House Bill 46, titled "Make Healthcare Affordable," is a disclosure-and-offset bill aimed at limiting the growth of state health insurance mandates. It would require any future legislation that creates a new health benefit mandate to also include repeal of at least the same number of existing mandates and to appropriate recurring funds equal to the estimated cost of the new mandate. The bill defines "health benefit mandate" broadly to include required coverage for services, treatments, prescription drugs, provider-type requirements, cost-sharing rules, prior authorization or utilization management rules, and certain pharmacy benefit manager requirements.
The bill also specifically targets the North Carolina State Health Plan for Teachers and State Employees. It would make a list of existing insurance statutes apply to the State Health Plan and would delay the application of new Chapter 58 health benefit mandates to the Plan until the start of the next plan year after the mandate becomes effective. The overall effect is to create a fiscal and procedural hurdle for enacting new health coverage requirements, while also clarifying how those mandates flow through to the State Health Plan.
HB46 would amend Chapter 120 to add a new legislative rule governing bills that contain health benefit mandates, and it would revise G.S. 135-48.51 to expand and time-shift how certain insurance coverage and operational mandates apply to the State Health Plan. In practical terms, it would affect future health insurance legislation by requiring mandate offsets and recurring appropriations, and it would influence the timing and administration of coverage requirements for state employees and teachers covered by the State Health Plan. The bill would also affect insurers, employers, taxpayers, the Department of the State Treasurer, and other state agencies involved in administering or funding mandated benefits.
The bill’s stated purpose and framing are strongly supportive of reducing healthcare costs and limiting the financial impact of state-imposed insurance mandates. The preamble emphasizes affordability, inflation, employer burden, and taxpayer costs, suggesting the sponsors view the measure as a consumer- and business-friendly reform. No committee debate or recorded votes were provided, so the available record does not show formal opposition or support beyond the bill’s pro-affordability framing and sponsorship.
The main point of contention is likely the bill’s restriction on future health benefit mandates, especially the requirement that new mandates be paired with repeal of existing mandates and with recurring appropriations equal to the mandate’s cost. Supporters would likely argue this prevents unfunded or costly coverage expansions and helps control premiums, while opponents may view it as making it harder to enact new protections or benefits for patients. Another likely area of dispute is the bill’s broad definition of health benefit mandate, which reaches beyond direct coverage requirements to cost-sharing, prior authorization, provider access, and pharmacy benefit manager regulation.