Health care cost illusions still underpin debates

North Carolinians are feeling the strain of rising healthcare costs — and as the 2026 short session approaches, how lawmakers address affordability could influence what families pay, how employers structure coverage and how providers are reimbursed.

Why it's important: Health care affordability is shaped by a complex mix of insurance design, pharmaceutical pricing, regulatory decisions, provider costs and patient needs, all interacting within the broader health care landscape.

• For policymakers, that means reform requires examining how decisions in one part of the ecosystem affect the rest — not just the most visible components of care delivery.

Heal the System, a North Carolina-based 501(c)(4) organization, argues that when legislative efforts address costs in isolation without accounting for these system-wide dynamics, financial pressure often shifts to patients, providers or employers instead of declining.

Key numbers: The organization's 2025 bipartisan survey of more than 700 North Carolina voters found that many constituents see insurance practices as central to affordability challenges.

• 74% blame insurance companies for today's high health care costs.
• 66% have an unfavorable opinion of health insurance companies.
• 67% believe patients face unnecessary delays because of prior authorization processes.
• 60% say they've paid more in premiums over the past two years.

At the same time:

• 61% have a favorable opinion of hospitals overall.
• 62% rate their local hospital's quality of care as excellent.
• 54% believe hospitals face financial difficulties due to the uninsured patients they treat.

What this means: The findings suggest that public concern about how insurance practices shape costs and delays may not be fully reflected in how reform efforts are prioritized across the broader system.

The breakdown: Research reinforces the structural cost-shifting dynamics shaping affordability.

• Employer-to-employee shifts: In North Carolina, employee contributions are disproportionately high compared to total premium levels, placing a greater share of the cost burden on consumers.

• Administrative burdens: Initial claim denials and prior authorization requirements can shift costs and administrative strain throughout the care delivery process. Research shows 93% of physicians report that prior authorizations delay care, and 29% report serious adverse events due to those delays.
• Market leverage and reimbursements: Insurance companies negotiate reimbursement rates and define network participation, shaping how financial pressures are distributed across providers, employers and consumers.

In other words: Affordability isn't just about how much care costs to provide — it's about how costs are structured, negotiated and distributed across the entire health care ecosystem.

The takeaway: As lawmakers prepare for the 2026 short session, reforms grounded in a comprehensive understanding of this complex landscape will be more likely to improve affordability without weakening access or simply shifting costs.

• Voters already get it — effective policy should reflect it too.

Learn more and get involved.