Both major gubernatorial candidates want to make health insurance more affordable and accessible to the 1.5 million uninsured North Carolinians.
But they would tackle the problem in very different ways.
Charlotte Mayor Pat McCrory, the Republican, favors incentives, such as tax credits, to encourage more of the uninsured to buy private insurance.
Lt. Gov. Bev Perdue, the Democrat, would expand government-funded programs, such as Medicaid and the state children's health insurance program, to cover more children and their low-income parents.
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Both candidates support tax credits to help small businesses or their employees obtain insurance.
Mike Munger, the Libertarian candidate, supports efforts to reduce the cost of primary care so it would be more affordable, even without insurance. He favors health insurance that covers catastrophic events rather than routine care. And he favors increasing the role of physician assistants and nurse practitioners to make primary care less expensive.
Despite these plans, health care hasn't received as much attention as education and transportation in this election. Given the economic downturn and the slowdown in state tax revenue, the successor to Gov. Mike Easley may not have the money for bold moves to help the uninsured.
“It may take a more phased-in approach,” said Tim Crowley, Perdue's press secretary.
Jack Hawke, general consultant to the McCrory campaign, said any governor will probably have to wait for a second term before keeping promises to spend more on health care.
“We can't even run our health plan for state employees, we're so far in debt,” he said. “That's just a reality check.”
Meanwhile, the number of uninsured in the state has increased by more than 200,000, or 16 percent, in the past five years, according to the U.S. Census Bureau.
When it comes to health insurance, children are one of the three groups most likely to be uninsured, said Pam Silberman, president of the N.C. Institute of Medicine.
Others likely to be uninsured are adults who earn about $42,000 or less and people who work in businesses with 25 or fewer employees.
Many states are expanding public health programs to cover more children and poor adults. Small businesses are a particular challenge in a system that relies heavily on employer-provided health insurance. “Everybody's trying to figure out a solution to cover small businesses,” Silberman said. “How much tax credit do you have to give somebody to encourage them to offer health insurance?”
No matter who wins, the new governor will need cooperation from state legislators. Still, a governor's endorsement is important to make anything happen, said N.C. health analyst Adam Searing.
He saw it a decade ago when Easley threw his weight behind the passage of a “patients' rights bill” that allows patients to sue insurance companies that deny necessary medical coverage.
“We finally got somewhere when Gov. Easley came in and made this a priority,” Searing said. “He got all the major players together, the insurance companies and doctors, and made everyone sit down and hash out their differences.