Let's face it: Being a health insurance company is not exactly a path to glowing consumer respect.
Discouraging expensive patients by charging thousands of dollars in premiums per month to people with pre-existing conditions such as cancer hasn't been a very popular policy these last few years. Then there's the practice of recession or dropping people who are already insured after they get sick by combing through their old insurance applications to find some irregularity. And who can forget the practice of charging women significantly more than men for the same health coverage?
While these practices are already banned or eventually will be as result of the new health law, the law most emphatically does not eliminate private health insurers from the market. In fact, private health insurance - how most people are insured through their employers - is encouraged by the new law. So, while insurers will face stricter regulation of their most egregious practices, they will actually maintain their current business.
And that's not all. Tax credits for small businesses and subsidies for individuals who buy their own coverage mean millions more people who previously couldn't afford coverage because they didn't work for large employers will be entering the private insurance market.
Insurers are worried about meeting new rules (such as having to spend 80 cents of every premium dollar on actual medical services) and having to take anyone willing to pay a standard premium without being able to charge more for so-called pre-existing conditions. But most companies realize that the health landscape has changed and that they will have to adapt.
Which brings me to the role of health advocates. For years, we worked hard for laws that would make insurance more fair and more affordable. We also worked hard to improve the quality and effectiveness of care. While the new health law certainly isn't perfect, it does set us on a course in North Carolina and the nation for widespread availability of affordable health care, something that's never been true in our country. The debate will continue over the new law, and it will require tweaks to deal with unanticipated problems over the next few years.
However, the framework for reform is in place, and it is now the responsibility of everyone involved - from patients to doctors to advocates to insurers - to work together and take advantage of the huge opportunities to improve our system for the better.
I've certainly never been one to shy away from forcefully giving insurance companies the perspective of a North Carolinian just trying to buy and use affordable health coverage. But passage of the health law is a big win for advocates like me. And part of the responsibility of winning big is being willing to work with people and organizations you might have disagreed with in the past in order to make the plan you won - including all the compromises - work.
This doesn't mean that we should take our eyes off the potential for unfair insurance rate increases and other unsavory practices. But it does mean taking the opportunity to work with former opponents and allies alike on issues such as payment reform that hold the potential to substantially increase health quality and effectiveness while reducing costs at the same time.
The new health law expands coverage and lays out the framework for reducing costs. But success for everyone with higher quality care and affordable premiums will require all parties, including health advocates, to put aside past disagreements and work together.
Adam Searing is director of the N.C. Health Access Coalition, part of the N.C. Justice Center.