news-record.com

A proposal to provide affordable health insurance for all North Carolinians expects almost everyone with any connection to health care to participate - and might well fail if they don't.

It also doesn't say how much the program would cost or provide many details on how it would be paid for.

The plan, released Monday by the nonprofit N.C. Justice Center, would require money from the federal and state governments, employers, hospitals, insurers and families.

Governments' role - primarily funding and expanding insurance programs for low- and moderate-income families - would have to pass Congress and the General Assembly. One bill passed by Congress in 2007, a federal expansion of insurance for poor children, was vetoed by President Bush.

The plan calls for the state to raise its cigarette tax by about 65 cents per pack to help pay for the program - traditionally an unpopular proposal in this tobacco-growing and cigarette-manufacturing state.

The state also would consolidate small-business and individual health insurance markets to spread risk across a larger population and make insurance cheaper. And it would require private insurers to insure people with pre-existing medical conditions at the same rates as those without. The industry likely would oppose both measures.

Individuals or families who could afford health insurance would have to buy it or pay a penalty on their state income taxes once a full range of affordable options for health insurance is in place. Whether such a range is achievable is one question; whether forcing people to buy insurance would be politically popular is another.

Employers would have to offer standard health coverage - which isn't defined - or help subsidize a pool of affordable, private health insurance plans. Private insurers wouldn't be required to offer plans.

Lew Borman, spokesman for Blue Cross and Blue Shield of North Carolina declined to comment on the plan, saying the company had not had time to analyze it.

Hospitals would be expected to help subsidize that pool.

Tim Rice, president and CEO of Moses Cone Health System, said that a one-size-fits-all standard for hospitals might not be appropriate because they provide different levels of charity care and absorb different levels of bad debt.

The proposal also calls on the state to establish a state/university partnership to research what's causing increases in health care costs and examine the effectiveness of expensive drugs and treatments. But there's no guarantee all parties would participate.

Ed McDonald, a spokesman for U.S. Rep. Howard Coble, R-N.C., said Coble likely would oppose raising the tobacco tax to help pay for the program. He also called the program vague.

"There's nobody who doesn't want to expand health care to people who don't have it now," McDonald said. "But how are you going to pay for it and who's going to be covered?"

A spokesman for U.S. Sen. Elizabeth Dole, R-N.C., said she would study the proposal.

Attempts to reach other members of the Greensboro-area congressional delegation for comment were unsuccessful. A spokesman for the N.C. Department of Health and Human Services did not return a phone message.

Contact Lex Alexander at 373-7088 or lex.alexander@news-record.com