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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.

 

In case you missed it over the weekend, Raleigh’s News & Observer hit the nail on the head Sunday morning with this lead editorial entitled “The Affordable Care Act surpasses goals in NC”. Today’s Fitzsimon File “Monday Numbers” edition provides further confirmation. This is from the editorial:

“To hear the Republican candidates for the U.S. Senate in North Carolina tell it, “Obamacare” is about the worst thing that ever happened to the people of America and certainly North Carolina. They’ll repeal and replace it, they say, or certainly repeal it, and leave consumers to the wonderful world of the free market….

But here’s the problem with the Republican rant. It has been outrun by Obamacare’s successes. Read More

Health-Reform-SBHere’s this morning’s most important and thus far under-reported news story in North Carolina: the huge spike in enrollment numbers in health insurance as the result of the Affordable Care Act.

This is from a story (buried on the business page, for some reason) in Raleigh’s News & Observer:

“North Carolina enrollments for health insurance surged to 357,000 as tens of thousands of residents signed up for subsidized coverage in the final weeks of eligibility, the U.S. Department of Health and Human Services said Thursday.

The late rush of insurance enrollments under the Affordable Care Act elevates North Carolina to the fifth-highest slot in the nation, surpassing most expectations for the law’s first year of enrollment, particularly in a Republican-controlled state that did not run its own insurance exchange.

Enrollments here represent a third of the state population eligible for health insurance, and are expected to take a significant chunk out of North Carolina’s uninsured population, which was 17 percent in 2012. Almost all of North Carolina’s enrollments came with federal subsidies for the applicants, suggesting that many of those signing up had been unable to afford coverage in the past.”

Moreover, another 74,000 have been obtained coverage under Medicaid. As Chris Fitzsimon notes this morning in Friday Follies, despite all of the imperfections and all of the relentless opposition and innumerable obstructions thrown at the ACA by the ideologues on the right, President Obama and the other architects of health care reform have fashioned a remarkable achievement — they have dramatically improved the lives of millions of Americans (including more than 430,000 North Carolinians) in a profound and irreversible way.

No wonder conservative politicians are getting more and more concerned about the political implications of their ongoing and increasingly futile efforts to oppose and repeal the ACA.

Read more here: http://www.newsobserver.com/2014/05/01/3825943/nc-enrollments-for-subsidized.html?sp=/99/104/#storylink=cpy

Richard Burr 2US Senator Burr is the star witness at the NC General Assembly’s “bash the Affordable Care Act” here at UNC Greensboro today. Unfortunately Burr, described as “the foremost authority on health care in the Senate” by one of the legislators here, is making some pretty big mistakes in his testimony.  Amazingly, these mistakes just happen to contribute to his attack on the Affordable Care Act:

1.  Burr, in explaining his opposition to NC taking the federal money to expand the NC Medicaid program, suggests that NC Medicaid program doesn’t require beneficiaries to be assigned a primary care doctor.  He says if he could change the NC Medicaid program for the better he would require every beneficiary to be assigned to a primary care provider. Earth to Burr:  NC’s Medicaid program already does that.  From NC Medicaid’s website:

CCNC/CA is North Carolina’s Medicaid program. It provides you with a medical home and a primary care provider (PCP) who will coordinate your medical care.

As a CCNC/CA member, you are eligible for all the services that Medicaid covers. Being a member also has the following advantages:

You can choose a medical home with a primary doctor. A medical home can be chosen for each family member. Your local County Department of Social Services (DSS) office has a complete list of participating doctors. If you do not choose a medical home, you will be automatically assigned to one.

You can call your primary doctor day or night for medical advice. Check your Medicaid ID card for your doctor’s daytime and after-hours phone numbers.

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Screen Shot 2014-04-14 at 4.17.51 PMThe Congressional Budget Office (CBO) released the fourth year report on projections of the cost of the Affordable Care Act.  The news is good and consistent with the trend over the previous four years: CBO now projects $104 billion less in costs under the Act than it did last year.  The reduction in costs is due to a variety of factors but two big ones stand out.  First, plans being offered under the health exchanges have significantly lower premiums that were originally anticipated, largely a result of narrower networks of providers and tighter management of health care in the plans – a trade-off that has resulted in big savings.  Second, all health costs – both in government programs like Medicare and Medicaid and in the private sector – are projected to grow  more slowly than just last year.  The CBO points out that this is becoming a trend:

A notable influence is the substantial downward revision to projected health care costs both for the federal government and for the private sector. For example, since early 2010, CBO and JCT have revised downward their projections of insurance premiums for policies purchased through the exchanges in 2016 by roughly 15 percent, and CBO has revised downward its projection of total Medicaid spending per beneficiary in 2016 by roughly half that percentage.

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