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Tension Builds Over Plan To Implement Health Reform In NC

Much of the debate about health care overhaul right now - in North Carolina and across the nation - is focused on efforts to repeal the law. But work is also quietly underway to implement key portions of it in North Carolina. Two competing bills have been filed in the General Assembly and the battle lines have been drawn. No one should be surprised that tensions are high surrounding these two measures. "This is the most major legislation we've had in decades dealing with health insurance," says Republican State Representative Jerry Dockham. He is the lead sponsor of House Bill 115 - The North Carolina Health Benefit Exchange Act. By 2014, states are required by the new federal health care law to create "benefit exchanges." That's what Dockham's bill does. Benefit exchanges are basically online marketplaces where people without health insurance - and small businesses that can't afford to offer it - can find an affordable plan. The federal law sets the bar for how these exchanges should look. States can add extra consumer protections. Dockhams bill doesn't. "I think people were very disappointed that that bill got filed," says Democratic State Representative Verla Inkso. She's part of a 27-member group organized by the NC Department of Health and Human Services and NC Department of Insurance. The group has been working since August on recommendations for a health benefit exchange in North Carolina. State insurance regulators, lawmakers, consumer advocates, medical providers and insurance companies are part of the group. The plan was for Representative Insko to file a bill that represented as much of a consensus as the group could muster. But Representative Dockham filed his own bill first, and it clearly favors the insurance industry. Dockham says Blue Cross Blue Shield of North Carolina was involved in drafting the bill, along with many other health insurance companies, drug makers, the NC Chamber of Commerce and the NC Medical Society. Dockham's bill even gives the NC Chamber and Blue Cross Blue Shield guaranteed seats on the exchange's governing board. It's not unusual for an industry to be the primary driver - and drafter - of a bill. But Representative Inkso says the insurers pushed hard for compromises in her bill, so to go and file their own version feels like a betrayal. "When you go into a consensus building process and you are working in good faith and believe everyone else is working in good faith, and then you see something that's so completely different come forward, it undermines trust," says Insko. But Barbara Morales-Burke of Blue Cross Blue Shield of North Carolina says her company "has to evaluate whether it's a bill that it can support." She attended all of the workgroup meetings and was vocal with her concerns about "not going beyond the federal law to allow the exchange to pick and choose which insurers get to participate, and or dictating beyond federal law what the plan design should look like." Morales-Burke says all those extras will make it more expensive for insurance companies to participate and that will mean higher premiums. The workgroup actually managed to agree on a lot of extras, which Representative Insko included in her bill. Representative Dockham's version strips them all out. But the biggest difference between the two bills is who gets to be in charge of the exchange. Insko's bill prohibits anyone who works for the insurance industry from being on the board, which is crucial for consumer advocates. "The point of the exchange is to provide you with objective information. It's to look at what's in the best interest of consumers and hold insurance companies accountable," says Adam Linker of the NC Justice Center. "All of that would speak to excluding insurance companies from the board." There are three states that already have benefit exchanges - Utah, California and Massachusetts. None of them gives the insurance industry a voting seat on the board. But Representative Dockham thinks conflicts of interest can be kept in check if the governing body is big enough that no single member controls decisions. Yes, his bill guarantees Blue Cross a vote, but "let's face it," says Dockham. "Blue Cross is the largest health insurer here in North Carolina, and probably without Blue Cross participating in a big way, this exchange may or may not work." "How the exchange should be governed" was the main sticking point for the 27-member workgroup and will likely dominate the debate as lawmakers begin reviewing the two competing bills in the next week. Representatives Insko and Dockham are forming a new group of stakeholders to try and bring their proposals closer together. But Insko already feels at a disadvantage. "I'm gonna be working from a bill that's already compromised and they're gonna be working from a bill that gives them everything they want, so they'll get further compromise," says Insko. "It was a smart move (for them)." And not at all surprising from an industry that has proven it's skill in maneuvering through the legislative process.