tiny Money)
Staged fall: A North Carolina man who claimed he fell 25 feet from a ledge and got trapped on a narrow cliff in Virginia may have staged the fall, according to rescuers. The Guilford County man has a history of “calling in false 911 calls where he claims to be in need of rescue,” according to a press release. (Observer)
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