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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.

 

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Sen. Richard Burr has an idea: maybe it’s time to reform our health insurance system. We could set up state-based marketplaces, give tax credits to purchase private insurance, and create some new protections for people with pre-existing conditions. But first we need to repeal the Affordable Care Act because it sets up state-based marketplaces, gives tax credits to purchase private insurance, and creates some new protections for people with pre-existing conditions.

The fact that Sen. Burr’s proposal is a watered down version of Obamacare is not its most entertaining feature. Partisan opponents of the Affordable Care Act have spent several years introducing alternatives to health reform that are just less workable variations of the law the nation has spent the past three years implementing.

What is most entertaining about Sen. Burr’s new proposal is what it says about prevention. Although the Affordable Care Act is one of the largest, most comprehensive investments ever made in prevention, it was not enough for Sen. Burr. In debates and news interviews he constantly harped on the lack of investment in prevention as the primary driver of his opposition to the ACA. In fact, he introduced an ACA alternative in 2009 called the Patients’ Choice Act. Title I of that act is “Investing in Prevention”. Prevention, after all, is the key.

What, then, does this new proposal, called “The Patient Choice, Affordability, Responsibility, and Empowerment Act,” have to say about prevention? Nothing, nothing at all. In the detailed summary of the bill there is no mention of prevention. So, Sen. Burr is now proposing that we throw away a unprecedented, large-scale prevention effort currently underway and replace it with nothing.

It’s easy enough to laugh off these public relations stunts. Even Sen. Burr has admitted that repeal is unlikely. It’s even less likely now that millions of people are enrolled in ACA plans and are receiving tax credits. But it’s sad that this is what passes for legislating nowadays. There are things that need fixing in health reform. Legislators should get to work and stop trying to strip away protections for American consumers.

 

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Earlier this week, at the behest of local providers and other residents, the Durham City Council passed a resolution urging Gov. Pat McCrory and the North Carolina General Assembly to stop blocking Medicaid expansion. You can see coverage of the vote here.

And below is the text of the resolution:

Resolution Expanding Medicaid

WHEREAS, Durham prides itself on being the City of Medicine; and

WHEREAS, there are an estimated 18 percent of Durham County residents who are uninsured; and

WHEREAS, the Patient Protection and Affordable Care Act provides federal funding for states to expand Medicaid to all citizens earning less than 138 percent of the federal poverty level; and

WHEREAS, this Medicaid expansion would extend insurance coverage to more than 500,000 North Carolinians and save the state approximately $65 million over ten years; and

WHEREAS, the Durham City Council thinks all residents should have access to quality, affordable health coverage;

THEREFORE, BE IT RESOLVED THAT:

1) The City Council urges the North Carolina General Assembly and the Governor to accept federal funds to expand Medicaid in North Carolina.

2) This resolution shall be effective on and after its passage, and shall be shared with the members of Durham’s General Assembly delegation.

The pressure to expand Medicaid is not easing. We will see if the legislature starts listening.