OK, we passed health reform in Washington. Yes, we actually did – although, believe it or not, there are plenty of people according to the polls who don’t even realize the law was passed. Some North Carolinians are starting to see benefits like no more lifetime limits on policies, no more pre-existing condition exclusions for kids, and a federal high risk pool for people who have been turned down for insurance. But the major changes are still a couple of years away, most significantly the establishment of the NC State Health Insurance Exchange where people who can’t get good health insurance through their company or small business can go to buy affordable coverage.
North Carolina sets up this Insurance Exchange and decisions will be made over the next few months in North Carolina that will have a major impact on people buying coverage through the Exchange. For example, the federal government doesn’t say plans in the exchange have to have a good benefits package – that’s a decision left up to the state. Ditto the expense of plans in the Exchange. If there isn’t some serious competition and bidding among insurers, health plans in the Exchange could quickly become very expensive. Finally there’s choice. Some minimal choice is required federally, but once again, NC could have an Exchange where consumers have little choice between fairly similar plans unless the Exchange is set up correctly.
If North Carolina puts together an Exchange the wrong way then we could end up with a flea market health exchange – poor quality plans, not much choice, and confidence men behind the scenes ready to charge high prices for goods of dubious value. How do we avoid this? Right now the NC Institute of Medicine is bringing together health care interests to make recommendations to the Administration and General Assembly on the Exchange and other areas. But the final decision makers will be the members of the coming NC General Assembly. And people need to start making their voices heard.