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News
A North Carolina judge denied the state's request to block Atrium Health's Affordability Protection Program, letting it take effect during the upcoming open enrollment period. The program lowers out-of-pocket costs for State Health Plan members, but state officials warn it shifts costs back to the plan and could force a $50/month premium hike for all 750,000 members by 2028. The legal dispute is far from over, with the state exploring other legal options.
A North Carolina judge handed Atrium Health an early legal win on Tuesday, denying the state treasurer's request for a temporary restraining order against Atrium's new Affordability Protection Program. The program, which lowers copays for State Health Plan members below even the state's own Preferred Provider Program rates, will now be in effect during open enrollment and throughout the 2027 plan year.
The conflict stems from the state's Preferred Provider Program, which steered the plan's 750,000 members toward lower-cost providers by reducing their copays. Atrium, which was only partially designated as a preferred provider, responded by launching its own copay discount program — a move the state called a "shell game" designed to make Atrium appear cheaper without actually reducing overall costs, particularly for high-cost services. The state treasurer's office, while disappointed by the ruling, noted the judge acknowledged the program could cause "irreparable harm" to the plan, and said it is still exploring other legal pathways.
By the Numbers:
Why it matters: This case highlights the growing tension between large health systems and public payers over cost transparency and network design. The outcome could set a precedent for how health systems respond to tiered network strategies — and who ultimately bears the financial burden.
