Guest Opinion: Hospitals seek to put dollar figures on their impact

Published 6:52 am Friday, January 6, 2023

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By Colin Campbell

North Carolina’s hospitals were a key player in negotiations over Medicaid expansion and other health care issues in 2022, and that will no doubt continue this year.

Represented by the N.C. Healthcare Association, the hospitals will again be pushing the legislature to expand Medicaid without pairing it with a sweeping repeal of Certificate of Need regulations. And they’ll need the General Assembly’s approval to unlock federal funding through the Healthcare Access and Stabilization Program.

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That’s likely why the Healthcare Association recently commissioned RTI International researchers to quantify the economic and social impacts of hospitals and health care systems on North Carolina. The report, which is available at, has some big numbers that could encourage lawmakers to tread carefully on making changes to the complex health care economy.

Legislators will no doubt also be hearing from State Treasurer Dale Folwell, who has proposed bills tackling pricing transparency and medical debt collections. And the hospitals will face off with powerful insurance companies like Blue Cross Blue Shield, who are pushing the Certificate of Need changes.

Here’s a few of the key statistics from the RTI report about the economic impacts of hospitals:

  • Local hospital systems are one of the top three employers in 45 of the state’s 100 counties, and they rank among the top 10 employers in 92 counties.
  • More than 500,000 jobs, or 8% of jobs in the state, were “supported by health system and hospital activities” in 2020. That figure includes 268,000 people who work directly for the health systems and hospitals, plus 247,000 other jobs supported “through indirect, business-to-business spending and induced household spending.”
  • Hospitals and health systems provided “charity care, losses from Medicare and Medicaid, graduate medical education, donations and services” totaling $5.79 billion, and they paid $2.5 billion in state and local taxes.

Colin Campbell is editor of the North Carolina Tribune, a daily newsletter that covers the intersection of business and state politics.