- Causey says that flood insurance, safer roads, better senior care, and fighting insurance fraud are top priorities in 2025.
North Carolina Insurance Commissioner Mike Causey says the need for statewide flood insurance coverage tops his list of 2025 priorities. The devastating effects of Hurricane Helene on western North Carolina in late September left thousands of people with no home, and no coverage.
“We learned a hard lesson back in 2018 when Hurricane Florence hit where we had 23 counties underwater,” Causey told Carolina Journal in a phone interview Wednesday. “We had over 100,000 people that lost their homes and everything in it, and then we find out after the fact that most of those people had no flood insurance because homeowners’ insurance policies do not cover floods or earthquakes. So, after Florence, you had between 80,000 and 100,000 homeowners who filed claims on a homeowners’ insurance policy and got $0 because it was all flood damage.”
He said when Florence hit, less than 2% of homeowners in the state had flood insurance. Soon after, the Department of Insurance (NCDOI) went across the state with an educational program that talked with and got continuing education credit for realtors, insurance agents, engineers, architects, surveyors, and other groups about the need for flood insurance. As a result, there has been a small uptick of homeowners who now have flood insurance, primarily along the coast.
Most people in the mountains, however, don’t have flood insurance and never expected to have their businesses or homes washed away from floodwaters after Helene, with losses Causey said are estimated to be between $50 and $60 billion.
He would like to see the General Assembly develop a plan similar to what the legislature came up with in 1969, which was called the Beach Plan but is now known as the Coastal Property Insurance Pool.
While the legislature doesn’t administer the plan, it is still considered a state plan designed for those who couldn’t get homeowners’ insurance through a private company.
The North Carolina Joint Underwriting Association provides coverage by using international reinsurance companies that write reinsurance insurance for specific amounts, which is very similar to a private homeowners insurance policy.
Causey said that the program has worked very well, and close to 70% of the homeowners in North Carolina’s 20 coastal counties are covered under the state plan. The North Carolina General Statutes have defined it as the “Market of Last Resort,” but he said that for many counties, it is their “only resort” or choice they have.
Causey told CJ that more insurance companies need to be willing to write private home flood insurance policies and hopes that the state legislature will look at other ways that the state could help.
“It really needs to be almost a requirement, so I think looking at different options, working with the insurance companies and the insurance industry to see things they could do,” he said. “We launched an effort after Hurricane Florence to work with the North Carolina Rate Bureau, and it took a couple of years, but we got approved in North Carolina private flood insurance policies.”
Health Insurance Task Force on “prior authorization”
A second priority for Causey is to convene a task force with health insurance companies and medical providers to make sure there is a level playing field in the healthcare insurance markets and to make sure that patients and policyholders are getting a “fair shake” for the premium dollars they pay. One of the main focuses he said will be on health plan prior authorization policies.
“I hear from lots of doctors and hospitals about how difficult it is to get reimbursement from some of these health insurance companies and the hoops they have to jump through,” he said. “We have a big problem with the cost of prescription drugs, and you’ve got the insurance companies that are really controlling a lot of that through what’s called pharmacy benefit managers, and they’re basically driving the small independent pharmacies out of business. They won’t even reimburse the pharmacy enough to pay what the pharmacy has to pay for prescription drugs.”
Causey said he thinks what brought a lot of this to the forefront was the reaction to the murder of United Healthcare CEO Brian Thompson, who was assassinated in New York City in December.
“Instead of people having sympathy for the family and the tragedy that happened, you had people saying, ‘well, that’s those evil insurance companies,’ so that was very disturbing,” he said. “But I’ll tell you, it hit a nerve with the public because as I’ve traveled across the state on a regular basis almost every week, either there’s a patient complaining to me about being denied some necessary prescription. The health insurance company says ‘you can’t have this, you’ve got to have a generic version’ or they’re denied some sort of medical treatment that the doctor said is necessary, and they’ve overused this term they called prior authorization, and it’s really become a public policy concern.”
Causey said the head of United Healthcare in North Carolina and a large medical provider are very interested in joining the task force.
safer roads, senior care, and insurance fraud
Other priorities include fighting distracted driving, which he said we are all paying for, either with higher insurance rates due to the number of accidents that keep going up across the state or with their lives with the number of fatalities.
Causey would like to see a “hands-free bill” passed in the state that would allow drivers to talk on their phones but not hold them while driving.
He also said the state needs another 200-300 state troopers out on the roads enforcing driving laws.
“We don’t have enough officers,” Causey told CJ. “So, I’m hoping the General Assembly will look at those issues this year and appropriate whatever money is necessary for the Highway Patrol to recruit and retain more officers and other law enforcement agencies having similar issues.”
Fighting insurance fraud, which has been a priority of his since he took office in 2017, also remains on his radar.
“We have one of the best criminal investigation divisions in the country,” Causey said. “We have officers that are sworn as United States Marshals. They’re top-notch law enforcement, and they really do a heck of a job in going after the perpetrators, and there’s a lot of insurance fraud.”
He told CJ that almost half the claims submitted for Medicare, Medicaid, and many other health insurance claims are fraudulent, and it’s not that difficult to prove insurance fraud.
“If you lie to an insurance company to get a higher reimbursement, that’s fraud, and it’s a felony if you’re convicted,” Causey said. “So, we take it seriously, and there are 400 to 500 arrests every year, and most of those end up getting convicted.”
Finally, he talked about the insurance department overseeing continuing care retirement communities.
“We’ve got legislation pending, and I’m hopeful the legislature will act on that,” Causey said. “We need tougher state regulations for the Department of Insurance to go after the violators. We’ve had a number of cases where our senior citizens have been taken advantage of by some of the staff at some of these facilities, with the financial abuse and the money comes from the people that are there. Your loved ones, your parents, your grandparents, your family members.”
One example of this is Aldersgate, a Charlotte non-profit senior living community.
He added that the department goes to prosecute the cases and finds they don’t have “the teeth in the statutes” to really do what needs to be done.