Progressive Voices

By Adam Searing, Director of the North Carolina Health Access Coalition

NC Blue Cross is North Carolina’s largest nonprofit health insurer. It insures over three million people in the state. Despite its status as a nonprofit, it has also raked in nearly $1 billion in profits since 2001.

NC Blue Cross is also an organization that was created, in its own words, as “a community project whose motive was never pecuniary gain for those who promoted it.” 

NC Blue Cross CEO Bob Greczyn recently said, “Personally and as a company, I think we believe in universal coverage.” 

This year, NC Blue Cross was also instrumental in making sure that an affordable proposal that would have guaranteed access to health insurance for every child in the state was limited instead to only a few thousand children. In addition, the company’s four top executives all were paid more than $1 million each in 2006 with the CEO receiving over $3 million alone.

These contradictions illustrate the quandary NC Blue Cross finds itself in as it distances itself from its historical role. They also show the masterful job Blue Cross and other health insurers are doing in changing the health debate in order to preserve their profits and deflect public criticism.

The health insurance business is one of the most unpopular industries in the United States. It is often – and rightly – seen as the major roadblock to meaningful health reform. Here in North Carolina, insurers consistently rank as one of the top political givers, and employ a legion of lobbyists in Raleigh. Over the last decade none of the mostly minor health reform changes made to increase coverage has passed without their approval.

Despite this, insurers have sensed a sea change in public opinion on healthcare recently and now see a need to respond. Over 60% of North Carolinians – and even higher numbers nationally – support moves to make health coverage universal. People are willing to pay substantially more in taxes for health care for all and are increasingly frustrated with the very visible inaction in Washington.

This shift poses a challenge for a huge and extremely profitable insurance company like Blue – namely, how to appear to be open and advocating for change while at the same time protecting profits gained from the status quo?

NC Blue Cross has been masterful at this game of smoke and mirrors. A prime example is Blue’s publication of “The Faces of North Carolina’s Uninsured” – a booklet that is at the centerpiece of the company’s effort to change its image and that seeks to transform the private insurance market’s failure to offer affordable health coverage to 1.3 million North Carolinians into a problem largely of the irresponsible young and the selfish rich. 

The report highlights the fact that the 18-34 year old age group makes up 57.8% of the uninsured in a section titled “The Invincibles.”  The section implies that many young people could afford coverage but don’t buy it and that this is a major reason so many people are uninsured.

The reality is much different.  Blue chooses not to highlight that 800,000 of the 1.3 million North Carolinians without health insurance have incomes less than twice the federal poverty level – or $34,340 annual income for a family of three.  Or that only 3% of North Carolinians without health insurance report that the reason is “they don’t need insurance.”  Or that 64% of the uninsured report that they don’t have coverage because it is either too expensive or their job doesn’t offer it.

Blue saves the most damaging assertions for last however.  Citing proprietary data from their own insurance company association, Blue argues in a section titled “Shattering the Low-Income Stereotype” that that there are millions of people without health insurance making $50,000 or even $75,000 a year.  Blue then asserts the “personal responsibility” arguments yet again.  The implication is again that the problem of the uninsured is really a problem of individual financial management.

While highlighting misleading and questionable data and downplaying the real reasons people are uninsured, Blue’s effort never actually crosses the line into an outright falsehood.  Blue also does present some real reasons people lack coverage – like the problems with small businesses affording decent health plans.  Overall however, the document and NC Blue’s effort on the uninsured pushes the idea that the problem of the uninsured is really one of personal choice and not one requiring major changes to our health system – like getting rid of insurance companies and their outsize profits.

Sophisticated political tactics like Blue is using in the current debate around our health system have been around in our nation’s capitol for years.  Their appearance in NC shouldn’t be surprising though.  With billions in profits at stake and an executive suite now filled with newly-minted millionaires, NC Blue has every incentive to protect its place at the top of the health insurance heap.

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This entry was posted on Saturday, September 22nd, 2007 at 8:14 am and is filed under Progressive Voices. You can follow any responses to this entry through the RSS 2.0 feed.