“Last year, when the economy tanked, we were turning eight to 10 patients away” from the weekly general medicine clinic, Long said Tuesday, adding that the number has stabilized in recent months.

In Henderson County, 22,000 people qualify for services at the Free Clinics based on income and insurance coverage.

Wilson understands the challenges of providing medical care. he recently was named CEO of BlueCross BlueShield of North Carolina and is touring rural communities in the state this week, trying to better understand the health care system.

He supports the Free Clinics. the BlueCross BlueShield Foundation has awarded the organization more than $150,000 in grants and has allocated $10 million in funds to free clinics around the state. the organizations help fill some of the coverage gaps in the health system, Wilson said.

The business of health care is challenging, he said. Congress has debated health care reform for well over a year, and insurance companies don’t know how the industry’s rules and regulations will change if President Barack Obama signs a bill.

“We have been very clear from the beginning of this debate that we support health care reform,” Wilson said. “But simply because we don’t support everything in the Senate bill does not mean we oppose reform.”

The House and Senate passed versions of health care reform legislation last year. it appears the Obama administration plans to have the House pass the Senate version and then reconcile the bill.

“Until the rules become clear, it becomes difficult to adequately plan,” Wilson said.

The health care debate has not been a smooth process for BlueCross BlueShield.

The company got into trouble with the Attorney General’s office in January after it hired a firm to perform “robocalls,” or calls with voice recordings made to households advocating the company’s position on reform. the company opposed a public option, which would give people the opportunity to buy health insurance from the federal government and compete with private insurance companies.

“It would be bad competition,” Wilson said.

BlueCross BlueShield agreed to pay a $95,000 fine because the calls violated rules that regulate mass calls in the state.

Wilson said it would be unfair for a private company to have to compete with the federal government. the government does not pay taxes and is not required to balance its budget each year.

Proponents of the public option argue that it would force insurance companies to compete. They would have to lower premiums to attract customers away from the federal insurance program.

The House bill has a version containing the public option, but the Senate bill does not.

Wilson said he has serious concerns about the Senate bill. under the legislation, people are required to buy health insurance if they don’t receive it through work, and companies are required to insure all of their employees.

Wilson said the Senate bill has too many loopholes, and the penalties are not stiff enough. the purpose of reform is to increase the number of healthy people who are insured in order to spread the costs, but the Senate bill keeps too many people outside the system, he says.

“Auto insurance works because everybody must be in, and the penalties are high,” Wilson said.

‘A price to pay’

BlueCross BlueShield conducted a study of the Senate bill based on the numbers from the Congressional Budget Office. the study showed North Carolina residents could see a 55 percent increase in premiums and small businesses could see a 31 percent increase.

Obama has argued that the increase is not from premium increases, but from regulations on the minimum coverage required in a health insurance policy.

“There is a price to pay for whatever the mandates will be,” Wilson said. “There is very little in (the bill) that will contain costs. We are all for coverage, but there is a cost.”

Insurance companies are willing to support reforms, such as forbidding denial of coverage for pre-existing conditions, if the exemptions are removed from the Senate bill.

“Like car insurance, if you get a larger pool, you can spread the risk,” he said.

The role of government in reform should be to subsidize lower-income people in order to help them pay for private insurance, Wilson said.

“It took us 60 years to get here,” he said. “I’m not sure how you think you can solve a 60-year problem with one piece of legislation.”

Insurers' CEO talks health care