Senate Bill 418 would authorize the North Carolina Commissioner of Insurance to establish and operate a state-run Health Benefits Exchange. The bill amends the Commissioner’s powers in G.S. 58-2-40 to expressly require creation of a state exchange under the federal Affordable Care Act or other applicable federal law, and it gives the Commissioner authority to change rules, policies, and procedures as needed to implement and administer the exchange. It also allows the Commissioner to apply for and accept federal funds and to create advisory boards or committees to support the exchange.
The bill further revises G.S. 143B-24 to clarify that the General Assembly controls the State’s level of involvement with any federally facilitated exchange and that state agencies may not commit resources to a partnership exchange model or take unauthorized steps toward forming a state-run exchange. In addition, it appropriates $100,000 in recurring General Fund support to the Department of Insurance for fiscal year 2025-2026 to establish and operate the exchange. The act would take effect when it becomes law, with the appropriation beginning July 1, 2025.
Impact
If enacted, the bill would change North Carolina insurance law by expressly directing the Commissioner of Insurance to create and operate a state-based health insurance exchange and by expanding the Commissioner’s rulemaking and administrative authority for that purpose. It would also limit unauthorized state participation in federally facilitated or partnership exchange arrangements, while preserving only those federal-state interactions not aimed at creating those exchange models. The bill would create a recurring state budget obligation of $100,000 for the Department of Insurance.
Sentiment
The available record shows no committee transcript or vote history, so there is no documented floor or committee sentiment to summarize. Based on the bill text alone, the measure appears to be a proactive administrative and policy change intended to move North Carolina toward a state-run exchange, with a modest initial appropriation to support implementation.
Contention
The main point of contention likely concerns whether North Carolina should establish its own health benefits exchange at all, as opposed to continuing with or relying on a federally facilitated model. The bill also raises questions about the scope of executive authority, because it gives the Commissioner broad discretion to implement the exchange while simultaneously reaffirming legislative control over the State’s level of participation. Any debate would likely center on costs, state autonomy, administrative burden, and the policy implications of separating from federal exchange operations.