Lawmakers should reexamine NC’s health insurance system in 2023

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Editorials and other opinion content provide perspectives on issues important to our community and are independent of the work of our newsroom reporters.

Lawmakers

Kwan Cheung, left, receives his first dose of the Moderna COVID-19 vaccine, from Lindsay Bradshaw, a physician assistant, at UNC Healthcare on January 14, 2020, in Chapel Hill, N.C.

ctoth@newsobserver.com

In an age when subjective truth is on the rise and facts are often manipulated, data provides clarity. That’s why I founded Meredith Poll nearly eight years ago—to make the most comprehensive and objective study of the issues that matter most to NC voters and ultimately their decision-making at the ballot box and beyond.

So when the North Carolina Center for Health and Democracy asked me to do it reconnaissance About consumers’ attitudes about health insurance, it was a no-brainer. I thought it was critical that as NC health experts and lawmakers continue to debate how to improve our state’s healthcare system, they should be fully aware of how people feel about a central component of that system: health insurance.

David McLennan headshot.jpg
David McLennan

The goal of our survey was to gain a clearer understanding of North Carolinians’ views and attitudes toward commercial health insurance companies broadly, as well as to assess how consumer sentiment is affected based on people’s actual interactions with their insurance company.

When we dug into the data, our findings were exciting.

While North Carolina residents say they are generally satisfied with their insurance provider, less than 10% felt the health insurance company had their best interest in mind.

North Carolinians blame health insurance companies more than any other part of the health care system for rising health care costs. In fact, every demographic group surveyed had health insurance companies as a primary reason for these increased costs.

This concern about rising costs is compounded by the fact that the two most important factors influencing consumers’ decision to purchase health insurance plans are monthly premium costs and out-of-pocket expenses. High premium costs result in very high levels of dissatisfaction for consumers with almost half reporting that they are not completely satisfied.

Large numbers of North Carolina residents report greater dissatisfaction with their insurance companies after a claim is denied, a procedure not covered by insurance, or having to go through unnecessary paperwork to get treatment. Nearly three in four of those who have a denied claim report that they are dissatisfied or extremely dissatisfied with their insurance company.

Similarly, those who said they had a health procedure that was not covered by their insurance company or received a surprise bill also saw their level of dissatisfaction increase.

The claims rejection rates reported by North Carolinians in this survey also exceed national rates based on the latter. Data from the Kaiser Family Foundation. On average, the KFF found that 18% of claims were denied nationwide with 16% denied because the claim was for an excluded service, 10% for lack of prior authorization, and only 2% for medical necessity.

My conclusion from the survey is that there is something wrong with the NC health care system in general and with the way insurance companies treat customers. It needs to be fixed. I’ve seen friends and family members get into serious health situations and become frustrated with their own health insurance provider. It’s undue pressure.

While patients across the country face these trends, North Carolina is unique in its limited health insurance options. For example, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) control 97% From the health insurance market to the state’s Individual Affordable Care Act. Perhaps unsurprisingly, according to the survey, people insured by Blue Cross NC reported an overall satisfaction level of just over 47%. The lack of health insurance options in the country means a lack of competition in prices, premiums and coverage.

State legislators must promote policies and practices that encourage competition and ensure that the insurance market has choice and transparency. Insurance companies must offer legitimate plans that cover care without jeopardizing North Carolina’s hard-earned dollars with denial, delayed care, and complicated appeals.

As we enter a new legislative session, NC lawmakers must take these health insurance issues seriously—not just for patients but for the long-term effectiveness of our entire health care system.

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