N.C.’s ACA enrollment drops as repeal looms

North Carolina’s total enrollment under the Affordable Care Act has slipped since last year, a first for the state since health insurance was sold under the federal health care law.

The enrollment update was issued Tuesday in the waning days of the Obama Administration as part of a last-ditch effort to salvage the ACA from what appears to be an imminent Congressional repeal. The ACA promotional campaign will also feature messaging on TV, radio and social media – as well as reminder letters from the IRS to people who are still uninsured – until open enrollment ends Jan. 31.

Federal data show that North Carolina’s total ACA enrollment was 534,293 as of Dec. 31, down 4.4 percent from 558,892 enrolled a year ago. North Carolina remains one of the highest-enrolling states in the country under the law, commonly known as Obamacare, behind only much larger states like Texas, Florida and California.

North Carolina, however, is down to one statewide ACA insurer, Blue Cross and Blue Shield, after Aetna and UnitedHealthcare decided last year to drop ACA coverage for a quarter of a million customers at the end of 2016. Aetna and United didn’t cover all 100 counties of North Carolina, but the carriers sold ACA plans in most metropolitan areas. The only other ACA insurer, Cigna, covers just five counties in the Triangle.

Federal officials, speaking in a conference call with journalists, said North Carolina’s early success in enrolling residents is the best explanation for the state’s apparent lag this year.

“There are fewer remaining uninsured,” said Christen Linke Young, Principal Deputy Director of the Center for Consumer Information and Insurance Oversight at Centers for Medicare Services, which administers the ACA.

“North Carolina is one of those states,” she said. “It is harder to reach the people who are still uninsured.”

Republicans have excoriated President Barack Obama’s signature domestic policy achievement on many fronts, including the federal mandate requiring most Americans to purchase health insurance even if they don’t want to. Republicans have also decried what they say is the resulting cost increases the law caused by forcing health insurers to cover people who are ill and have preexisting conditions who were previously considered uninsurable.

Officials with the U.S. Department of Health and Human Services repeated their warning Tuesday that the Republican strategy of quickly repealing the health law, and delaying the repeal’s effective date by a year or more, could unravel the health insurance markets the ACA has created. Republican opponents of the ACA, who had tried to repeal the law more than 60 times while Obama was in the White House, have promised they will implement a replacement health care law but have not offered a concrete proposal.

Nationwide ACA enrollment is at 8.7 million, up from 8.6 million a year ago, in the 39 states like North Carolina that use the federal marketplace instead of their own ACA exchanges. Total national enrollment is at 11.5 million, about 286,000 ahead of enrollments one year ago, HHS said.

Officials said Tuesday they expect a spike in enrollments in the final days of open enrollment, especially among young, healthy people.

“They are among the great procrastinators,” Young said.

The officials said that this year saw the largest premium increases since the ACA markets became effective in 2014. But they said that federal premium subsidies cover most of the premium increases, so that most customers can get a plan for under $75 a month with subsidies.

Federal officials said Tuesday that insurers had previously underpriced their products; they now predict that prices have stabilized, absent Republican attempts to gut the law.

A report issued Tuesday from the Council of Economic Advisers, an agency within the White House, said that this year’s price increases were a one-time adjustment. The report said rates increased 22 percent on average nationwide, the highest annual adjustment since the ACA policies became available.

Blue Cross raised its rates 24.3 percent on average this year, after raising rates 32.5 percent last year. The Durham insurer has said it lost $405 million in ACA plans in two years. Blue Cross, like other insurers, has been trying to control premiums by eliminating some doctors and hospitals from covered networks and shifting customer costs from monthly premiums to annual deductibles.

This story was originally published January 10, 2017 at 3:16 PM with the headline "N.C.’s ACA enrollment drops as repeal looms."