Wayne Goodwin, North Carolina’s insurance commissioner, isn’t a household name, but his work on behalf of consumers affects almost every household. His pushback against rising homeowners insurance rates has insurance companies suing him in state court. And his skepticism about requested hikes in auto insurance has helped give North Carolina the lowest rates in the nation.
But when it comes to health insurance rates under the Affordable Care Act, the consumer’s champion has done little. It’s not that Goodwin doesn’t want to help North Carolinians facing double-digit rate hikes. It’s that he’s not allowed.
“I’m frustrated, angry and sad that in many ways our office is prohibited from acting in ways that I expect and the people expect. We can do better, as a state we can do better,” said Goodwin, a Democrat elected statewide.
Republicans who control the legislature are unlikely to sympathize with Goodwin’s lament. For Republicans, the messier and more expensive “Obamacare” gets in North Carolina, the better. After all, they said it would be a “trainwreck,” and in North Carolina they did all they could to bend the rails.
A 2013 law passed by the Republican-controlled General Assembly barred the state from expanding Medicaid, setting up its own ACA exchange or partnering with the federal government in running one. By default, North Carolinians who want the ACA subsidies must buy insurance through the federal exchange at Healthcare.gov. The state law also ordered the Department of Insurance and the Department of Health and Human Services to return $74 million in federal aid that was intended to educate North Carolinians about the new health care law and help them choose the best plan for their circumstances.
With another round of ACA enrollment starting Nov. 1, North Carolina’s average premium increase is among the highest in the nation. Blue Cross/Blue Shield, the only insurer selling ACA policies statewide, is boosting premiums by an average of 32.5 percent. The two other companies selling ACA policies regionally are increasing premiums by an average of more than 20 percent.
About a half million North Carolinians who bought insurance through Healthcare.gov are wondering how to respond, but the law forbids the state Department of Insurance from offering advice on how to shop for a more affordable plan. Callers to Goodwin’s department are told they need to talk to Uncle Sam.
What’s maddening for Goodwin isn’t simply that he can’t give advice to consumers. It’s also that the lack of a state exchange hobbled his ability to attract more insurance companies to sell ACA plans in North Carolina – an increase in competition that would have held down rates.
“In 2011, I already had two companies that expressed interest in coming to North Carolina,” Goodwin said. “I’m confident if we stayed on the path of (setting up) a state exchange, we would easily have five more companies.”
The insurance commissioner also regrets that he is blocked from taking a tougher line on rates submitted by the few companies that are selling here. “It would have helped if the state had left me with the muscle to push back and fight for consumers,” he said.
The legislature’s resistance to all aspects of the ACA is costing consumers several ways, Goodwin says. There’s a 4 percent tax for using the federal exchange that might be lower with a state exchange. Insurance companies bake that federal tax into their rates. The legislature’s unwillingness to expand Medicaid under the ACA puts sicker and more expensive patients into the ACA insurance pool, driving up rates. And the lack of expansion increases costs for hospitals, which leads to higher premiums for anyone buying health insurance in North Carolina.
No state exchange, no state insurance department advocacy, no Medicaid expansion have “put us in North Carolina, in many respects, at ground zero for the worst possible result,” Goodwin said.
For a state official committed to getting the best deal, Goodwin is bewildered that partisan animosity is taking money out of the pockets of North Carolinians. He said cooperation in Congress could fix some of the ACA’s flaws and the General Assembly could reduce costs through Medicaid expansion.
Goodwin calls the effect of the GOP’s hardline “a stubborn tax.” And he thinks it’s time for that tax to be repealed,
“The point that was to be made has been made,” he said. “Let’s move on. Let’s help North Carolinians, let’s have lower rates, let’s serve our families, let’s help people in rural hospitals, let’s save our budget from sending more and more money down a hole when the money could go to our public schools.”
It all makes sense, but the reflexive opposition that contributes to North Carolina’s higher rates doesn’t have anything to do with sense.
Barnett: 919-829-4512, firstname.lastname@example.org