Former Gov. Roy Cooper is running for Senate on “making things cost less,” making lower healthcare costs a key plank of his senatorial campaign. However, North Carolinians have paid the highest healthcare costs when he was governor.
Forbes found that the Tar Heel State was the most expensive state for health care, with the highest average premiums for residents with “plus-one” coverage through an employer, or $4,781 annually. It also had the second highest average premium for residents with family health insurance through family health insurance through an employer.
Cooper’s North Carolina also ranked fifth highest for average deductibles with single health insurance coverage through an employer.
A Heritage Foundation analysis found that North Carolina faced a 183 percent increase in premium when Cooper was the state attorney general and governor. This led to a $480 per month increase in premium.
The Kaiser Family Foundation (KFF) has detailed how, from 2017 to 2024, under Cooper’s governorship, Affordable Care Act (ACA), or Obamacare, premiums reached a 2018 high and remained elevated afterwards.
In 2017, Blue Cross and Blue Shield of North Carolina (Blue Cross NC), announced that the company’s premiums for the 2018 Obamacare plans rose by an average of 14.1 percent.
Then in 2022, Bright Health said that it would cease selling individual health plans through Obamacare by the end of the year.
As governor, said in 2017 that he wanted the state’s hospitals to cover the costs of Medicaid expansion, claiming that they would be “by the largest beneficiaries.” He argued that they should cover the costs by agreeing to a “mandatory assessment.”
If the money were not coming from hospitals, then it would have to come from taxpayers, Cooper argued.
Hospitals were not in favor of Cooper’s plan.
Reports found that while Medicaid expansion crushed many states because their rural hospitals have been burdened with more patients without a similar increase in doctors. Medicaid also reimburses hospitals at a lower rate than private insurance and Medicare; however, it is different in North Carolina. The state’s Medicaid reimbursement rates are closer to commercial costs than other states, which could lead to higher commercial rates for everyone and leave Medicare beneficiaries with fewer options, as many providers who would prefer to accept Medicaid enrollees instead.
A year after Cooper signed H.B. 76, or the Access to Healthcare Option, which officially expanded Medicaid in North Carolina, Medicaid expenditures spiked by $27.8 billion, a $6.3 billion increase from 2023.
Shortly after Cooper expanded Medicaid, Martin General Hospital filed for bankruptcy and closed its doors, leaving the 22,000 North Carolinians of Martin County without a hospital. Betsy Johnson Hospital closed its labor and delivery unit months after Medicaid expansion, leaving Harnett County without a maternity facility. Mission Health closed the Asheville Specialty Hospital, the last remaining long-term acute hospital in the western part of the state.
Cooper’s Medicaid expansion, according to the Foundation for Government Accountability (FGA) came “at the expense of other state priorities. For example, K-12 education’s share of the budget
decreased by 20 percent over the same period, with additional funding pulled from public safety and transportation to cover the rapidly rising costs of Medicaid.”


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