The N.C. Senate is tying prohibiting the use of state Medicaid funds at Planned Parenthood facilities to its latest modified attempt at enhancing pricing transparency from hospitals and ambulatory surgical centers.
Republican Senate leadership plans Monday to use the gut-and-replace strategy on House Bill 192, which passed the House on June 25 with a focus on public employee salary and benefits increases.
The revamped HB192 version is titled “Defund Planned Parenthood & Cost Transparency.”
It is not clear how quickly the bill will be heard in the Senate during the second extra legislative session that begins Monday and ends Thursday.
The Planned Parenthood language follows the script of several Senate Republican cultural war bills, some of which claim their intent is to support an executive order from President Donald Trump, only to vetoed by Democratic Gov. Josh Stein.
It is likely, according to analysts, that Stein would veto HB92 if it clears the legislature.
Meanwhile, Rep. Donny Lambeth, R-Forsyth, and a key House healthcare legislation negotiator, said Sunday that “I am not aware of any agreement with the House” on the revamped HB192 language.
Defund Planned Parenthood
Planned Parenthood offers abortion services in North Carolina, providing information on options and financial assistance.
State law allows for abortion up to 12 weeks of pregnancy with limited exceptions later in pregnancy for medical emergencies or cases of rape and incest.
In the instance of the revamped HB192, bill sponsors say they are responding to language within the controversial “One Big Beautiful Bill” that authorized the federal defunding of elective abortion centers beginning in 2026.
They also cited the U.S. Supreme Court’s June 26 ruling in “Medina vs. Planned Parenthood” that states have the right to bar Planned Parenthood from receiving state Medicaid funding.
“Americans and North Carolinians have made clear that they do not want their tax dollars subsidizing abortions,” according to HB192.
According to a June Pew Research Center survey, 59% of North Carolinians support legal abortion and 39% oppose legal abortion.
The revamped HB192 would discontinue any state Medicaid contracts through the N.C. Division of Health Benefits with Planned Parenthood Federation of America Inc and associated entities. The division would be instructed to “engage other Medicaid providers” to provide those services.
If HB192 becomes law, it would be made effective retroactive to the July 1 start of the 2025-26 state fiscal year.
North Carolina has experienced a major increase in demand for abortions from women in Southeast states where abortion is prohibited after six weeks — if the state permits it at all.
According to an April report from the Guttmacher Institute, a national nonprofit focused on reproductive issues, North Carolina had the second highest number of out-of-state abortion patients in 2024 at 16,600.
That total represented 36% of all abortions performed in North Carolina, coming primarily from Georgia and South Carolina.
Health care pricing transparency
HB192 contains limited health care pricing transparency language from the Senate’s version of HB434 that the House rejected in June.
Both chambers have since been attempting to reach a compromise on bipartisan legislation that aims to lower some healthcare costs for North Carolinians, while increasing pricing transparency from hospitals and providers.
The House and Senate bills address surprise medical bills by requiring that patients receive written notice of any additional bills they may incur.
The first of the two key components inH192 is that a hospital or ambulatory surgical center would not be able to refer a patient’s unpaid bill to a collections agency or similar entity “unless it has first presented an itemized list of charges to the patient detailing, in language comprehensible to an ordinary layperson, the specific nature of the charges or expenses incurred by the patient.”
The second component is that patients would be able to obtain a “good faith estimate” of any charges they’d be obligated to pay for non-urgent services scheduled in advance. The proposal requires that a patient’s bill not exceed 5% of that estimate.
HB192 would require hospitals and ambulatory surgical centers provide the good-faith estimate at least three business days before a patient schedules a non-urgent medical procedure. The good-faith estimate would include at least 300 non-urgent services as specified by the federal Centers for Disease Control and Prevention.
The federal rule “requires hospitals to post all prices online, easily accessible and searchable, in the form of a single machine-readable standard charges file pricing for all items, services and drugs by all payers and all plans.”
CMS is responsible for determining overall compliance in 15 different categories that include: complete standard charge file; codes (of any type); gross charge; discounted cash price; negotiated minimum; negotiated maximum; negotiated rates; all payers and plans; 300 most common shoppable list; price estimate tool; and price estimate tool provides cash price.
If HB192 become law, the changes would take effect Jan. 1.
Not included in HB192
HB192 does not have several other components included in either the House or Senate bill to increase health care pricing transparency.
For example, left out is expanding required disclosures for hospitals and ambulatory surgical centers to include each billable item and service associated with a patient’s care, whether in-network or out-of-network.
The written notice is to include any information about out-of-network providers who may provide care to the patient, as well as requires a facility to provide an itemized list of charges to any patient before it can refer an unpaid bill to a collection agency.
Other key components left out: requirements that urgent health care services be reviewed by health insurers within 24 hours or less; codify the appeals process; and any doctor conducting a review be actively licensed in that specialty for at least three consecutive years.
Health insurers would be required “to publicly post in a timely manner” any amendments to their terms for review, or if they intend to impose new restrictions. A denial would not be allowed if the new requirements or changes haven’t been publicly posted on the insurer’s website.
The bills also prohibit the sole use of artificial intelligence for utilization review determination to deny, delay, or modify any service.
A likely popular with patients component prohibits providers from collecting a facility fee “unless the services are provided at a hospital’s main campus, at a remote location of a hospital, or at a facility that includes an emergency department.”
The State Auditor’s Office would have the authority to examine facility prices charged to out-of-network and uninsured patients, and to ensure compliance with transparency requirements.
One potential obstacle to bipartisan passage of the bills involves more chipping away at the state’s certificates of need laws, this time affecting inpatient rehabilitation services, facilities and beds that could be provided by smaller nonprofit groups and by for-profit providers.
The House has been reluctant to weaken the certificate of need laws, which are designed to prevent unnecessary duplication of services in communities.
rcraver@wsjournal.com
336-727-7376
@rcraverWSJ
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