Insurance without ACA, other rules passed by Senate

The vote was 37-10, with four Democrats joining the Republican majority on the bill, including Senate Minority Leader Dan Blue, D-Wake. The Senate will take one more vote, likely Thursday, then the measure heads back to the House for more debate.

"I think that people are looking for some way to get insurance and not have the ever-expanding increases in premiums," Blue said after the vote. "We have to address some of the anxiety people have."

House Bill 933, which started as legislation to entice more psychologists to work in North Carolina schools, sets up these new health benefit plans and specifically deems them not to be insurance, exempting them from regulations. It was requested by the North Carolina Farm Bureau, as well as realtors, as a way to help members avoid skyrocketing health insurance premiums.

To offer plans, nonprofits would have to have to be incorporated in North Carolina, have been around for 10 years and provide membership opportunities for people or businesses in all 100 counties.

Advocates for the poor said the measure would let groups cherry-pick healthy customers from the state's Affordable Care Act insurance exchange, leaving behind sicker and older North Carolinians who would see their own costs increase. They also sounded the alarm over a lack of consumer protections, with the North Carolina Justice Center saying the bill would allow "unregulated health insurance companies to make an easy buck at consumers’ expense."

"It's easy to keep premiums down when (1) you don't have to cover the sick, (2) you don't have to cover the old, (3) you don't have to cover people who will need health care, and (4) you don't have to cover maternity, prescriptions, mental health services or other benefits," the group's Health Advocacy Project tweeted out during Senate debate.

The measure wouldn't take effect until 2020, a change state Sen. Ralph Hise, R-Mitchell, added to the bill in recent days because insurance companies have already set 2019 marketplace rates without accounting for the legislation. The Justice Center called this an admission that the measure will increase premiums for people left in the exchanges.

The Farm Bureau has said it's just seeking a way give families affordable insurance options. The program would be patterned after similar ones in effect in Iowa and Tennessee.

Democrats ran several amendments on the floor Wednesday that would have brought some regulation to the plans, but Republicans blocked them.

In addition to Blue, Sens. Don Davis, D-Pitt, Erica Smith, D-Northampton, and Paul Lowe, D-Forsyth, voted for the bill.

Blue said that, with Republicans blocking fixes to the federal Affordable Care Act, he wanted to show a willingness to do something and "not just tilt at windmills." He said he remains in favor of the ACA as well as expanding Medicaid, which would provide taxpayer-funded insurance to hundreds of thousands of North Carolina's working poor.

Blue also acknowledged Wednesday that the plans offered under this latest reform "might be pretty sorry."

Hise, chairman of the Senate Health Care Committee, said the bill simply offers these groups a chance to "choose what the plan is and the members will decide if that's an option for them or not." He said people who sign up will be protected by the contracts they sign instead of state regulators.

Hise rejected the idea that "all that's needed for something to be good is a little more government oversight."