The General Assembly isn’t scheduled to reconvene for the start of its 2026 short session until April, but the National Federation of Independent Business (NFIB) has already begun pressing lawmakers to bring health insurance costs under control.

NFIB State Director Gregg Thompson this week sent a letter to legislators, telling them that rising insurance premiums are hurting Main Street’s bottom line.

“North Carolina may be ranked as one of the best states to do business, but that success is threatened by the soaring cost of health insurance,” Thompson said.

“Health care costs have become a hidden tax on small businesses and employees alike, eating into paychecks, profits, and our competitive edge. Every new rule, fee, and layer of red tape pushes premiums higher and puts pressure on both employers and employees,” he said. “If we want to stay the top state for business, we have to get serious about making health care more affordable.”

“There’s no single solution, but there are clear steps we can take,” Thompson said. NFIB is urging lawmakers to:

• 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.
• 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 Eliminating outdated Certificate of Need laws that drive up costs is a good place to start.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,” Thompson said. “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,” he said. “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.”