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May 13, 2025
Research shows fewer small businesses can afford to offer health insurance
North Carolina has the highest healthcare costs in the nation, and small business owners were hoping lawmakers would finally take steps to bring those costs down.
Instead, the House has advancing a series of health insurance mandates that would drive costs even higher.
“Small business owners have been struggling with rising health insurance premiums for years,” NFIB State Director Gregg Thompson said. “Now, the legislature is considering bills that would make it even harder for them to offer coverage while doing little to help the vast majority of workers.”
Each of the bills being pushed this session benefits a narrow special interest at the expense of everyone else:
- HB 152 addresses access to transcranial magnetic stimulation
- HB297 is an imaging mandate written for the radiologist lobby.
- HB489 requires a minimum payment of 400% of Medicare rates for an ambulance ride.
- HB567 mandates costly lab tests that benefit large lab companies.
- HB906 requires unlimited payments for medical devices—no matter the cost.
“These mandates don’t apply to self-insured companies, which are usually big corporations,” Thompson said. “That means only small businesses will be stuck footing the bill.”
According to a recent NFIB report, Addressing the Health Insurance Affordability Crisis for Small Businesses, the percentage of small businesses offering health insurance has plummeted from nearly 50% in 2000 to just 30% today.
“Even well-intentioned mandates end up backfiring,” Thompson said. “When the government tells small businesses what coverage they must provide, the result is always the same: higher premiums. That leaves employers with three bad choices—absorb the cost, pass it on to their workers, or stop offering coverage altogether.
“We need relief, not more mandates,” Thompson said.
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