The North Carolina commission tasked with finding ways to lower healthcare costs met on October 2, 2026. The group included independent practitioner Dr. Karen Smith, facilitator Barak Richman, NC DHHS Secretary Dev Sangvai, state Treasurer Brad Briner, and Mark McClellan, director of the Duke-Margolis Institute for Health Policy. The commission is seeking ways to make healthcare in North Carolina more affordable while improving quality.
The commission is considering investing in primary care as a way to lower overall patient costs and improve health. One option is setting annual spending targets for primary care for both public and private insurers. However, leaning more heavily on primary, care is a challenge because the state doesn’t have enough doctors in rural counties. Dr. Tunde Sotunde, Blue Cross North Carolina president and CEO, said the state is short about 2,000 doctors. He added, “At the end of the day, we have to solve for this. Status quo is not going to work. We have to come up with creative solutions. The bottom line is that we are facing a significant access issue in our rural and underserved parts of the state.”
Dr. Karen Smith, an independent primary care doctor with an office in Raeford, likened talk of different ways of paying doctors to performing CPR on a patient that is bleeding to death. “Right now, independent primary care practices are hemorrhaging,” she said, “because they can’t afford to stay open.”
Another suggestion that nurse practitioners be empowered to treat patients without supervision from doctors revealed the familiar fault lines between advanced practice nurses who want independence and doctors who oppose it. Tina Gordon, CEO of the North Carolina Nurses Association, said, “Advanced practice registered nurses have known for many, many years they could be doing more for the people of North Carolina, but have been restricted by a 1970s-era regulatory structure. This has never been about what nurses want. This is about what nurses can do, and what patients need.” Steve Keene, CEO of the North Carolina Medical Society, representing the doctors, said physician supervision for advanced practice nurses is an important safety feature. “I do not think we are in a position to say conclusively that it’s time to change,” Keene said.
Legislators have filed bills to allow advanced practice nurses to work without doctors’ supervision, but they have not become law. Last month, a nurse practitioner filed a lawsuit to overturn the requirement.
