Insulin price cap approved by U.S. House as Georgia’s Warnock pushes for Senate passage

NC nonprofit hospitals under scrutiny for billing millions to poor patients in lieu of providing charity care  

Treasurer Dale Folwell

A new report by the North Carolina State Health Plan and the National Academy for State Health Policy found North Carolina nonprofit hospitals billed nearly $150 million to poor patients who should have qualified for charity care.

State Treasurer Dale Folwell joined by a bipartisan group of legislators Wednesday expressed dismay at the lack of accountability in how charity care is awarded.

Under the current system, unless a patient qualifies for charity care, hospitals attempt to collect any outstanding balance. Patients with limited means to pay often find themselves facing the threat of legal action, damage to their credit, or pressure to open medical credit cards that charge interest.

“Not-for-profit hospitals receive tax exemption for providing community benefits, but there is a serious lack of transparency,” said Marilyn Bartlett, a C.P.A. with the National Academy of State Health Policy who helped conduct the study. “Sometimes the information was not available and there’s no way to verify accuracy.”

Sen. Jim Burgin (R-Harnett)

“There was a great deal of billing and assigning bad debt to patients who really should have been charity care,” said Dr. Vivian Ho, an expert in health economics at Rice University who peer reviewed the study.

“That is a pattern that seems to be occurring across all levels of nonprofit hospitals – ones that earning high profits on North Carolina, one that are large, ones that are small,” said Ho.

The numbers presented Wednesday are thought to be an underestimate because only 16% of state  hospitals provided reliable data.

But the analysts calculate  North Carolina nonprofit hospitals should have provided an average 11.9% to 28.7% of their bad debt as charity care in FY 2019.

Sen. Jim Burgin (R-Harnett) said the report was not intended to attack hospital employees who have been under tremendous strain during the pandemic.

“A not-for-profit is really a different animal. We the public are the stockholders of a not-for-profit. We give them tax-exempt status on their income on a lot of their taxes. They recover sales tax back. And they don’t pay property taxes,” explained Burgin.

The Harnett County Republican said he was distressed to learn that some hospitals steer their patients toward plastic to payoff their bill.

According to the report, Atrium Health Wake Forest Baptist, UNC Health, Cone Health, and AccessOne Health encouraged patients to use medical credit cards, which can charge interest up 18% after the initial promotional period.

Sen. Jay J. Chaudhuri

“I hate that we are telling people who are in a bad financial state to get a credit card with a high interest rate that’s going to make their credit worse.”

Sen. Burgin said he would welcome the chance for hospitals to address the report’s findings when the joint legislative health commission meets in February and March.

Sen. Jay Chaudhuri (D-Wake) voiced his own concerns about the prospect of low-income individuals not receiving charity care if they qualified.

“Too many of our citizens confront the real issue of medical debt. That’s due to premiums and deductible for North Carolinians that are the highest in the country. But that’s also due to some hospitals, certainly not all hospitals, that aggressively pursue patients for collections for often small overdue bills.”

Chaudhuri said medical debt is the most likely kind of debt to lead North Carolinians to bankruptcy.

One in five North Carolinians currently has outstanding medical debt.

In collections on purpose

State Treasurer Folwell said after surviving a battle with COVID, he allowed his own medical bills to go into collections to try to better understand the plight of those struggling to payoff a sizeable hospital bill.

“I’m in collections on purpose.  Because I want to see exactly what a person goes through when they don’t pay their medical bill. You can’t really figure out what’s happening to the average citizen in our state until you put yourself in collections and see how you are treated,” Folwell said.

Folwell said that outstanding debt could not only damage one’s credit score but alter their upward mobility.

“When you have destruction of your credit score, it has generational consequences because it limits your access to capitol at low interest rates.”

Attacking and demonizing hospitals

The North Carolina Healthcare Association (NCHA) was quick to push back on the report saying hospitals’ charity care spending and community benefit investment activity is transparent and accountable.

NCHA faulted Treasurer Folwell for publicly demonizing the state’s hospitals at a time when their professionals were dealing with record hospitalizations due to COVID.

Here’s more from the association’s statement:

His press conference, a public relations stunt, shows how out of touch he is with what is going on today in hospitals in every part of the state as medical staff and administrators rise to each new challenge with resolve to provide safe, compassionate care to every patient. In contrast to the Treasurer’s actions attacking hospitals, hospital administrators are finding ways to help strained staff, doing tasks like cleaning floors and delivering food to patient rooms, due to workforce shortages and hospital employees calling out sick with COVID-19. As exhausted hospital teams press on with giving their all to every patient, the Treasurer is now distracting them from their work by causing them to have to take time to explain and correct his half-truths to patients, communities, and media.

Legislators at Wednesday’s press conference said legislation to address charity care accountability could be raised in this year’s short session.

The NCHA said any legislation introduced should consider how to expand coverage, how to help hospitals invest in infrastructure while retaining and expanding its workforce.

As virus infections spike, NC hospitals issue public plea to the unvaccinated

With COVID-19 infection rates spiking across North Carolina due, in large part, to the rapid spread of the omicron variant — particularly amongst unvaccinated individuals — the following open letter was distributed today by the North Carolina Hospital Association on behalf of 50 North Carolina health system and hospital chief executive officers and chief medical officers representing more than 115 hospitals.

January 12, 2022 

To the patients, families and communities we are proud to serve:  

It is our mission to care for you and support you – a commitment that will never waver. That’s why we want to be up front with you: North Carolina is at a critical juncture in the battle against COVID-19 and we need your immediate help to slow community spread of the virus. 

The omicron variant is highly infectious. While it might cause only mild illnesses for some people, including some who have been vaccinated, our hospitals are filling up fast with COVID patientsa vast majority of whom are unvaccinated. This situation is putting daily strain on our ability to care for those who have other urgent medical needs that are not COVID-related. It is heartbreaking, which is why we are reaching out to you. 

With COVID-19 spreading like wildfire, your personal decisions about how to coexist with the virus directly affect the health and well-being of your family and community. Our best chance of returning to living healthy, normal lives is to make sure our families, friends and work colleagues are choosing to be vaccinated and getting their recommended booster shots.  

Here is some important information to know:  

  • Vaccine and booster doses are readily available. They help the human immune system to be ready to recognize and fight back against COVID-19 infection. Vaccinated people are less likely to require hospitalization or die from COVID-19. 
  • You can get the virus again even if you had it before. Antibodies from an actual infection do not last as long as the antibodies produced in response to the vaccine, which is why vaccination is recommended even for people who have had COVID.
  • Everyone ages 5 and older can get vaccinated. Everyone ages 12 years and older can also get a booster shot. 
  • It’s okay to have questions about vaccines. If you do, talk to a health care professional you trust.

Also please continue to practice the 3 W’s, protecting each other by wearing a mask properly covering your nose and mouth, waiting six feet apart (social distancing), and washing or disinfecting hands frequently 

We will eventually get past this. But first, let’s work together to contain the rapid spread of COVID-19 in our local communities and make 2022 a happy and healthy new year. 


Teresa Herbert, MD, MPH, FAAP, Chief Medical Officer
AdventHealth Hendersonville 

Chuck Mantooth, President & Chief Executive Officer
Appalachian Regional Healthcare System Read more

UNC’s Gillings School of Global Public Health moves to online instruction for first three weeks of semester

UNC-Chapel Hill’s Gillings School of Global Public Health (

UNC-Chapel Hill’s Gillings School of Global Public Health is moving instruction online for the first three weeks of the Spring semester, which begins for undergraduates Monday.

The announcement came late Friday in an email from the school’s dean, Dr. Barbara Rimer and  Dr. Laura Linnan,  senior associate dean for Academic and Student Affairs. Their message cited and linked to Policy Watch’s recent story on UNC epidemiologists’ projections that under current conditions the campus could see more than 22,000 COVID-19 infections  in the next month, due to the more infectious Omicron variant.

“At Gillings, our leadership team has actively monitored this situation,” the message read. “We have sought and received input from faculty, staff, students, and colleagues across campus. We have been in regular contact with our infectious disease experts here at Gillings and on campus and know from them that we can expect high rates of infection this month. The safety and health of students, staff and faculty remain paramount.”

“For this reason, we believe the best public health decision for our staff, students and faculty is to adopt remote instruction for the first couple of weeks this semester with the full intention of returning to in-person instruction, unless public health and safety dictate otherwise, the week that begins with Monday, January 31,” the message read. “This decision is consistent with a consensus vote of our school leadership team. We know it will disappoint some that we will start entirely in remote status, but the intent remains to be in-person by the end of January.”

Read the full email here.

Federal health officials believe the COVID-19 omicron variant is more transmissible than the delta variant, but could cause milder symptoms. However, omicron has led to record numbers of infections in the state, as well as high rates of hospitalizations; the severity of the disease can vary depending on a person’s vaccination status and underlying health conditions.

A desire to return to in-person instruction at UNC System schools has clashed with caution over the current wave of infections. While faculty and students at a number of the system’s schools have pushed for a fully remote beginning to the semester, administration at Chapel Hill instead decided to leave decisions about modes of instruction up to deans at each of the schools at the university. While some deans are allowing more flexibility than others, most are citing university administration’s assurance that the school’s own health experts have assured them that in-person instruction can be done safely. Opinions among deans could shift with Gillings, home to some of those experts, now opting to go fully remote for the balance of the month. Many faculty on campus said Friday and Saturday they hope the decision will serve as an example to their own schools, whose leaders have warned against substituting one’s own judgement for that of scientists and medical experts.

Last week, after Policy Watch published its story on disturbing projections of the number of infections on campus in as students returned to campus, the school disabled its COVID-19 dashboard, which reports numbers of infections reported on campus. The school initially gave no explanation for doing so, then posted a statement saying that the dashboard would be updated again beginning Monday. The school has since said they are reevaluating what information is relevant to report given the Omicron variant’s difference from previous variants of the disease and will make that decision in consultation with the UNC System office and the state Department of Health and Human Services. DHHS has not disabled or altered its own dashboard and other UNC System schools have so far continued updating their own without unexplained pauses or alterations to how the information is reported to the public.

The move led some faculty members and students frustrated with the level of transparency on decisions about monitoring and reporting to begin crowdsourcing the archives of the dashboards at each school so that they can document how reporting changes.

At North Carolina State University, the system’s largest campus by enrollment,  students and faculty members are pushing the school’s administration for as much flexibility as faculty at UNC-Chapel Hill. In an e-mail last week, representatives from the campus’s chapter of the American Association of University Professors urged university leaders to allow faculty to decide their mode of instruction during the current spike in infections.

That email, in full:

Chancellor Woodson and Provost Arden,

We understand the pandemic and recent COVID variants have created continued challenges, particularly as we begin to prepare for the start of the new semester. While we believe a delayed start would have been the best approach for handling the latest COVID surges, we now understand that it is unlikely we will change course a few days before classes begin. However, the NC State AAUP Chapter leadership and members want to make you aware of some troubling communications from our colleagues, and to make what we view as a reasonable  request.

Several faculty colleagues have expressed grave concerns about teaching in-person classes. They cite concerns about teaching to a full room of undergraduates and returning home to elderly parents, small children who are not able to get vaccinated, pregnant spouses, and immunocompromised family members.

Almost equally as troubling is the message these faculty members receive when they express these concerns to their department heads and/or deans. These leaders have told them there is a process to request a change in class delivery but also discouraged them from applying or told them not to apply at all. At the same time, department chairs told many of these faculty members there is no chance their request will be approved. Telling faculty members not to apply for change of delivery mode or telling them there is no chance of getting approved if they apply, in effect, makes the request process a complete farce.

We would also like to note that several faculty members were despondent and expressed that they felt as though University leaders did not care for their health and well-being. Others were dismayed that colleagues across the UNC System had campus openings delayed or were given flexibility to move their courses online, while NC State faculty were shown no such consideration.

Given these concerns and the recent spikes in COVID infections, we strongly urge you to allow faculty members to decide their mode of course delivery, instead of going through an approval process that requires the Provost to ultimately approve their request. Faculty should only have to provide their department head with a good faith explanation as to why they are changing their delivery method. In other words, our request is simple: treat faculty like the professionals they are and give them the authority to choose their course delivery method.

We have included all faculty senators, along with our chapter members and other interested faculty on this email to make them aware of their colleagues’ concerns.

Thank you for your attention. We look forward to your response.


Paul Umbach
Professor and NC State AAUP chapter president

David Ambaras
Professor and NC State AAUP chapter vice president

Stephen Porter
Professor and NC State AAUP chapter treasurer-secretary


How to track what’s happening at other campuses:
Last week Luke Carman, a PhD student at N.C. State and co-chair of the UE 150 UNC System Council, created an online tracker to document and publicize how each of the 16 UNC System campuses is responding to the Omicron variant through policies, health initiatives and decisions about modes of instruction. Carman said he began the work as a reaction to the lack of easily accessible public information about the steps being taken at and the shifts at each school.

Rev. Barber tests positive for COVID-19, encourages vaccines and boosters

Rev. William Barber

Rev. William Barber has tested positive for COVID-19.

Barber, the former president of the North Carolina NAACP and current president of Repairers of the Breach and co-chair of the Poor People’s Campaign, announced his diagnosis in a statement early Thursday in which he praised vaccines and boosters and encouraged people to get them to protect their own health and that of those around them.

“My symptoms so far are very mild, and I am following CDC guidelines to notify close contacts and enter isolation for five days,” Barber wrote in the statement. “I want to express my gratitude for the vaccines and booster shots that prepared my body to fight the virus, and I encourage anyone who has not received a vaccine or booster, if they are eligible, to do so as soon as possible.”

“Even as we take every possible precaution to prevent the spread of this virus, new and extremely contagious variants emerge,” Barber wrote. “Throughout this pandemic I have noted that poor and marginalized people are hurt first and worst by a public health crisis. As we continue to organize and build power for a Mass Poor People’s and Low-Wage Workers’ Assembly and Moral March on Washington, DC, and to the Polls, June 18, 2022, we must do all we can to care for one another by preventing the spread of Covid. Recent estimates by the Organization for Economic Cooperation and Development suggest it would only take $50 billion to fully vaccinate the whole world. Let’s choose life over profit, and do it now.”