Let’s not underestimate the significance of the sort of public option the Senate is expected to have in their health care bill for North Carolina. We’ve said it again and again here, but for most individuals and small businesses in North Carolina, NC Blue Cross is the only insurer available. Even for businesses up to around 50 people or so, they are the only real option. United Healthcare gets some business, but they are an also-ran. Just ask anyone who either runs a small business or tries to buy health insurance for a larger business – they are going to tell you Blue Cross is really the only realistic option. You can vary deductibles and co-pays to reduce initial premium costs, but that’s about it.
That’s why, when our Health Access Coalition went all over our state this summer, we heard a consistent theme from small business and individuals – we want more choice. I think it wasn’t just that Blue would raise people’s rates through the roof and they would have nowhere else to go, although that was obviously a problem. What people really wanted was at least a realistic chance of another plan from a different company. If it was just as much, they could at least feel that they were in the ballpark with the huge prices they were being charged by Blue – so they wouldn’t feel as bad about paying and could look at the other ways we need to reduce health costs. But having NC Blue as the only company in the market inevitably leads to people feeling they are being ripped off.
The public option as proposed by the Senate isn’t perfect. First, states could opt out. Therefore expect a battle royal from NC Blue Cross who will use every deep connection they have with NC state government to make the General Assembly reject the plan for North Carolina. We will have to work hard to keep Blue from stopping the competition they so clearly fear. In addition, apparently, the public plan option would have to negotiate rates like other insurance companies. This is going to make it fairly expensive – on par with Blue Cross – since the public plan won’t be able to use the full negotiating pressure of the federal government to pay Medicare rates.
OK, it’s not perfect, but this sort of option can provide an important competition for Blue Cross in our state. And, since Blue Cross has become bloated, executive top-heavy, and complacent in raising rates with abandon, they could use the competition. We need to support this change and then fight like hell against the inevitable NC Blue Cross effort to reject the plan in North Carolina.