PLATTSBURGH The attention of leaders at the state level has been received in the hopes its effect will mean closer examination of the health insurance market and health care industry in Clinton and Essex counties. The Plattsburgh-North Country Chamber of Commerce held a forum Dec. 4 in which New York State Health Insurance Superintendent Eric R. Dinallo listened to and addressed concerns of the chamber of commerce Health Insurance Task Force. The main objective of the forum, which chamber president Garry F. Douglas said was ultimately achieved, was to stress to Mr. Dinallo the stark difference between the rural and urban health care system and health insurance market. "We cannot be treated the same in Clinton, Essex and Franklin counties as Albany or Syracuse or Binghamton or Buffalo," said Mr. Douglas. "The marketplaces are different. The types of practitioners are different. We are still dominated by sole practitioners struggling to maintain a quality of life and a small practice on the same reimbursement level that actually delivers a much higher standard of living to a group a practice in Albany." The issue was sparked when former state Insurance Superintendent Howard D. Mills III approved a carve-out of Clinton and Essex counties from the Albany community rating region for purposes of setting health insurance premiums, said Mr. Douglas. That decision was later reversed by Mr. Mills following public scrutiny, though was reinstated upon a lawsuit filed against the state by Blue Shield of Northeastern New York. The decision ultimately led to the ability of companies such as Blue Shield to charge a higher differential rate in Clinton and Essex counties alone. "That's a remarkable precedent because it is the beginning of the unraveling of the regional community rating system in upstate New York," said Mr. Douglas. The precedent a decision such as that would set, said Mr. Douglas, was understood by Mr. Mills predecessor, Gregory V. Serio, who vehemently opposed such action. Regardless, the decision was made by Mr. Mills, he said, and small coverage groups within the two counties are expected to see rates to increase 20 percent beginning Jan. 1. However, there has also been debate as to whether or not Mr. Mills original approval was granted on a two-year trial period basis, documentation of which has yet to be found. If the agreement was made verbally, said Mr. Douglas, the legality and upholding of the agreement would be as impossible to enforce as any other verbal agreement. If such actual documentation of an agreement does exist, said Mr. Dinallo, his department will find it and see it is complied with, essentially providing a window of opportunity to abolish the Clinton and Essex counties carve-out. The issue of adequate reimbursement is also being examined at the state level, said Mr. Dinallo. The prior approval of rates by the state is essential in ensuring health care providers are provided with proper compensation for their services. "Without prior approval, it is our incumbent responsibility to robustly check at the end of the year whether they have reported with their actuarial projections as to why they needed the increased rate," said Mr. Dinallo, "and if they havent made the right kinds of payments with the consumers and providers, there ought to be a serious kind of calling on the carpet about this." Mr. Dinallo explained while it is perfectly legal to perform "file and use," which essentially allows health insurance providers to set their own rate and furnish just cause at the end of the year, the insurance providers need to follow through with their reporting. "This is not for me to threaten every health insurance provider in the state," explained Mr. Dinallo, "but if you dont want to engage in a regulatory understanding and coming to agreement on a rate, but instead want to basically have a file and use, which is perfectly legal, you need to be scrupulous about reporting on the back end." In addition to tackling the problem of adequate reimbursement, Mr. Dinallo further said the states Medical Malpractice Task Force has been charged with the task of finding "better or more creative" ways to attract and retain physicians. Government subsidies for struggling hospitals and recruitment incentives such as student loan forgiveness to attract physicians are possibilities being examined to help short term. A silver lining which can be found in the seemingly dark cloud, said Mr. Douglas, is that more attention has been drawn to the issue, with the hope of drawing other health insurance providers to the area. The ability to charge slightly higher rates in Clinton and Essex counties could initially lure more providers which would ultimately mean more competition, and eventually lower rates, he said. "I do think that will help; it will help drive down costs," Mr. Dinallo said of giving the community more choices for health insurance providers. In the long term, said Mr. Douglas, reform is needed, though it is essential future reform recognizes the rural versus urban health care issue. "The same policy when applied will actually destroy health care in a rural area, though it might be manageable to bigger interests in metro areas," said Mr. Douglas. "It really is a different market, its a different set of concerns for people in the North Country," Mr. Dinallo said in recognition of Mr. Douglas comment. "Permitting these carve-outs, permitting these predated sectionalizing is really a negative to the benefits that usually come out of insurance, especially health insurance. Costs spiral very, very quickly when you create a smaller and smaller pool." It is imperative businesses be able to provide health insurance to their employees at a reasonable cost, said Mr. Douglas, as many are making the decision of whether to be insured or to be able to afford other necessities. "There are those who are going without because they cant afford it," said Mr. Douglas. "That critically undermines everything we want to achieve in this area." "Our hospitals are struggling to stay afloat while doing an outstanding job to make sure we have all the critical services we need, in spite of the fact the numbers make it very hard to sustain those services," said Mr. Douglas. "The crisis isnt just looming, its now here."