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Healthcare costs continue to dominate voters' concerns in North Carolina, and a new statewide survey suggests there is broad bipartisan agreement on what policymakers should do about it.
According to a survey of 600 likely general election voters, cost and affordability are by far the top healthcare concerns for North Carolinians. Nearly six in ten voters identified healthcare costs as the issue that worries them most — more than twice as many as those who cited access to care.
The findings paint a clear picture: voters are frustrated with rising healthcare costs and are increasingly skeptical of a healthcare system that often prioritizes higher prices rather than better care.
Just as importantly, voters are not struggling to identify solutions. The survey tested a range of healthcare reforms currently being debated in North Carolina, and support was overwhelming across party lines.
Patients Should Pay the Same Price for the Same Care
One of the strongest-performing proposals involved site-neutral payment reform — the idea that patients should not be charged dramatically different prices for the same service simply because it is delivered in a hospital-owned facility rather than an outpatient center or independent physician office.
After learning that patients often pay substantially higher prices for MRIs, infusions, specialty injections, and other services when they are provided through large hospital systems, 87 percent of voters supported aligning prices across care settings.
The result reflects growing public concern that, for many patients, the location of care can have a bigger impact on the bill than the service itself.
Voters Want Limits on AI-Driven Costs
Artificial intelligence has become a growing source of concern in healthcare as reports emerge about hospitals and health systems using the technology to maximize billing revenue without receiving improved care.
The survey found that nearly three-quarters of voters support prohibiting hospital systems from using AI tools in ways that generate unnecessary bills, increase charges, or otherwise drive up patient costs.
The finding comes as policymakers examine how AI is being deployed in healthcare billing and utilization management. While technology has the potential to improve care, voters appear deeply concerned about its use to generate larger medical bills.
340B Reform Receives Near-Universal Support
Few proposals generated stronger support than requiring hospitals participating in the federal 340B drug discount program to pass savings directly to patients.
The 340B program allows eligible hospitals to purchase medications at steep discounts. However, many hospitals are not required to share those savings with patients at the pharmacy counter.
When voters were told that some hospitals purchase discounted drugs and then resell them at higher prices, 92 percent supported requiring the savings to be passed through to patients.
Voters Support Stronger Oversight to Combat Waste, Fraud, and Abuse
88 percent of North Carolinians support giving state regulators more audit authority to oversee hospital system billing practices, investigate potential fraud and overbilling, and ensure healthcare providers are not charging patients and taxpayers for unnecessary or improperly coded services.
95 percent voters also support requiring hospitals systems to publicly disclose prices for common procedures and services, making it easier for patients to compare costs and understand what they will be charged before receiving care.
These findings reflect growing concern that opaque pricing, aggressive billing practices, and inadequate oversight contribute to higher costs. Voters appear to believe that stronger regulatory accountability and greater price transparency are important tools for lowering costs.
A Rare Point of Bipartisan Agreement
In an era when voters disagree on almost everything, healthcare affordability appears to be a rare exception.
Every healthcare reform proposal tested in the survey received majority support. Several received support from more than 85 percent of voters, including Republicans, Democrats, and unaffiliated voters alike.
The message from voters is straightforward: healthcare costs are too high, and policymakers should prioritize reforms that increase affordability.
