Small-business owners in North Carolina are reaching out to legislators for help, citing hospital mergers as one reason their health-care costs are soaring.

The fusion of former hospital competitors has left employers in the state with fewer options for services, as well as higher expenses for both companies and workers, which could ultimately hinder business expansion.

State Treasurer Dale Folwell revealed that even at the top levels, they're grappling with challenges such as cost transparency.

"The fact," he said, "is that this is the only product in your life that you don't know the value and the price of it, even after you have consumed it."

In a recent national poll, 45% of entrepreneurs said soaring health-insurance costs have forced them to hit the brakes on expanding their businesses. The majority of companies in North Carolina are small businesses, but together they employ more than 1.7 million people. So, Folwell said, the higher rates could signal lasting economic impact.

Greater NC Black Chamber of Commerce regional president Valerie Benton Smith stressed the urgent need for affordable, quality health care for businesses to stay competitive. She emphasized that without regulations on hospital consolidation and pricing, small companies in particular will keep facing obstacles.

"Small-business owners struggling with the expense of providing health-care benefits to their employees face a stark choice when costs rise," she said, "drop or cut health-care benefits, making it hard to attract quality candidates or divert funds to health care."

She said addressing the growing burden of escalating health-insurance costs is essential to ensure the growth and stability of small businesses. In the survey by the group Small Business for America's Future, 86% of business owners said they believe federal and state governments should actively intervene in health-system consolidations.

CORRECTION: The name of the California law is the 'End of Life Option Act.' A previous version of the story used the word 'Options,' not 'Option.' (11:20 a.m. PDT, June 16, 2025)

California's law legalizing medical aid in dying could be made permanent if lawmakers approve a bill currently before the State Assembly.

Senate Bill 403 would eliminate the sunset clause in the 2015 End of Life Option Act.

The law allows mentally capable, terminally ill patients with less than six months to live to get a prescription to end their life.

Advocate Dan Diaz says his wife, Brittany Maynard, moved to Oregon in 2014 to make use of that state's Death With Dignity Act.

"Brittany is gone, so now I'm fighting for all terminally ill individuals that might find themselves in Brittany's predicament," said Diaz, "so that they don't have to do what she did, of leaving their home state after being told you have six months to live."

The End of Life Option Act is currently set to expire in five years. Medical aid in dying is legal in 11 states plus Washington D.C. -- but California is the only jurisdiction with a sunset provision.

Leslie Chinchilla, California state manager with Compassion & Choices Action Network, said over the past decade, there hasn't been a single substantiated case of abuse involving medical aid in dying statewide.

"The California Department of Health does a yearly report on medical aid in dying," said Chinchilla. "There has been no instance of coercion or abuse, and really the law is working as intended."

In 2023, more than 1,200 terminally ill Californians obtained prescriptions for medical aid in dying and 69% took the medication.

Patients with end-stage renal disease have two treatment options: dialysis or a kidney transplant but because donor kidneys are scarce and wait times are long, most will need to start dialysis while they remain on the transplant list.

Research from Arizona State University aims to better understand the differences in the decision-making process among clinicians about whether to accept or reject a donor kidney.

Ellen Green, associate professor of health solutions at Arizona State University, the study's principal investigator, said candidates are matched with an organ donor through the nonprofit United Network for Organ Sharing and once matches are made, they are sent out to clinics where patients with end-stage renal disease are on waiting lists.

Green and her co-investigators want to determine if an individual clinician's willingness plays a role in accepting or rejecting a kidney donation.

"In this initial study, we don't know whether or not this is a good thing or a bad thing," Green observed. "It could be that the variability is demonstrating that some clinicians are pushing the envelope while other clinicians are learning and have resources to deal with certain types of transplants that maybe are higher risk."

There are about 90,000 people in the U.S. that are waiting for a kidney transplant, and 11 people die every day in that wait, according to UNOS. Studies show while many kidney donations are deemed viable, almost 30% are declined for transplantation despite strong demand. In Arizona, 730 kidney transplants were completed in 2024, according to the Organ Procurement and Transplantation Network.

As an economist, Green noted it is a challenge to understand how a system which is not driven by price operates. She acknowledged while their study looks to learn more about clinicians' willingness, she understands other variables can affect the decision-making process.

She hopes her work will help increase the availability of donated kidneys.

"What we want to better understand is, from a clinician-to-clinician perspective, is there something that we can do or better understand about this decision-making process that we can leverage to increase those chances," Green emphasized.

Green pointed out understanding individual decision-making is something flying under the radar and argued it needs to be incorporated into current models, otherwise opportunities to have successful kidney transplants could be negatively affected.

As Congress reviews budget slashes to health care in President Donald Trump's "One Big Beautiful Bill Act," a new evaluation from the nonpartisan Congressional Budget Office projects 16 million Americans, including 1.8 million Medicaid and Healthy Indiana Plan recipients, would go without health insurance.

If the bill passes as is, said Josh Bivens, chief economist at the Economic Policy Institute, a nonpartisan think tank, health providers would see a sharp increase in what is known as uncompensated care, when people without coverage get sick but are unable to pay.

"And it means hospitals and doctors no longer receive that income stream from Medicaid payments," he said. "And lots of them are going to be forced out of business, and there's going to be closures of hospitals, especially in rural counties."

Republicans question the Congressional Budget Office projections, believing that cutting $715 billion from Medicaid eliminates fraud. They want to add specific work mandates for healthy working-age adults. The GOP bill aims to fund Trump administration priorities, including more immigration raids and border wall construction, and extending tax cuts passed in 2017.

According to the research site KFF, nearly 569,000 Hoosiers are enrolled through the Affordable Care Act's Medicaid expansion.

Bivens said he fears that if the bill becomes law, he sees the measure as a transfer of income from vulnerable families to already wealthy Americans. He noted that the average cuts to Medicaid, which would take effect after the 2026 midterm elections, would be more than $70 billion per year.

"And then if you look at the tax cuts that will be received by just people making over $1 million per year, those are $70 billion as well," he said. "We're going to take $70 billion away from poor families on Medicaid, and we're going to give it to families who are making more than $1 million per year."

Six Nobel laureate economists have signed an open letter opposing cuts to safety-net programs in the budget reconciliation bill, warning the measure would add $5 trillion to the national debt.


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