It's fair to say North Carolina's treasurer, Dale Folwell, isn't on great speaking terms with the state's hospitals and health systems, many of its politicians, or health insurance companies for that matter.
All of them have been the focus of Mr. Folwell's ire, whether it be claims of excessive executive pay, rubber-stamping politicians or "sore loser" insurers.
"My job is to advocate for the invisible, those that protect, teach and otherwise serve," Mr. Folwell insists regarding his mission to make healthcare more affordable for North Carolinians. "People can't see through their poverty."
The invisible men and women are those who are largely forgotten, who work one to two jobs, who pay their taxes and pray for a better outcome for their families, he told Becker's.
And he blames local nonprofit hospitals and health systems for being at the root cause of such rising costs while executives enrich themselves and price transparency is largely nonexistent.
Many of the health systems have defended themselves against such accusations when Mr. Folwell released a highly critical report Feb. 15 focusing on the state's nine largest systems, describing the changes in executive pay as "the biggest transfer of wealth in our generation."
Charlotte-based Atrium Health, for example, said it was important to offer top executives a competitive compensation package and pointed to the system's record of not having any layoffs or rural hospital closures during the pandemic.
Greensboro-based Cone Health said its executives took part in pay reductions, with director-level staff taking a 10 percent cut and its CEO reducing his pay by 35 percent. It was also false to say that the health system used any COVID-related funds to float executive pay.
The North Carolina Health Association described some of the claims from Mr. Folwell as "egregious."
Politicians and insurance companies also a target
It is not only the local health systems that Mr. Folwell has in his sights, describing local politicians as PINOs — politicians in name only.
"The night they get elected, they peak," he said, adding that they spend the rest of their time in office focused on reelection instead of doing their job and serving the community.
And health insurer Blue Cross and Blue Shield of North Carolina is currently in a legal dispute with the state after its employee health plan selected Aetna to run the program after over 40 years with Blue Cross Blue Shield.
"Nobody likes a sore loser," he said of the legal action taken by BCBS. "The state health board voted unanimously to give the contract to Aetna. It wasn't the body, not the engine of the car, but we changed the transmission after 44 years."
BCBS said it is mounting the legal action because of procedural doubts.
"Blue Cross NC believes our bid to the State Health Plan serves the best interests of the Plan's members," the insurer told Becker's. "This bid process left too many unanswered questions about how costs and access to care for state employees and teachers will be impacted."
Whatever the rights or wrongs, Mr. Folwell shows no sign of slowing down in his mission despite his many opponents, saying it is all about protecting regular North Carolinians.
"This is not a Democratic or Republican issue, it is a moral issue," he said. "I am the keeper of the public purse, but I have also had to be the protector of the consumer."