More than half-a-million people in North Carolina have signed up for Affordable Care Act health insurance in a year that was supposed to mark the beginning of the collapse of the federal health insurance law.
National ACA enrollment was 8.45 million people, just 3.3 percent lower than a year ago, the Centers for Medicare & Medicaid Services reported Thursday.
North Carolina’s enrollment also declined in line with the national average, logging 502,464 people, down from 519,803 a year earlier. North Carolina has consistently ranked fourth nationwide in total ACA enrollments, behind Florida, California and Texas.
The enrollment numbers could still rise because they don’t include a last-minute surge of applications that haven’t been processed yet, the federal agency said in a news release. More than half the total enrollments took place in the seventh and final week of open enrollment, which ended Dec. 15, according to agency data.
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The strong enrollment totals were surprising because, after 70 failed congressional attempts to repeal the 2010 law, commonly known as Obamacare, several changes were expected to make ACA coverage less enticing. The federal government eliminated the financial penalty for failing to get health insurance and expanded availability of cheaper options, such as association health plans and short-term health plans that don’t have to offer the same level of coverage as ACA plans.
Meanwhile, just a week ago, a federal judge in Texas overturned the ACA, declaring it unconstitutional, but that decision is on hold while the case is appealed.
ACA coverage for 2019 becomes effective Jan. 1.
“I thought it was going to be a real challenge,” said Mark van Arnam, co-director of the N.C. Navigator Consortium
in a phone interview. “But people have found this coverage to be valuable.”
The Navigator Consortium deployed about 150 navigators this year, down from about 250 last year, because federal funding for the program was cut from $2.5 million to $500,000. The nonprofit consortium trains and oversees navigators throughout the state to instruct the public on the ins and outs of health insurance benefits so that people can make informed decisions on ACA coverage.
ACA plans are sold directly to individuals and their families, with federal subsidies for lower- and middle-income households. In North Carolina, about 90 percent of people covered under the ACA received some level of subsidization, and the people at the lowest income levels of eligibility can get health insurance without paying a monthly premium.
The more than 8 million signups are those buying individual health insurance on the federal marketplace, in 39 states that don’t have their own exchange to sell the plans.
“Enrollment is down, but not by as much as many expected given the substantial headwinds created by policy changes at the federal level,” said Larry Levitt, senior vice president for health reform at the nonprofit Kaiser Family Foundation in an email. “The ACA marketplace has been incredibly resilient, in large part due to the federal premium subsidies that make coverage much more affordable for low- and modest-income people.”
Adding to the ACA’s woes, the nation’s historically low unemployment rate means more people have jobs, which translates to more people having access to employer-sponsored health insurance, so they don’t need to buy ACA coverage on a federal or state exchange.
Even amid declines in enrollment, there was an increase in seven of the 39 states that use the federal ACA exchange. In the other 11 states, including California and New York, enrollment totals have not been reported because the open enrollment periods typically last longer than the federal period that ended Dec. 15.
But some forces are working in favor of the ACA. In North Carolina, Blue Cross and Blue Shield cut its ACA rates 4.1 percent statewide, which ranged from a cut of 22.5 percent to a 9.5 percent increase, depending on the policy and the county in which it was purchased. The Durham insurer said that the rate cut would save a $140 a month on average in the Triangle.
Blue Cross is the only insurer that offers ACA plans in all 100 North Carolina counties.
It’s not clear how the recent changes to the law affected North Carolina enrollments. The Trump administration expanded the use of so-called association health plans, but those aren’t being offered in the state at this time.
Short-term health plans, which don’t require coverage of pre-existing conditions and have more flexibility in charging more to sicker and older people, had been limited to three months but are now available for a year at a time. They are offered by Blue Cross and UnitedHealthcare, among others, but enrollments in those plans are not publicly available.