Point of View

N.C. isn't getting its health exchange right

May 23, 2011 

— Access to affordable health care is essential to quality of life and peace of mind. I should know: I don't have it.

A 63-year-old UNC-Chapel Hill graduate, mother of three and grandmother of three, I lost my job in July 2010. I managed to pay for COBRA for a month or two; I then applied to Blue Cross for a policy with a $5,000 deductible, but was turned down.

This places me in the company of at least 1.7 million other North Carolinians who are without health insurance.

Uninsured people are not the only ones who want health care to be affordable. There are North Carolinians from all walks of life who understand that the current system is unjust and unsustainable. Right now the health care debate seems complicated, and the health insurance industry and some state legislators are counting on that to make you throw up your hands and leave everything to them.

Don't do it. Decisions are being made about matters of life and death, and we should evaluate them carefully.

Here's an example: The state House of Representatives is considering HB 115, a bill that establishes a health insurance exchange that ideally would offer citizens and small business owners a choice of health insurance policies from competing providers, a change that could lower costs and make things easier for people like me. Unfortunately, HB 115 has serious flaws that would promote business as usual and diminish the exchange's effectiveness in creating a consumer-friendly health insurance marketplace. Problems with HB 115 include:

Conflicts of interest: Two seats on the 11-member board are reserved for health insurers, the very group the exchange should oversee. Additional seats will go to members selected by the N.C. Hospital Association and the N.C. Medical Society. Only two seats are available for the public.

A user tax! If HB 115 is approved, the exchange will tax you if you buy coverage. That's on top of what your policy will cost.

One-sided appeals process: There is no provision for citizen appeals, but insurers are expressly allowed to appeal exchange rulings that displease them.

Lack of requirements for clarity: The bill should require policy descriptions with standardized comparative information, apples-to-apples outlines of policies in terms we can all understand.

Advertising by insurers: Consumers should be able to consider each policy offered by the exchange on its own merits without being assaulted by advertising, but that won't happen if HB 115 is approved in its current form.

Most people without insurance live in dread of even the most minor illness because the costs of doctors and prescription drugs are so high. Protracted illnesses often push families into bankruptcy. I am one of the lucky ones: I sold my house in Asheville after my job was eliminated, I'm receiving unemployment benefits, I have a place to live and I have kept my dental insurance. But I am paying exorbitant costs for health care. This is bad for me, and it is bad for the economy

Health insurance exchanges have wide support on both sides of the aisle and the potential to improve our quality of life if they are set up to maximize value and service to the consumer. I'm one of a growing number of North Carolinians who are angry that some of our legislators are undermining the potential of this vital citizen marketplace by stacking it with insurers and vested health care interests.

I'm particularly incensed that two of the primary sponsors of HB 115, House Insurance Committee Chairman Rep. Jerry Dockham of Davidson County, a former insurance agency owner, and Rep. Harold Brubaker of Randolph County, are the top two recipients of Blue Cross money in the General Assembly, according to research by Democracy North Carolina. Between them, these two insurance industry allies have received $44,250 from the Blue Cross PAC since 2000.

North Carolina is a state where patients run a one-in-five risk of being harmed by hospital care, according to a recent study. We rate 39th in life expectancy and a heartbreaking 44th in infant mortality among the 50 United States. I think we can do better, particularly if we revise our priorities, give our citizens a greater voice in our health insurance exchange and refuse to allow well-financed special interests to determine health care policy.

Donna B. Clark, of White Lake, formerly worked as a public information professional. She spoke at a recent meeting of the Insurance Committee of the state House.

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