01:00 AM EDT on Friday, October 29, 2004

THE ANNOUNCEMENT in Liz Anderson's Oct. 8 article, "Blue Cross loses state pact," that United Healthcare of New England will replace Blue Cross & Blue Shield of Rhode Island as administrator of the state employees' health plan effectively dispels the myth that the reason we don't have competition in the state is that no one can compete with the perceived almighty Blue Cross & Blue Shield, which has the majority of health-insurance business in the Ocean State.

What 99.9 percent of Rhode Islanders don't seem to understand (including health-insurance agents, elected officials, health-care providers, business owners, reporters, and talk-show hosts -- with all due respect) is that national carriers, such as United Healthcare, which don't need to ensure that they have X percentage of business from any one state, could very easily thrive in Rhode Island if our legislators made the necessary legislative changes to bring the carriers back.

If health-insurance markets were easily understood, we wouldn't have been suffering with our current crisis for as long as we have.

For dozens of years, such national companies as Mutual of Omaha, John Alden, Celtic, Principal Financial Group, and Trustmark offered high-quality and usually much more affordable health-insurance alternatives to individuals and small groups in Rhode Island. They did this alongside Blue Cross & Blue Shield for years.

What made them leave the state had nothing to do with the inability to compete with Blue Cross (which they had done for so many years, or else they wouldn't have stayed as long as they did), but it had everything to do with Rhode Island's unfriendly legislative atmosphere, which got worse and worse until it was so bad that they all left.

National carriers have been on record for two years saying what changes are needed if Rhode Island wants to see competition return to its health-insurance market.

These are changes that the majority of states have made. There, health-care costs are substantially less than in Rhode Island. Explanations of the reforms from national carriers are available at the Rhode Island Association of Health Underwriters Web site, www.riahu.org.

Implementing these legislative and regulatory changes would easily solve Rhode Island's health-care crisis and bring substantial price relief, along with more carriers and choices to Rhode Island.

New Hampshire once drove out dozens of carriers. It was down to only three when state officials finally fixed the health-insurance market there.

Now, a few years later, New Hampshire has eight carriers, and individuals save as much as 60 percent of what they used to pay in health-insurance premiums, for better coverage. Small businesses have saved as much as 40 percent.

New Hampshire residents began to reap the benefits within six months of some of the reforms' being enacted.

Just think: Health-care costs and options would no longer be a deal breaker to business owners and managers thinking of moving to Rhode Island if its insurance regulatory structure were simply brought up to date by implementing these reforms.

Can we count on our legislature to get the job done next session, so we might see some additional carriers back in Rhode Island, perhaps by next summer, along with much lower health-care costs and more choices? It remains to be seen whether our legislators will get the job done.

At least we all ought to know that it is the state's health-insurance regulations that are keeping carriers away, and not Blue Cross & Blue Shield. Let's at least put that myth to rest once and for all!

Emily Harding is the principal of Health Plan Specialists and founder of the Rhode Island chapter of the National Association of Health Underwriters (www.riahu.org).