N.C. creates own health insurance plan for high-risk patients : ROB C

Chad asked:

When Cary Hicks lost his group health insurance earlier this year, he was floored by how much an individual policy could cost him because he is a diabetic.

“I was looking for anything,” said Hicks, who runs a small construction company. “I didn’t have insurance. I couldn’t afford any.”

That’s when Hicks discovered a new public health insurance program created by the North Carolina legislature. He now pays $550 a month in premiums — not cheap, but one-third of what a similar policy would have cost him in the private market.

As Congress debates how to overhaul the nation’s health-care system, North Carolina has dipped its toe into the public-option debate. Those who can’t find affordable health insurance from private companies because they have cancer, heart disease or other ailments now have the option of buying insurance from a high-risk pool set up by the state.

The program, called Inclusive Health, is little known. It has enrolled 2,050, only half of the number expected. But an estimated 1.4 million North Carolinians don’t have health insurance.

Inclusive Health is aimed largely at helping middle-class people who wake up one morning and find themselves without health insurance. Enrollees have either been turned down by private insurance companies, have lost their jobs or don’t have access to Medicare or Medicaid.

Hicks, 54, of Garner, said he had never given much thought to health insurance before this year. He was covered under his wife’s policy until January, when her employer, Corporate Press, a 40-year-old Raleigh printing company, went out of business. His construction company, which mainly builds fences, was too small to afford health insurance.

Bad luck sometimes comes in bunches. Hicks, who had not been hospitalized in 12 years, got an infected elbow in March, and the infection spread to his bloodstream. It put him the hospital for a week — a $12,000 out-of-pocket expense.

After a taste of being uninsured, Hicks went shopping for a health insurance policy. But because he is a severe diabetic, and therefore viewed as a high risk, the cost was prohibitive. Hicks said the state’s biggest insurer, Blue Cross and Blue Shield of North Carolina, which has 86 percent of individual health insurance policies in the state, offered a policy with a $1,648 monthly premium. Hicks said that was unaffordable at a time when his household had gone from two incomes to one.

“We’ve got to eat, and we’ve got a house payment,” Hicks said. “It was just too much to handle.”

He saw a brief item in The News & Observer about the start of a new state health insurance program. Within a month, he had enrolled in Inclusive Health. His premium is $550 per month, and it covers his three daily shots of insulin, his blood pressure medicine and other medical costs.

North Carolina became the 35th state to create a high-risk health insurance plan in 2007, after a decade of debate in the legislature. It began offering insurance policies in January.

The measure had the backing of health groups, physicians, hospitals and insurance agents.

Adam Searing, a health-care consumer expert, said North Carolina’s high-risk pool is relatively industry friendly compared with those in other states. It includes a restriction that the risk pool charge premiums 175 percent of what private insurers charge, so as not to compete with private markets. And it provides no subsidies for the poor.

While it helps middle-class people without insurance, it is of little use