In spite of the significant expansion of government programs such as Medicaid and NC Health Choice over the last several years, the number of uninsured North Carolinians has steadily increased. In addition to being inefficient, such programs are not even popular. “A 2002 Commonwealth survey found that 65 percent, whether insured or not, would prefer private coverage, where only 10 percent would want Medicaid or Medicare,” notes a 2005 Heritage Foundation brief. North Carolina lawmakers would be wise to focus on policies that allow more citizens access to private health insurance, rather than forcing the poor and uninsured to depend on Medicaid and other such programs.
Increase healthcare options for poor adults
As could be done for children eligible for Medicaid and NC Health Choice, the state should offer premium assistance to adults who would otherwise be eligible for Medicaid. Another alternative is to permit poorer adults and families already enrolled in Medicaid to opt-out of the current reimbursement system (see below).
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What Voters Like |
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• Allowing individuals who purchase their own insurance to take the same tax deduction that businesses use (88%) • Being allowed to purchase out-of-state health insurance (86%) • Tailoring their insurance policies to their own needs to reduce the cost of coverage (77%) • Regulatory reforms and tax credits, as opposed to government programs, to help the working poor and uninsured gain access to healthcare (56%) |
Enable low-income citizens to purchase affordable, customized insurance plans
Until “flexible benefits” plans can be offered to all North Carolinians, such options should at least be made available to the most vulnerable citizens. The uninsured and those earning up to 200 percent of FPL should be granted waivers that enable them to purchase basic health insurance free from costly mandates. After all, owning a basic model car is better than having no car at all.
Offer inexpensive, flexible benefits plans to young “invincibles”
Forty-seven percent of uninsured adults in North Carolina are 18-34 years of age. Moreover, nearly one-third of those ages 18-24 have no insurance. Allowing insurance companies to reach out to these young adults by offering affordable “flexible benefits” options will reduce the number of uninsured and bring a very healthy, low-cost demographic into the overall risk pool – thus lowering insurance premiums for everyone. Blue Cross has already introduced such a plan – called “Tonik” – in six states. An estimated 70 percent of those signing up for Tonik were previously uninsured.
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Opting Out of Medicaid in Florida |
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In 2005, Florida introduced a pilot plan aimed at reforming the state’s Medicaid program. The plan’s basic premise is to offer Medicaid enrollees an “opt-out” of the traditional Medicaid program and instead provide financial assistance so enrollees can purchase private insurance from a select group of state-approved managed care plans. Clients receive a monthly subsidy and have access to a state Medicaid counselor who assists them in purchasing their insurance. The amount of assistance is determined using a risk-adjusted method similar to that used by insurers when determining premiums. The pilot was launched in 2006 and already has more than 200,000 enrollees who have chosen the private sector option. After only two years, providers are also developing innovative features – such as credits to encourage routine child screenings and mammograms. |
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Who Are the Uninsured in North Carolina? |
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In a 2006 North Carolina Institute of Medicine (NCIOM) study, it was revealed that 55 percent of the uninsured have not purchased insurance because they think it’s too expensive. U.S. Census data, however, indicates that almost one in five of North Carolina’s 1.3 million uninsured earn more than $75,000 per year. Forty percent of uninsured individuals make more than $46,300 – the median household income in North Carolina. These numbers suggest that many of the uninsured in North Carolina can afford to purchase health insurance, but are choosing not to because they feel the coverage is not worth the cost, or because they would rather spend their money on other priorities. More from the NCIOM study regarding the uninsured in North Carolina (data from 2005-06): • 78% of uninsured are in families where at least one person works full-time |
