The state's largest health insurer contends that the health care reform bill in the U.S. Senate would trigger major premium increases for its customers and lead people to drop coverage because of high costs.
Blue Cross and Blue Shield of North Carolina projects the average annual cost of premiums for its individual policies would be 53percent higher, or $1,714 more, in 2018. Premium costs for small businesses would rise an average of 29percent, according to the nonprofit insurer.
Congress is widely expected to enact reforms that will have the greatest effect on health care since the creation of Medicare. But the bill being considered by the Senate is still in flux and, if and when it is passed, the Senate's brand of reform would have to be reconciled with the House version.
Although many consider Blue Cross an opponent of reform because it has campaigned against provisions such as the public option for health insurance, CEO Bob Greczyn insists Blue Cross is on board.
"We expect - and hope ultimately - that something passes," said Greczyn, 58, who is retiring Feb.1. "We just want to make sure at the end of the day that we don't end up with something that makes it worse, not better."
Greczyn, in a meeting with reporters and editors at The News & Observer, argued that the insurer's analysis offers a compelling argument for a final bill that includes a strong mandate requiring health insurance. Another issue is that reform, at least in a version being considered by the Senate, would shift costs to younger, healthier people, Greczyn said.
Advocates of reform counter that the insurer's warnings gloss over the benefits of proposed reforms, including subsidies that would be available to low-and moderate-income families. There also would be a tax subsidy to help small businesses offer health insurance to their employees.
"In the end, consumers would pay significantly less because of their ability to access the tax credits," said Families USA spokesman Dave Lemmon. A family of four could earn up to about $88,000 and still qualify for tax credits under the Senate bill, he added.
Families USA, a national advocacy group, issued a report Thursday that estimates that by 2019, reform will increase the number of North Carolinians with health coverage by nearly 1million. About 1.5million North Carolinians were uninsured last year.
Blue Cross' projections are misleading, said Adam Searing, a health care expert at the Raleigh-based N.C. Justice Center and a frequent critic of the insurer.
"It's like someone who is running around an airplane yelling the plane is going to crash because it doesn't have any wings," Searing said. "But if you look out the window you can see the wings."
Other economists and the nonpartisan Congressional Budget Office have reached very different conclusions, Searing said. Most North Carolinians get health insurance through their employers, and the CBO projects the cost of those policies won't be affected by reform.
The CBO projects the average cost of individual policies would rise 10 percent to 13 percent.
"Even Blue Cross admits," Searing said, "that for people who are older, say, in their 60s, who are paying the highest premiums, their premiums are going to go down."
Searing contended that Blue Cross is doing its best to torpedo reform, despite its protests to the contrary, because it profits enormously from the current system.
Blue Cross has more than 3.7million members statewide, including about 300,000 people with individual policies.
A significant flaw in the proposed Senate bill, Greczyn said, is that the penalties for those who choose not to buy insurance - a $95 penalty the second year and eventually up to $750 - aren't strong enough to compel people to purchase coverage.
A stronger mandate is important, said Greczyn, because "the more people you get in the pool, the more opportunity you have to spread those costs over a greater number of people."
Greczyn said he suspects that many younger, healthier people won't purchase health insurance because the penalty pales compared to the thousands that they would have to pay in premiums.
Whatever version is approved by Congress, Greczyn predicted that health care reform will be with us for a long time.
"My guess is that, no matter what passes, you're going to have Health Care Reform II, you're going to have Health Care Reform III, because we're going to get into the implementation of this and we're going to find out that some of these things just ain't gonna work, and then we'll have to fix them."
