Bellicose BATTLER: North Carolina's pugnacious treasurer relishes stirring up entrenched institutions.

• Author: MacMillan, Mike

Dale Folwell has put himself in collections. It's not that the North Carolina state treasurer necessarily objects to paying the charges he incurred for a checkup at a Winston-Salem hospital; it's more that he wants "to see exactly what a person goes through when they don't pay their medical bills."

The amount is small, a few thousand dollars, but the objective is big: bring yet more attention to what he says is the "weaponization of credit" on the part of the hospitals and the damage this inflicts on those at the lower rungs of the economic ladder. This, he says, can be ruinous.

Folwell's antipathy for large hospital systems is well documented. It appears to be reciprocated if a July 2019 email from a Cone Health executive in Greensboro to the State Health Plan is representative. Characterizing state plan executives, including Folwell, as "sorry SOBs," the writer suggested that they "burn in hell." To date, Folwell's quest to establish better transparency in hospital pricing has had a certain tilting-against-windmills quality to it, but it's hard to doubt his sincerity. In late May, he upped the ante again and backed a N.C. House bill intended to "limit the ability of large medical facilities to charge unreasonable interest rates and employ unfair tactics in debt collection."

The North Carolina Healthcare Association avers that it has moved on. The trade group's lobbyist, Cody Hand, says, "We're not bothered by what the treasurer does or doesn't say about us," he says. "We would be happy to work with (him) to design a plan of care that puts the state employees and retirees in the driver's seat."

The little guy

The collections matter shines a light on what appears to be a key element of Folwell's approach to running the treasurer's office. He tends to view things filtered through personal experiences, whether it's his mother's job on a hospital switchboard or his years spent collecting garbage in Winston-Salem. His sympathies lie with the little guy. It is, he says, in his Quaker blood to be "fair and just."

Folwell has racked up some notable successes during his nearly 20-year career in state government. He cites his role in helping improve the state's workers' compensation program finances while serving as assistant commerce secretary under Gov. Pat McCrory. During his tenure, the system went from a deficit of about $2.5 billion to a surplus of $1 billion in part by levying a surcharge on employers and more closely scrutinizing payouts. Other major achievements he invokes include his efforts to expand organ donation awareness and a bill moving the cutoff date for children entering kindergarten from October to August.

The lifelong Republican has been elected treasurer twice, both times by about 5.5 percentage points, even as Gov. Roy Cooper, a Democrat, won at the top of the ballot. In 2016, he defeated Dan Blue III by about 244,000 votes out of 4-45 million cast. He won again in 2020, beating Ronnie Chatterji by 275,000 votes, this time with 5.35 million votes cast.

Of his current position, he likes to say, "We're in the check-writing business," referring to the 950,000 or so North Carolinians who depend on the state for health care and retirement benefits.

Here again, he has taken this responsibility personally, traveling the state and handing out payments from North Carolina's Unclaimed Property Division, which is part of the treasury. In March, he delivered $2,593.04 to the United Way in Montreat. More recently, he delivered $9,900 to the March of Dimes in Wilmington.

Ask me anything

The treasurer's office is located in a nondescript building in an office park just north of downtown Raleigh. The place suggests someone who is frugal with the public purse; there is a standard-issue conference room flanked by a warren of offices and cubicles. This day's agenda includes the weekly Council of State meeting, with Gov. Cooper, Attorney General Josh Stein, Secretary of State Elaine Marshall and others. This week it is being held via Zoom. Folwell dials in from a windowless room via a computer sitting atop three volumes of the general statutes of North Carolina. When it's his turn to speak, he recognizes the work done by bank tellers and calls out...