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By Josh Dobson, President and CEO, North Carolina Healthcare Association
There is no denying that healthcare policy at the federal level is rapidly evolving, with decisions that will have far-reaching effects on Medicaid and the broader healthcare system. While these developments will have profound impacts, we must also recognize the power we have at the state level to ensure North Carolina’s healthcare system is strong, accessible, and sustainable.
For too long, the healthcare system in North Carolina has been operating like a house of cards—every addition (like new policies or fixes) makes the structure taller, but less stable for patients and providers. We all feel the impact of a system that doesn’t always work for the people it’s meant to serve, whether through rising costs or a lack of access to care. It’s time we stop accepting these shortcomings and do something to change it.
North Carolina’s healthcare ecosystem is a complex network of participants—patients, doctors, hospitals, insurance companies, pharmaceutical companies, government, and technology providers—from federal, state, and local levels.
In this dynamic environment, each part of the system influences the others. Insurance companies’ decisions can affect patients’ access to care, while hospitals must balance patient care with operational challenges and the financial realities of a rapidly changing industry. Pharmaceutical companies develop essential drugs and determine their price. Government policies shape everything from Medicaid eligibility to hospital reimbursement rates, and as these policies evolve at the federal level, their effects ripple through every aspect of our healthcare system.
All these players must collaborate effectively to achieve optimal patient outcomes—and to navigate a shifting policy environment while managing the rising costs of care that too often burden the very people who need help the most.
Hospitals are at the cornerstone of this ecosystem, engaging daily with all aspects of our healthcare system. Our hospital care teams are on standby to provide high-quality specialty, critical, and emergency services to anyone who walks through their doors, at any time, regardless of their ability to pay.
But hospitals are more than just healthcare providers—they are economic engines, community safety nets, and trusted partners. North Carolina hospitals are among the top 10 largest employers in more than 90% of the state’s counties. Last year alone, North Carolina hospitals provided more than $6.2 billion in uncompensated care, demonstrating their commitment to serving all residents, regardless of ability to pay.
From our vantage point, hospitals can see the healthcare system at large, its strengths, its vulnerabilities, and the impact it has on the people and communities they serve.
When the system is working as it should, we see tremendous success. Take, for example, the collaborative response to Hurricane Helene, where hospitals, healthcare providers, and government leaders worked together to deliver care and support to affected communities. Or the efforts around Medicaid expansion, which extended coverage to 600,000 North Carolinians, who previously lacked access to essential health services. These achievements show what is possible when all parts of the healthcare system work in concert to serve the public good.
But too often, we find ourselves responding to changes and external pressures with short term, band-aid solutions that fail to address the root causes of the challenges we face. It’s time to find bold, long-term solutions to create a healthcare system that truly meets the needs of North Carolinians.
While federal decisions shape the healthcare landscape, North Carolina cannot afford to be a passive observer. We have the power—and the responsibility—to implement state-level solutions that drive real outcomes for our residents.
We need an affordable system that prioritizes preventive care, reduces unnecessary bureaucracy, improves access for underserved populations, and allows hospitals to continue their vital work. This will take hospitals, doctors, insurers, government leaders, and patients all working together to build a system that is more efficient, equitable, and effective.
As the new CEO of the North Carolina Healthcare Association (NCHA), I am committed to helping address the systemic issues that hold our healthcare system back. Over the coming months, NCHA will convene discussions with healthcare and community leaders across the state to better understand the underlying issues embedded in our current system.
Together, we can build a healthier future for North Carolina, where patients receive compassionate care, communities thrive, and the healthcare system is equipped to meet every need. But we must act with urgency if we are to create the kind of healthcare system our people deserve. NCHA is ready to restart the conversation, and we invite all stakeholders to join us in this effort.
Let’s improve our healthcare system—and build something better for North Carolina’s future.
Josh Dobson became president and CEO of the North Carolina Healthcare Association in November 2024, previously serving as commissioner of labor for the N.C. Department of Labor and a N.C. state representative.
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