Charles T. Frock, CEO of FirstHealth of the Carolinas, spoke on hospitals and how they deal with the uninsured during the opening session of the Winter Membership Meeting of the North Carolina Hospital Association (NCHA).

The NCHA is a statewide association representing 135 hospitals and health networks. Frock is its chairman this year.

Among those attending the Winter Membership Meeting, which was held Feb. 21-22 at Embassy Suites in Cary, was Rich Umbdenstock, president of the American Hospital Association.

A CEO of various health care systems and hospitals for more than 30 years, Frock has served in his current position with FirstHealth of the Carolinas since 1991. He was recently recognized as a Fellow by the American College of Healthcare Executives.

In a speech titled "We Are the Stewards of the Uninsured," Frock told his NCHA audience that most Americans don't spend much time thinking about health care in general and even less time thinking about the plight of the working uninsured. There is a reason, he pointed out.

"You could say that we already have universal coverage in this country," he said. "It's called the emergency room and EMTALA."

Passed as part of the Consolidated Omnibus Budget Reconciliation Act of 1986, EMTALA (Emergency Medical Treatment and Active Labor Act) is a federal law that governs when and how a patient can be refused treatment or transferred from one hospital to another when he is in an unstable condition.

"People are being cared for, even the uninsured," Frock said.

According to Frock, health care hasn't done a very good job of raising awareness about the uninsured.

"That isn't our job," he said. "Providing health care is. And we do that so well that most people aren't worried that it won't be there for them when they need it."

But, he pointed out, a growing number of states and health care organizations around the country are "becoming the stewards of a solution instead of remaining victims of the problem" by taking the lead to resolve the issue of the uninsured.

One, he said, is the state of Maine and its universal coverage experiment called "Dirigo" or "I lead." Another is FirstHealth of the Carolinas and its FirstPlan product, a group of benefit plans tailored for small businesses and offered through FirstCarolina-Care, FirstHealth's wholly owned health plan subsidiary.

The FirstPlan model spreads the costs of covering the uninsured among five participants: the health system, the physician network, the insurer, small business owners and small business employees.

"Through the strength of these partnerships, we have successfully offered FirstPlan to small businesses and now have 500 previously uninsured enrollees in our market, or about a 10 percent reduction in Moore County," he said. "This may sound like a modest impact. But nationwide, a 10 percent reduction would equal 4.5 million people. In North Carolina alone, it is about 100,000."

Frock also spoke about a second, and less successful, FirstHealth venture to cover the working uninsured. Called CoverMoore and modeled after FirstPlan, it was offered in partnership with the Moore County Chamber of Commerce to create an affordable health plan for Chamber members.

The goal was to cover 400 previously uninsured workers. However, when the program ended after an aggressive four-month promotion, only 130 had been identified.

"When the dust settled, we held a debriefing and concluded that the product was too complex, perhaps too exclusive, and had the appearance of uncertainty," Frock said. "We determined that there was still misunderstanding about the value of health insurance among employers and their young and healthy employees, who often opt out of insurance. Most importantly, and despite our vigorous communications, the employer community just didn't see the uninsured as its problem. There wasn't sufficient demand for the product."

Frock predicted that as with automobile liability insurance, which is required by all but three U.S. states, universal health-care coverage may have to be mandated before it can be realized.

In closing, Frock encouraged his audience to do three things in the coming year:

n Raise awareness in local communities about the issue of universal coverage

n Support efforts at the state level to broaden coverage

n Remind federal-level senators, representatives and their staffs just how crucial universal coverage is

"I urge each one of you to turn up the volume in your provider communities," he said. "Inspire creativity; be a catalyst to the cause. Make something happen to reduce the ranks of the uninsured. Sooner or later, one of us will find the grail, but only if we keep searching."