Buckle up: The health care reckoning is here

Consumers are frustrated – and they’re right to be. Health care is broken, and it’s about to get a lot worse.

Last week, I noted the severity of the cost problem, outlining where people’s premium dollars go and why health care is so expensive.

This week, my goal is to show, with urgency, that the system isn’t just strained, it’s undergoing a seismic shift. Two big forces drive the reckoning we face.

First: Over the past several decades, policy efforts have failed to address health care’s rising costs. Bottom line: It’s harder for North Carolinians to afford coverage. This will become apparent when the enhanced premium tax credit expires at the end of this year. According to Centers for Medicare & Medicaid Services (CMS), the loss of these subsidies could impact 919,000 individuals and families in North Carolina who buy their own health insurance. Without these subsidies, many will be unable to afford coverage, which means they’ll go without and rely on ER care. Uncompensated care will rise, straining hospitals and providers, who’ll face financial and workforce challenges.

Second: Some in the health care system have questionable motives. This causes intense market volatility. For example, we’ve had two health insurers exit the North Carolina ACA marketplace since 2022. Earlier this year, a national for-profit insurer – the same company trusted to serve our state employees – told countless North Carolinians who buy their own health insurance that they won’t cover them anymore starting January 1, 2026. This instability doesn’t just rattle the marketplace – it shrinks coverage, drives up costs, and interferes with the delivery of health care.

We must change course

For North Carolinians to stand a chance at having affordable health care, we must act together, with creativity and a willingness to place individual interests aside.

At Blue Cross and Blue Shield of North Carolina (Blue Cross NC), we are doubling down on efforts to make health care more affordable. We urgently ask others in the industry to join us with meaningful action plans and commitments of their own.

Our action plan

Today, I’m sharing three steps Blue Cross NC is taking.

We have a strong track record of partnership and collaboration, but we must go further. We will meet with any partner who shares our commitment to maintaining quality while lowering costs.

Second, for any action we contemplate, we’ll ask the question: Does this lower costs for members or raise them? We’ll hold ourselves and others accountable for any actions that add unnecessary strain on families and business.

Finally, I’ve directed my team to put every idea on the table, addressing these pain points: lack of transparency, misaligned incentives, our fragmented system, drivers of health, access, legislation, and regulations.

As a start, here are a few promises we make, and we’ll share more approaches in the coming months here :

1. We answer to our members, not shareholders. We commit to investing resources back into solutions that improve affordability and access for our members and communities.
2. We help our members find quality, affordable care. For example, we’re improving our Blue Cross NC website to help members find the best price on a procedure or prescription.
3. We continue our work to reduce administrative burdens and costs for doctors, with the goal of making it easier for doctors to get into our networks and to get answers to coverage questions in real time. And, we pledge to keep listening and reviewing our practices in response to feedback.
4. We help members with complex health needs coordinate care through dedicated customer service advocates. For example, our Behavioral Health Care Navigation team connects members who have non-urgent mental health or substance use needs with support.
5. We listen to the communities we serve. They’ve told us that the youth mental health crisis is crippling communities. We’re using our influence, resources, and ability to bring stakeholders together to tackle this challenge.

As the CEO of Blue Cross NC, I implore my colleagues across the health care industry to join us in acting now. Whether we like it or not, we’re out of time. The reckoning is here, and it will require unprecedented collaboration and cooperation across every sector.

The people and businesses of North Carolina know the system doesn’t work. What many don’t realize is how challenging it’s about to get. Let’s show them we’re on their side. Working together, and with urgency, we can rebuild a health care system that reflects the dignity and humanity that every person deserves.

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This article originally published in Triangle Business Journal. It is the second installment in a two-part series on health care affordability by Dr. Tunde Sotunde, CEO of Blue Cross NC.