What The Health

What is What The Health?

Our goal is to give patients a voice. The sustainability of the North Carolina State Health Plan is at risk, and its fate depends on us. 

  • You’re paying more than you should for your health care. Health care is so expensive because the underlying system rewards monopolies and ever higher prices.
  • The State Health Plan is forced to operate like a blank check. The Plan can’t use its own data to negotiate the best deal for you. It’s your money, but current law limits our ability to guard it. The Plan cannot be fiscally secure until it gains control over its own spending. 
  • We believe patients have a right to know what hospitals and health providers are going to charge them before they get the bill. 

Your State Health Plan is worth protecting. Remember that you are a valued Plan member – and your State Health Plan is a valuable benefit!

    North Carolina Nonprofit Hospitals Fail in Providing Charity Care Despite Tax Breaks

    The State Health Plan and Johns Hopkins Bloomberg School of Public Health find troubling disparities in hospitals’ commitment to the most vulnerable members of their communities

    An analysis by Johns Hopkins Bloomberg School of Public Health and the North Carolina State Health Plan revealed that the majority of North Carolina nonprofit hospitals are not fully honoring their charitable mission. Although nonprofit hospitals reap lucrative tax breaks in exchange for serving the poor, their charity care spending varies wildly and with little accountability. 

    State Treasurer Dale R. Folwell, CPA, invited researchers from Johns Hopkins Bloomberg School of Public Health to extend their national study of hospitals’ charity care spending to North Carolina. Together with the North Carolina State Health Plan, these researchers found troubling disparities in North Carolina hospitals’ charity care spending.  

    Fewer than 25 hospitals exceeded the value of their tax exemption with the amount of their charity care spending in North Carolina. Our analysis suggests that North Carolina’s largest nonprofit hospital systems reaped tax breaks worth more than an estimated $1.8 billion in 2019-2020. Across the majority of these systems, charity care spending did not exceed 60% of the value of their tax breaks.

    Hover over the dots on the map below to show details. Page 1 includes an interactive map, and page 2 includes an interactive comparison chart.


    Key findings from the study include: 

    • North Carolina’s largest hospital systems benefited from federal, state and local tax exemptions worth more than an estimated $1.8 billion in 2020. 
    • The majority of those large systems’ charity care failed to exceed 60% of the worth of their tax exemptions.  
      • Multiple systems inflated their community benefits by claiming controversial “underpayments” from government programs.  
    • There are huge disparities in charity care spending across hospitals. 
      • Even for-profit hospitals operating in the red have provided higher levels of charity care than some profitable nonprofit hospitals in the state.  
      • Some nonprofits dedicated less than 0.5% of their total expenses to charity care, despite enjoying tax breaks equal to an estimated 5.9% of total expenses. For 25 nonprofits, charity care accounted for less than 2% of expenses. 
    • On average, North Carolina’s hospitals were three times more profitable than the national average operating profit margin in 2019.  
      • After nonpatient revenue like investments, North Carolina hospitals enjoyed a 10.91% average excess profit margin — triple the margins in agriculture, higher than Cable TV and almost equal to the margins of the alcoholic beverage industry.   
    • The burden of charity care spending often falls hardest on those hospitals least able to bear it.  
      • In North Carolina, the two most generous hospitals in providing charity care lost money in 2019. 
      • Only four of the state’s 15 most profitable hospitals delivered enough charity care to exceed the value of their tax exemption. All of these hospitals enjoyed profit margins greater than 20%, with six hospitals surpassing 30% margins in 2019.  
    • North Carolina has a crisis of accountability.  
      • No state official currently actively enforces charity care spending and tax exemptions. There is little active oversight and no enforcement. 
      • Other states require hospitals to equal the value of their tax exemption with charity care spending. 

    Click here to download the report

    An Important Message from Your State Treasurer

    An Interview with SEANC

    Why should you care?

    What The Health will equip you with the knowledge you need to help drive down the cost of your health care.

    • It’s coming out of your paycheck. Your wage increases, cost of living adjustments, tax cuts, and health care benefits are all swallowed by the rising cost of health care.

    • Your State Health Plan has a $32 billion unfunded liability because of rising health care costs and historic underfunding. That burden risks the affordability of health benefits for current and future members.
    • You can save hundreds or even thousands of dollars if you know how to navigate the health care system. We’ve launched pages on Facebook and Twitter to give you the tools you need to protect your financial health. 

    You can protect your own future and the future of your health care coverage. We’re going to teach you how to fight against waste, fraud, abuse — and charges that make no sense. 

    What can you do?

    We’re here to help you save money, but we need your help. We want to tell State Health Plan members’ stories, teach you how to protect yourself and your loved ones, and fight for change together.

    • Have a medical bill that seems too high or wrong? Or any itemized medical bill? Email us your story at WhatTheHealth@nctreasurer.com
    • Guard your financial health. Use price transparency tools to find out how much a surgery or medical scan might cost. Shopping for health care can save you hundreds or even thousands of dollars. 
      • Hospitals, Blue Cross Blue Shield, and CVS Caremark all have online tools that help you estimate how much a medical procedure will cost. 
      • Hospitals are now required to post standard charges for at least 300 shoppable services that can be planned in advance.  Unfortunately, many hospitals have failed to comply with federal price transparency rules, according to multiple reports.
      • For CVS Caremark, log into eBenefits and look for the CVS Caremark link on the left-hand menu.
      • To estimate your out-of-pocket costs, login to Blue Cross NC, click “Estimate Treatment Costs” in the banner at the top right, then select “Find Medical Costs.” This will allow you to estimate how much you might pay for medical scans or procedures. 
    • Remember: You and taxpayers are the one paying for your health care – not Blue Cross NC. They only process your claims and provide a network of medical providers for the State Health Plan. Every dollar spent on overcharged medical bills is one that can’t be spent on schools, public safety and roads.