NC officials begin process to help thousands of state workers switch doctors, as Duke negotiations sour

Tens of thousands of state employees, retirees and their family members may need to find new doctors in the coming weeks or months — unless a deal can be struck between two of North Carolina's biggest players in the health care industry.

State officials on Friday voted to approve a resolution that will formally start the work to identify new potential doctors for people who are at risk of losing their doctor unless Duke Health and Aetna can resolve their differences before Oct. 20 when their contract expires.

Duke Health, one of the state's biggest hospital chains, and Aetna, which insures 1.5 million North Carolinians, are engaged in an acrimonious contract dispute. Duke says Aetna should increase what it's willing to pay for services, due in part to the rising costs of health care equipment, salaries and more. Aetna says North Carolina already has among the highest health care costs in the nation and that Duke's request to raise costs even higher is unreasonable.

Caught in the middle is Aetna's biggest customer: The State Health Plan and its 750,000 members. Health plan leaders, including State Treasurer Brad Briner, aren't part of the negotiations, but they're seeking to push for an outcome that will be least disruptive to the current and former teachers and other state workers on the health plan. If Duke gets its way, Briner previously told WRAL, the State Health Plan will likely have to raise premiums — again — after voting last month to raise premiums on nearly everyone on the plan.

But if Aetna thinks Duke is being too unreasonable, it could always just decline to sign a new contract and leave Duke out of network entirely. That would lead to most of Aetna's customers who use Duke — including 70,000 state employees plus thousands more who have Aetna insurance through their private sector jobs — needing to find a new doctor. In general, Briner sides with Aetna's stance that Duke is asking for too much.

"Duke can solve this," Briner said during Friday's meeting. "I hope they will solve this, and this will all be for naught. But we are in the business of making sure we and our members are protected."

For a few thousand people with particularly serious medical issues, such as cancer, they won't be forced to find a new doctor even if Duke does go out of network with Aetna. State law allows them to continue on with their doctor if they want, and state officials said anyone who qualifies will need to get a form filled out by their doctor to keep receiving care. State Health Plan officials say they believe Duke and its doctors will work with patients to get that done, but they added that if anyone has trouble, they should contact the State Health Plan for help.

"Our sickest members have a lot going on in their life," plan director Tom Friedman said. "Filling out a form shouldn't be at the top of the list. But that is something they have to do."

Duke Health Executive Vice President Thomas Owens told WRAL last week the higher rates it's seeking weren't exorbitant, and that in fact they might not even keep up with the rate of inflation.

"We’ve not had a rate increase from Aetna in four years, despite remarkably challenging economic times for health systems with inflation for supplies, materials, goods and labor being remarkably high in the last four years," Owens said.

Duke officials have also questioned whether the State Health Plan would actually have to raise premiums on all members if Duke gets higher rates, since Duke only provides care for about 10% of the people on the State Health Plan. Asked about that Friday, Briner told WRAL in an interview that if Aetna agrees to pay Duke more, then every other hospital chain in the state will soon be asking for the same — since many of them have recently agreed to lower rates as the State Health Plan seeks to address a $500 million shortfall.

"We have asked every provider in the state to take the same, or less, and now I'm going to go out and give one provider a lot more?" Briner said. "We're going to go out and give a lot more to them? What do you think happens the next day? There's going to be a line down Atlantic Avenue [by the State Treasurer's office] of providers."

In the end, the vote Friday to pass the resolution passed without opposition. Six of the State Health Plan board members voted for it and two abstained.

"Instead of the health of local citizens who work as custodians, help take care of parks, local teachers, they would rather pad their investment portfolio off the backs of these workers," said Dr. Brian Miller, one of the board members, citing Duke's billions of dollars in investments. "I find that a fundamental moral failure, and I am sincerely disappointed."

Duke is a nonprofit and, according to its 2024 report on its charitable work, contributed nearly $1.1 billion worth of aid and benefits. It reported giving patients $159 million in financial assistance in that most recent annual report.