Raleigh and Charlotte account for North Carolina's highest enrollments for subsidized health insurance under the Affordable Care Act, according to new data released by the U.S. Department of Health and Human Services.
The federal data file released Thursday underscores the reality that high numbers of North Carolina's uninsured were living in the state's most affluent metro areas, in close proximity to some of the best health care services here that were beyond financial reach.
The data also reveal that while high enrollments were mostly concentrated in urban areas, pockets of low enrollments were scattered throughout the state. Outreach organizers said the information will guide their efforts this fall when they fan out to sign up residents for health coverage in the second year of the Affordable Care Act's insurance mandate.
"It's a really vivid reminder that we still have a lot of work to do," said Sorien Schmidt, state director of Enroll America North Carolina. "It also says to me we went to certain counties and really tried to help people there, and you can see that right here."
Schmidt pointed to Robeson County, one of the poorest in the state, as an example with high concentrations of insurance enrollments.
Earlier data had documented that North Carolina logged the nation's fifth-highest enrollment under the insurance law, but it wasn't broken down by region.
The newly released data represent enrollment numbers by ZIP code. The enrollments reflect totals as of April 19, at a point in time when more than 8 million had selected health plans nationwide, including 357,584 in North Carolina.
The national total has since fallen to 7.3 million as people have dropped out for various reasons, but state enrollment totals have not been updated in five months, and it's not clear how many have canceled policies in North Carolina. The state's largest insurer, Blue Cross and Blue Shield, said in May that about 15 percent of those who selected a health plan didn't pay their first monthly premium.
Cancellations can come about for a number of reasons. Some failed to pay their insurance premiums, others moved out of state or died, while others found jobs with health care coverage and didn't need an individual policy.
The new data show that ZIP codes with more than 2,000 enrollments are primarily in Wake and Mecklenburg counties, but they also include parts of Greensboro, High Point, Concord, Greenville and Asheville.
The Affordable Care Act, which requires most Americans to buy health insurance, provides subsidies for households with incomes between 100 percent and 400 percent of the federal poverty level. Those below 100 percent were expected to sign up for Medicaid, but North Carolina officials opted against expanding the federal insurance program for the poor, leaving several hundred thousand without coverage this year.
Higher unemployment rates and ingrained rural poverty likely mean that more residents in outlying areas didn't make enough money to qualify for the subsidies, said Adam Linker, health policy analyst with the N.C. Justice Center.
"You'll have somewhat of an urban-rural divide," Linker said. "Some of those folks in rural areas are living in an information desert, and a higher percentage of people fell into the Medicaid gap."
Pam Silberman, a professor at UNC's school of global public health, noted that about 40 percent of North Carolina's ZIP codes were not included in the new data dump. Federal officials did not release enrollments for ZIP codes with 50 enrollees or fewer.
Silberman said the federal data are difficult to assess because they don't disclose the total eligible population, so it's impossible to know whether a small percentage or a majority of eligible residents signed up for health insurance under the Affordable Care Act.
"They don't tell you anything by themselves," Silberman said. "You can't go to any ZIP code and know whether they've done a good job or bad job enrolling."
Staff researcher David Raynor contributed.