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HB 46

Homeschool freedom act.

2025 Regular Session Introduced by Ocean Andrew and 8 co-sponsors

The bill requires any new health benefit mandates to be offset by repealing existing mandates and to include a recurring appropriation for the mandate’s cost.

Assigned Chapter Number 49
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Bill Summary · HB 46

Summary — HB 46 (Make Healthcare Affordable)

Status: Introduced (House); effective date in bill — 30 days after enactment.
Subject areas: Health services, health insurance, State Health Plan (teachers & state employees), insurance mandates, employers, taxpayers.

Main purpose

HB 46 is written to increase transparency and fiscal accountability for laws that impose health benefit mandates. The bill requires that any new statutory health benefit mandates (broadly defined) be accompanied by offsetting repeals and an appropriation equal to the recurring cost of the new mandate — with special provisions for how mandates apply to the North Carolina State Health Plan. The stated intent is to disclose and limit the cost burden of mandated benefits on employers, taxpayers, and the State Health Plan.

Key provisions

  • Definitions (G.S. 120-272)

    • "Health benefit mandate" is defined broadly to include laws that:
    • Require coverage of specific services, treatments, or prescription drugs;
    • Require coverage by particular provider types (other than licensed physicians);
    • Regulate cost‑sharing (copays, deductibles);
    • Regulate insurer cost‑control processes (e.g., prior authorization);
    • Place limits/requirements on pharmacy benefits managers (PBMs);
    • Regulate how coverage is provided.
    • "Health benefit plan" and "State Health Plan" are also defined.

  • Required offsets (G.S. 120-272(b))

    • Any bill that creates one or more new health benefit mandates must also include repeal(s) of at least the same number of existing health benefit mandates that were in effect at the time the bill is considered.

  • Appropriation requirement (G.S. 120-272(c))

    • Any bill containing one or more mandates must include a recurring appropriation in the amount of the cost of that mandate to the Department of the State Treasurer and the State Health Plan (or other relevant state agency) prior to ratification.
    • Savings from any required repeal(s) may not reduce the appropriation obligation for the new mandate.

  • Application to the State Health Plan (G.S. 135-48.51)

    • Lists specific Chapter 58 provisions that already apply to the State Health Plan.
    • New Chapter 58 mandates that become effective on or after July 1, 2025, will apply to the State Health Plan starting with the next Plan year after the mandate’s effective date.

Who is affected

  • Employers (private-sector) — by changes in state-mandated coverage requirements that can affect premium and benefit costs.
  • North Carolina State Health Plan for Teachers and State Employees — explicitly governed as to when new mandates take effect for the Plan.
  • State taxpayers — through required appropriations to cover mandate costs.
  • Insurers, PBMs, and health benefit administrators — subject to new procedural and fiscal requirements for mandate implementation.
  • Healthcare providers and patients — any change in mandated coverage or provider-access rules could affect access, provider responsibilities, and utilization.

Potential impacts

  • Fiscal transparency: Requires explicit budgeting for mandate costs and attempts to make the fiscal consequences visible prior to enactment.
  • Policy constraint: The repeal-plus-appropriation requirements may raise the political and fiscal bar for adopting new health benefit mandates, potentially slowing new mandates.
  • Administrative effects: State agencies (Treasurer, State Health Plan) will have to estimate and track mandate costs and coordinate implementation.
  • Legal/implementation questions: Determining which statutes qualify as “mandates,” estimating recurring costs, and timing (Plan year application) could require rulemaking, actuarial analysis, and interagency coordination.

Timing / Procedural notes

  • The bill takes effect 30 days after it becomes law and applies to pieces of legislation considered on or after that date.
  • For mandates effective on or after July 1, 2025, the State Health Plan applies them beginning the next Plan year after a mandate’s effective date.

Prepared to expand with a one‑page fiscal implications note or to map how this would change the legislative drafting process for health-related bills.

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

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