Like Shooting Fish in a Barrel

I almost feel guilty doing this because it's so easy.  It must be hard to be an ideological conservative.  You need to toe the party line to get the votes, but what if one of your special interest buddies needs some, shall we say, "consideration?"  This was the position of the unfortunate Representative Nelson Dollar of Wake County yesterday when the heath insurance high risk pool was discussed and approved by the NC House Health Committee. 

The pool would allow people with serious medical conditions to purchase insurance at higher rates than healthy folks, but not so high as to be completely unaffordable – like the $1000 to $2000 a month premiums someone with, for example, multiple sclerosis is routinely quoted.  Excess medical costs for people in the pool are shared by a fee on all insurance companies in the state – just like in NC's automobile high risk pool.

This payment scheme offended Representative Dollar.  He supported the risk pool but insisted the state pick up the excess costs rather than spreading the cost among the insurance companies.  Wait a minute – is this the same Dollar who recently thundered, "Its time to cut the pork barrel and special interest money out of the budget…"?  Now he's ready at the drop of a hat to spend taxpayer dollars to relieve the insurance industry of covering the sickest (and most unprofitable) people in the state to insure.  I guess he thinks all those savings will be passed on to insurance company customers and not go to fatter executive salaries, stock option grants, and even bigger profits.  Hmmm.  I've got some beachfront property for sale – just step this way and ignore the sandbags.


  1. Rep. Nelson Dollar

    March 1, 2007 at 5:08 pm

    You might want to check your aim before firing. I voted for the High Risk Pool legislation in 2006 with essentially the same funding mechanism as in the current bill, and voted for the bill in the Health Committee this week. In fact, I’m a co-sponsor of the legislation because I beleive we need to be able to offer insurance to thousands of North Carolinians who are priced out of the market. My concern is that the per insured assessment will be pass on through the insurance companies to current policy holders. For small businesses who provide health insurance for their employees this funding mechanism will add to the cost of providing that coverage. And yes, I believe there is sufficient pork barrel and low priority budget items that could be trimed to provide the resources we need to fund the portion of the program not covered by the premiums. For a better assessment of my position on this issue I recommend watching Legislative Week In Review where Rep. Insko and myself discuss the issue.
    Rep. Nelson Dollar

  2. Adam Searing

    March 2, 2007 at 7:10 am

    Rep Dollar:

    Legislators reading “The Progressive Pulse”? With this kind of exposure can a mainstream media deal and breathless political commentator analysis of “the emerging North Carolina blogosphere” be far behind?

    I appreciate your comments but stand behind my criticism of your position of state funding for the high risk pool as inconsistent. The concept of a risk pool or, as the insurance industry calls it, a residual market, is one that has been around in the private health insurance market since the 1930s. Auto, property, and casualty lines all use some form of pool for consumers whose risks disqualify them from the ordinary market. These consumers pay higher rates and the excess cost is spread among the rest of the market. For a nice discussion of such markets from the industry perspective see:


    The risk pool in health care is a market solution for a small number of consumers who have been rejected by the individual health insurance market. And the costs of 8,400 people, no matter how sick they are, when spread among the five million privately insured people in North Carolina will be minimal.

    In addition, each individual insured in NC already pays over $400 in excess premiums just to cover costs for the uninsured. Bringing more uninsured folks into the system in the pool – and having them pay substantial premiums every month – will help stabilize the market and eventually bring this cost down.

    Finally, if you really want to spend the $25-$30 million that the risk pool costs, I’d recommend that instead of subsidizing the insurance industry to cover 8,400 people, you support our plan for extending affordable coverage to every uninsured child in North Carolina – all 87,000 of them – at a cost of $21 million. You’d cover ten times as many people and you could say that you helped provide universal coverage for children in North Carolina – not a bad accomplishment.


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