Atrium’s new “program” for State Health Plan (Plan) members is a shell game: it shifts agreed-upon costs to the Plan and, ultimately, North Carolina taxpayers.
The Plan is committed to providing members with a sustainable health benefit. Atrium’s “program” raises serious concerns because it appears to circumvent the terms of the parties’ agreement and potentially state and federal legal issues. The Plan is reviewing the impact, risk and legality of this effort by Atrium. While this appears to be a heroic step by Atrium, the fact is members are not receiving a clear and complete picture of their coverages or costs.
The Plan introduced a new tiered provider network for 2027 designed to preserve access to care while encouraging competition to put the Plan on a more sustainable financial path. This is necessary because the Plan cannot continue to absorb rising health care costs without consequences for members and every taxpayer in North Carolina.
The authority to set the Plan’s benefits and design rests with the State Treasurer and the Board of Trustees, not health system executives. A provider created program that ultimately increases costs to the Plan cannot be allowed to undermine those decisions or make care more expensive for members and taxpayers across North Carolina.
Less than a month ago, the Plan sat down with Atrium and agreed on a path forward for select Atrium hospitals to meet the needs of the Plan’s members in rural areas. This agreement was announced on Sept. 14 and adjusted provider tiers for members in those areas as of Jan. 1, 2027.
With the announcement of Atrium’s "program,” there is an appearance of cost changes for some Charlotte and Triad area Plan members. But if the Plan pays more to offset those costs, the expense ultimately is carried by members and taxpayers statewide. The Plan’s financial outlook remains volatile, and additional costs through a provider created plan put further pressure on premiums beginning in 2028.
Hundreds of thousands of individuals and their families depend on the Plan. The Plan is already walking a tightrope — health care costs continue to rise, and the Plan is working to ensure it can pay its bills. Separate benefits created by providers create instability and greater risk. The Plan cannot afford to let higher provider prices be repackaged as new “programs” while members and taxpayers are left with the bill.
The Plan will protect its members and taxpayers from efforts to shift higher costs onto them under the banner of a new and separate benefit “program.”