But West Virginians can do something about homegrown factors that drive up insurance prices, he said. They can bring down the price difference between West Virginia and Ohio. He pointed to one slide after another.
Three cities — Fairmont, Clarksburg, and Morgantown — want to build hospitals within 38 miles of each other on Interstate-79. "It all drives up the cost of insurance," Smith said.
"Greed exists all over this system," Smith said. "It's a universal problem." Several people nodded like they were in church.
As Smith spoke, people milled about the exhibit area down the hall where third party administrators had set up displays, offering creative ways to shift costs onto employees. "You can't just keep increasing the deductible and co-pay indefinitely," Smith said.
He flashed slides of a five-point plan his staff feels might drag insurance bills down: "We don't want to suggest that ours is the only approach," Smith said. "If somebody has a better plan, great. Let's get the ideas out there."
Weeks after he spoke to the personnel directors, Smith is still fine-tuning his ideas. He's getting a good reception, he says, but a Wise administration official dismissed his idea of bare-bones insurance, objecting that it doesn't provide for primary care or elective surgery or immunizations.
Once you add those things back in, Smith counters, you have a policy that is already on the market. And many people can't afford $200 or more a month. It doesn't help to offer people things they can't get.
That question will be the subject of much debate in months to come. More than half of the uninsured working-age adults (53.1 percent) in West Virginia make less than $20,000, according to the recently produced West Virginia University study of uninsured people in the state.
"I had a waitress tell me, 'I can't afford these products that you have on the market,'" Smith said.
"She's a single mother. She said, 'What scares me to death is that emergency hospital claim I have to pay for the rest of my life.'"
"That's the fear," Smith said. "That's what this would take care of."
We've got to think outside the box and make new plans that fit the times, Smith says. "We've got to be looking 20 years ahead."
Mountain State Blue Cross/Blue Shield will soon offer elementary schools those grants to develop healthy living programs. It already runs Dean Ornish programs to help people reduce and reverse heart disease. Management is looking at ways to offer lower premiums for people who take care of their health, Smith said.
He challenges others to get their ideas out there. "Everyone has to take responsibility to help solve this," he says.
"We don't expect everyone to agree with ours. The important thing now is to get the discussion going. If you wait until the door's about to shut, it's too late to do anything about it."
That prospect, he says, scares him more than anything.
The "Everybody at Risk" series will continue in coming months, following uninsured people, people in danger of being uninsured, and people who are trying to do something about it. Visit www.wvgazette.com/uninsured for information and links.
Staff writer John Heys contributed to this report.
To contact staff writer Kate Long, use e-mail or call 348-1798.