O’Connor, representing Blue Cross Blue Shield of NC responded that most will have to purchase insurance in 2014. The thinking behind this law is that we must pool risk and cost to bring affordability. This was really the crux for reform. Most will have to purchase insurance and that is really good public policy. One of BCBS concerns is whether or not the penalty for not purchasing insurance is heavy enough to drive enrollment.

The penalty is about $95 in 2014 and goes up to more than $300. There is concern that young healthy people will find it’s not worth it and choose not to buy coverage. It’s up to all of us to make sure that everyone purchases coverage. If you don’t make the penalty tough enough folks will opt out and the system will not work.