NC’s ACA costs, subsidies among nation’s highest

Affordable Care Act Navigator Keith Ward works with Cindy Murray of Knightdale, N.C. helping her through the steps of enrollment at Alliance Medical Ministry in Raleigh, N.C.
Affordable Care Act Navigator Keith Ward works with Cindy Murray of Knightdale, N.C. helping her through the steps of enrollment at Alliance Medical Ministry in Raleigh, N.C. 2013 News & Observer file photo

Newly issued federal data shows that North Carolina has among the highest health insurance costs under the Affordable Care Act by a growing number of measures.

Data issued Monday shows that North Carolinians covered by the ACA receive some of the nation’s highest subsidies per person, and the number of subsidized people would be even higher if all eligible enrollees took advantage of federal financial aid.

According to data issued Monday by the independent Kaiser Family Foundation, the average monthly ACA subsidy in North Carolina was $401 as of March 31, the third-highest in the nation. Only Alaska and Wyoming had higher average monthly subsidies, at $750 and $459 respectively, while most states were under $300 a month.

North Carolina’s steep health insurance costs continue climbing under the ACA, which was designed to contain cost increases, and insurers continue saying they’re forced to raise rates to pay for a sicker population that had previously gone uninsured for years. Why this issue is more acute in North Carolina than in other states remains somewhat of a mystery, but it is now plainly visible through the federal data reporting that came with the Affordable Care Act.

“We as a state are not a particularly healthy state,” William Roper, dean of the UNC School of Medicine and CEO of the UNC Health Care System, said last week in a meeting with News & Observer editors and reporters. Roper said the state’s health care costs can be explained by genes, diets and health practices.

The ACA is about to enter its fourth year of mandatory enrollment with fines for those who fail to obtain health insurance. President-elect Donald Trump and Republicans in Congress have vowed to repeal or scale back the federal health care law, but it is likely to remain intact in 2017 and it is unclear how it will be dismantled. More than 11 million had enrolled nationwide, including 545,354 in North Carolina, as of last March, and the total enrollment in 2017 is expected to surpass this year’s numbers.

Whatever the cause of North Carolina’s rising costs, the numbers are inescapable: Blue Cross and Blue Shield, the state’s largest health insurer, is raising ACA rates 24.3 percent in 2017 after raising ACA rates 32.5 percent this year. Blue Cross serves as a proxy for the ACA in the state, being the only health insurer to offer ACA plans in 100 counties, and only one of two insurers on the exchange next year (Cigna will offer ACA plans in just five North Carolina counties).

About a half million ACA enrollees in North Carolina are subsidized, so that 85 percent of ACA enrollees in the state are paying less than $100 a month, and 77 percent are paying less than $50 a month.

North Carolina, with one of the nation’s highest ACA subscription rates, is expected to cost $2.4 billion in federal subsidies in 2016, constituting the country’s fourth-highest subsidy bill, Kaiser Family Foundation data shows. California, Texas and Florida had total larger subsidy bills because they had larger total enrollments, but on average residents in those states are getting much smaller subsidies than North Carolina residents: $271 in Texas, $305 in Florida and $309 in California.

The U.S. Department of Health and Human Services said Monday that the federal subsidy system is under-subscribed. The agency said that about 91.5 percent of ACA enrollees were subsidized this year, but 93 percent are eligible, with 52,700 North Carolinians who are enrolled this year being potentially eligible for subsidies in 2017.

North Carolina’s cost curve and subsidization rates show no sign of letting up. In October, the agency said that the average second-lowest-cost Silver plan for a 27-year-old went up by 40 percent, from $319 a month to $446 a month. That’s a statewide average, however.

The same plan went up by 51 percent in Guilford County, to $440; by 40 percent in Mecklenburg County, to $469; and by 37 percent in Wake County, to $401. The Triangle has among the lowest ACA rates in the state, which makes the region feel a little more like the rest of the country when it comes to ACA costs.

John Murawski: 919-829-8932, @johnmurawski