On the exchanges

North Carolina legislators get good advice on how to set up a key part of the new health care law.

March 12, 2011 

The contrast in the General Assembly this week couldn't have been clearer. While the Republican push to put North Carolina on record against the Patient Protection and Affordable Care Act - the law dubbed Obamacare by its critics - was stirring up a stormy veto fight, the state insurance commissioner was quietly proposing a sensible way to improve medical coverage.

Sure, Gov. Beverly Perdue did the right thing by rejecting the GOP's bill, which smacked of so many discredited "nullification" efforts of the past. So did her fellow Democrats in the legislature who defeated attempts to override the veto. However the federal courts ultimately rule on the health reform law, today's task for the states is to set about planning to make it work.

At present, too many Americans have no health insurance, with dire consequences for their health and everyone else's health care costs. At its core, that's the malady the new law sets out to cure, and on Tuesday Insurance Commissioner Wayne Goodwin addressed a key support in reform's framework.

Goodwin proposed to resolve a knotty dispute over how North Carolina should structure its health insurance exchange, the mechanism that will offer consumers a choice of private - there's no "public option" - insurance plans. Basically, the exchange will be a marketplace in which individuals and small businesses can compare policies and premiums and buy insurance, with a federal subsidy if they're eligible. (It's expected that most people who get coverage through their employer will continue doing so.)

But who will shape the exchange's standards? And what about the elephant in the room - Blue Cross and Blue Shield of N.C.?

The nominal nonprofit has an overwhelming share of the state's individual health insurance market and dominates in group insurance plans too. Critics refer to it as a monopoly. Nonetheless, a Republican-sponsored bill in the House would guarantee Blue Cross a spot on the policy-making health exchange board. Conversely, a bill from the Democratic side would keep it (and all other insurance company representatives) off.

Goodwin proposes a decision-making board of seven members, none with ties to insurers or to other interests. Board meetings would be open, and the elected insurance commissioner would appoint a majority of the members. Five advisory committees would represent insurers, employers, consumers, agents and health care providers.

That seems like a way to get the key players' views into the mix, without having them shape it. Much would depend on the voting board's appointees - they must be realistic, expert and civic-minded. But first the legislature has to set up the exchange's structure. For that, Goodwin's compromise plan makes the most sense by far.

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