NFIB State Director Gregg Thompson writes about the need for North Carolina’s General Assembly to make health insurance costs a priority in next year’s legislative session.

I’ve worked with small and independent businesses across North Carolina for over 20 years, and in all that time, I’ve heard the same concern from our members:

Health insurance costs are out of control.

North Carolina is proud to be ranked the No. 1 state for business. That recognition didn’t happen by accident. It’s the result of smart policies and the hard work of our entrepreneurs.

But while we lead the nation in business climate, we’re near the bottom when it comes to health care affordability. That’s a hidden tax on every small business owner in our state. And if we don’t get serious about fixing it, we won’t hold onto our top ranking for long.

Premiums are climbing for small businesses, large employers, and individual workers. Employees feel it in higher paycheck deductions, bigger bills at the doctor or smaller raises. However you look at it, it means less money in the pockets of hardworking North Carolinians.

This isn’t just theory. A national survey of more than 700 employers found that nearly half plan to raise employee cost-sharing in 2025, and more than half expect to do so in 2026. We know from experience that North Carolina’s cost challenges are even steeper than the national average.

The same determination that made us the best state for business must now be applied to lowering health care costs.

There’s no single solution, but there are clear steps we can take:

• Stop piling on new mandates. Every new health care mandate drives up insurance costs for small businesses. In 2025 alone, eight new ones were introduced. Enough is enough.
• Increase competition. Eliminating outdated Certificate of Need laws that drive up costs is a good place to start. Competition lowers costs and raises quality in every other part of the economy. Health care should be no different.
• End hidden fees. Patients should never be stuck with a hospital “facility fee” for something like a routine checkup or a child’s doctor visit outside a hospital. These fees add millions in unnecessary costs every year.

When the General Assembly returns to Raleigh next spring, we’ll be there to remind lawmakers that small business owners want to provide health insurance. We want our employees and their families to have access to good, affordable care. But the math just isn’t working anymore.

If costs keep climbing, business owners will be forced into tough decisions that hurt workers and weaken our economy. That’s not the future any of us want.

North Carolina has already shown we can be No. 1 for business. Now it’s time to prove we can be No. 1 for affordable health care, too.