As we reported last week nearly 360,000 people have enrolled in health insurance plans through the federal Marketplace established by the Affordable Care Act in North Carolina. According to the federal data, 91 percent of these enrollees will receive financial help to pay their premiums.
Although impressive, this top line number does not tell the full story.
The fact sheets released by Health & Human Services also show that 74 percent of North Carolinians purchasing coverage through the Marketplace chose a Silver plan. As many people now know, insurance plans were listed on the federal website according to metal levels. These metal levels correspond to different cost sharing requirements. So an insurance policy that pays about 60 percent of costs is rated “Bronze,” and a plan that pays out 70 percent of costs is ranked as a “Silver” policy.
For individuals and families earning less than 250 percent of federal poverty level, about $58,000 for a family of four, Silver plans provide additional financial assistance by capping deductibles and co-insurance. That means the federal government will not only help with premiums, it will also ensure that families are not left with financially catastrophic deductibles.
The high rate of enrollment in Silver plans should be some comfort to physicians and hospitals that worried about patients facing unaffordable deductibles.
North Carolina’s robust enrollment figures, and the demographics of the enrollees, are good news for the stability of the state’s insurance market. Navigators, health insurance agents and brokers, providers and insurance companies all played a major part in driving consumers to the Affordable Care Act Marketplace. The state’s largest insurer, Blue Cross and Blue Shield of North Carolina, had a lot at stake.
BCBSNC was the only company to offer plans in every county. Weak enrollment would have meant a small pool of customers for the insurance company. With a modest customer base a few sick enrollees could drive up premiums for everyone. A large number of enrollees, on the other hand, means more stable and predictable costs for the company and should moderate premium hikes when new rates are released later this year.
There is also a good age mix among enrollees through the Marketplace in North Carolina. Insurers and analysts often draw arbitrary lines when setting age targets for enrollment. But, generally, younger people use fewer health services so insurance companies need them to offset the older folks to create a balanced pool of customers. Oftentimes analysts look at the percentage of enrollees younger than 35.
In North Carolina, 35 percent of enrollees are younger than 35. Also, 54 percent of enrollees are under the age of 45, what some may consider roughly middle aged.
So what is the bottom line from these figures? Obamacare will not, as critics charged, collapse under its own weight or create what some in the insurance industry call a “death spiral.” In fact, more insurance companies may see the success we’ve had in North Carolina and get into the market.
Also, it is critical to remember that those calling for the repeal of health reform are trying to transport us back to the bad old days when pregnancy was a pre-existing condition and insurance companies could deny coverage to uninsured customers for a broad range of reasons.
Instead of attempting to take coverage from 360,000 North Carolinians legislators should work to improve a law that is already working in our state.