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SB 24

Govt Mandates Increase Healthcare Costs.

2025-2026 Session Introduced by Ted Alexander and 22 co-sponsors

Any bill creating new health benefit mandates must offset with repeals of existing mandates and provide a recurring appropriation to cover the plan’s costs (State Health Plan).

Passed 1st Reading
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Bill Summary · SB 24

SB 24 — “Govt Mandates Increase Healthcare Costs” (North Carolina)

Status: Passed 1st Reading. Introduced: (as reported) Jan 30, 2025. Effective: 30 days after enactment (applies to legislative proposals considered on/after that date).
Primary code references created/amended: proposed new G.S. 120‑272; amended G.S. 135‑48.51.

Main purpose

Require the General Assembly to account for the fiscal and statutory effects of new health‑insurance benefit mandates by (1) forcing an offsetting repeal of existing mandates and (2) funding the recurring cost of any new mandate for the State Health Plan (teachers & state employees) or other affected state agencies. The bill also clarifies how certain existing Chapter 58 insurance requirements apply to the State Health Plan.

Key provisions (summary)

  • Definitions (new G.S. 120‑272):
    • “Health benefit mandate” — broadly defined to include laws that require coverage of services/drugs, mandate coverage by non‑physician provider groups, regulate cost‑sharing (copays/deductibles), change cost‑control processes (e.g., prior authorization), impose pharmacy benefit manager (PBM) limits, or otherwise regulate how coverage is provided.
    • “Piece of legislation” — any bill, committee substitute, conference report, etc.
    • “Health benefit plan” — as defined in G.S. 58‑3‑167. “State Health Plan” — NC State Health Plan for Teachers and State Employees.
  • Offsets required:
    • Any bill that contains one or more new health benefit mandates must also include statutory repeal provisions that eliminate at least the same number of health benefit mandates already in effect as of the time the bill is considered.
  • Appropriation required:
    • Any bill adding mandates must include a recurring appropriation equal to the estimated cost of the mandate, directed to the Department of the State Treasurer and the State Health Plan (or other relevant agency), to be included in the bill prior to ratification.
    • Cost savings from required repeals may not be used to reduce the appropriation required for the new mandate.
  • Exception (amended version): If the bill’s required actuarial note (per G.S.120‑114) shows a net decrease in cost from the mandates, the repeal/appropriation requirements do not apply.
  • State Health Plan applicability (amended G.S. 135‑48.51):
    • Lists specific Chapter 58 provisions (e.g., managed‑care reporting, access to non‑formulary drugs, specialist access, prompt payment, provider directories, ID cards, payment obligations, lymphedema/hearing aid coverage, continuity of care) that apply to the State Health Plan.
    • New Chapter 58 mandates effective on/after July 1, 2025 apply to the State Health Plan starting the next Plan year after the mandate’s effective date.

Who is affected

  • State legislators (must include offsetting repeals and appropriations when proposing mandates).
  • The NC State Health Plan (administration, budget).
  • State and local budgets / taxpayers (explicit recurring appropriations).
  • Employers, private insurers, PBMs, providers, and beneficiaries (new mandates may be harder to enact without offsets/funding).
  • Legislative staff and actuarial offices (increased demand for cost estimates and actuarial notes).

Procedural / timeline notes

  • The act applies to pieces of legislation considered by the General Assembly on or after the act’s effective date (30 days after enactment).
  • State Health Plan implementation of new Chapter 58 mandates is deferred to the start of the Plan year following a mandate’s effective date (if on/after 7/1/2025).

Potential impacts and considerations

  • Raises legislative and fiscal barriers to enactment of new health‑care insurance mandates by requiring explicit repeal offsets and funding.
  • Increases reliance on actuarial analysis and cost estimates; could slow lawmaking or shift debate toward budgetary tradeoffs.
  • Could protect State Health Plan finances by ensuring mandates are funded, but may complicate efforts to expand coverage/benefits without removing existing mandates or adding recurring appropriations.
  • The actuarial‑note exception allows mandates that reduce net costs to proceed without the offset/appropriation requirements.

Where to read the bill text

Primary statutory language appears in the bill’s proposed new G.S. 120‑272 and in amendments to G.S. 135‑48.51 (list of Chapter 58 provisions made applicable to the State Health Plan).

Compiled from official sources — confirm details with the bill’s official record.

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