Blue Cross Blue Shield of North Carolina, which has more than 80 percent of the health insurance market in the state, is trying to gain control of the insurance exchange that goes into effect in 2014 as part of the Affordable Care Act.

Each state must create an exchange of its own, collaborate with other states to create a larger exchange or allow the federal government to run an exchange. In North Carolina, more than a million people will buy their health insurance through the exchange once the law takes effect. It is meant to offer consumers a place where they can shop and compare among plans. The number of plans is supposed to be limited so people can compare.

The plan for North Carolina’s health exchange was to be developed by a work group set up by the NC Institute of Medicine. I have been at the meetings of this panel as an interested party, able to comment, but not to vote. The panel has people from all areas of health care, including physicians and members of the health insurance industry.

From the beginning, it was obvious they had a lot they were unhappy about:

• They wanted to be able to sell an unlimited number of plans, which will only serve to confuse consumers. Many of them will only serve the insurance companies with their high deductible and low co-pays. This is how insurance companies deceive customers now, and many people don’t understand the fine print until they get sick and discover they can’t afford care because their deductible is $10,000 or even more, and much of what they need isn’t covered at all.
• Insurance companies wanted no standardization of plans so consumers can’t compare apples to apples.
• Of the 15 companies doing business in North Carolina, 14 have asked for a waiver of the 80 percent rule which forces them to spend 80 percent of the money they receive in premiums on services. Medicaid spends 97 percent of the money it takes in on services. That’s because they don’t have to pay lobbyists, public relations executives and huge executive salaries and bonuses.
• They didn’t want regulation of rates and they didn’t want any company to be thrown out of the exchange for excessive rate hikes — or any other reason, for that matter.
• The insurance companies asked for voting seats on the exchange’s board of directors, allowing them to regulate themselves. At the meeting they raised that point, nearly everyone spoke out against it.

Soon after the meeting, a panel member who was an insurance company representative sent out a letter resigning from the panel because everyone was prejudiced against the poor insurance companies, who are only in business to help people, after all.

My thought was, “you do have a history, you know.”

So, they went and wrote their own bill and had it introduced by a friendly state representative in the NC House as House Bill 115. The bill gives insurance companies and their allies, all of whom opposed reform, seven of the 11 seats on the board.

They’ve been able to do this quietly because the media aren’t interested in the story, which is all the more reason you should be.

If this bill passes the house and senate in North Carolina, consumers will see no benefits from reform; it will have been destroyed from the inside.

To be fair, BCBS claims it didn’t write the bill, but it backs it wholeheartedly.

Another bill has been introduced, House Bill 126, that is pretty close to what the panel was backing. It has gotten no attention at all. H126 would leave insurance companies as advisors, which is the right way to do it.

As a health care advocate who has been involved in the process, I feel like we’ve been played like a cheap violin. We negotiated in good faith while they were just biding their time until this dangerous bill could be introduced.

Both houses of the NC General Assembly have big Republican majorities, and this is being played out here while the rest of the country is distracted by the labor issues and the unrest in the Middle East.

Other states’ insurance companies will follow suit. Health care reform will be destroyed from the inside and consumers will be forced to buy insurance from companies who are “regulating” themselves.

We must make a stand here, even as labor makes a stand in Wisconsin. The attacks on labor, health care, education and social justice in general are coming fast and hard, and if we don’t fight back, we lose big time.