Point of View

How NC (surprisingly) became a leader in ACA enrollment

January 28, 2014 

While North Carolina has refused to expand Medicaid under the Affordable Care Act and many politicians continue to complain about the federal health exchange, the roll-out of Obamacare in N.C. tells a far more positive story.

North Carolina is enrolling uninsured people at a rate at least twice that of any other state that has refused to set up its own health exchange and refused to expand Medicaid. In short, among states that are dragging their feet on the Affordable Care Act – no advertising campaigns, no speeches by the governor on how important it is for everyone to have access to health care, no Medicaid expansion that guarantees the lowest income workers coverage – North Carolina is by far leading the pack in private plan enrollment.

Even with the federal health exchange’s shaky start, N.C. has already enrolled 107,778 uninsured people in private health plans. Compare that with Virginia (44,676 enrolled), South Carolina (24,116), Georgia (58,611), and Tennessee (36,250). Only states like Florida and Texas with many more uninsured people than North Carolina are enrolling anywhere near our raw numbers, and they are far behind us in the percentage of uninsured getting coverage.

So what’s going on? There are several answers. Our success starts with North Carolina’s excellent Medicaid managed-care program, Community Care of North Carolina. Even though Gov. Pat McCrory and legislative leaders declined the federal opportunity to expand Medicaid, N.C. Community Care has provided a natural framework to enroll uninsured people in private health plans.

Under Community Care, local doctors, hospitals, health centers, health departments, social service offices, legal service providers and other community leaders have been quietly working together every day, every month and every year for a decade to help people access and use health care. Because of this, North Carolina’s Medicaid program is already a huge success both in delivering great care and containing costs. N.C. has had the lowest growth in Medicaid spending in the nation since 2007, according to the Kaiser Family Foundation. And a recent report from the N.C. General Assembly’s fiscal staff pointed out that North Carolina’s spending on Medicaid claims per person has declined overall by 11.6 percent since 2008. These cost savings have taken place while national Medicaid spending per person has increased by 6 percent over the same period.

So, when the Affordable Care Act’s health exchange opened for business, there were already networks with proven records of success in helping people get health care. These organizations jumped right in to the enrollment effort because they work with uninsured families every day and know what a huge benefit this is. In my organization’s outreach meetings around the state early on, we saw continual evidence of well-informed leaders from these types of groups already planning enrollment strategies.

Starting from the Community Care base doesn’t explain all our enrollment success, however. Excellent work by North Carolina’s legal aid program – which established an N.C. number (1-855-733-3711) so anyone could easily make an appointment with a counselor to talk over insurance options – an enormous investment in time and energy from local Community Health Centers around the state, a new office of an independent nonprofit focused on enrollment (Enroll America) and the work of many nonprofit and community groups all were indispensable.

Ironically, it is this very success driven by nonprofits and local leadership that points out not only the costs of North Carolina’s resistance to the Affordable Care Act but also the dangers of the current debacle going on in our own N.C. Department of Health and Human Services. Our locally driven success on Medicaid and the Affordable Care Act can survive only so long from assaults such as McCrory’s constant refrain that our money-saving, award-winning Medicaid system is “broken.”

Meanwhile, the governor’s own administration seems to be working hard to “break” Medicaid, with actions such as sending 49,000 Medicaid cards to the wrong children, paying exorbitant salaries to well-connected consultants and political operatives and not even being able to effectively pay hospitals and doctors for the Medicaid services they provide.

The good will and hard work of people across North Carolina have once again made our state a national leader in health – despite an increasingly hostile and discouraging environment being created in Raleigh. For McCrory, governor of all the people – including the hundreds of thousands of residents currently eligible for coverage under the Affordable Care Act – recognizing, celebrating and encouraging our success rather than attempting to dismantle it should be first priority.

Adam Searing is director of the Health Access Coalition for the N.C. Justice Center.

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