Good news and bad: Census finds big drop in NC uninsured, but state still lags thanks to G.A., McCrory

Yesterday the U.S. Census Bureau released state-level data on the number of people with and without health insurance in 2015. Good news: these data show that North Carolina’s uninsured rate has fallen from 15.6 percent to 11.2 percent between 2013 and 2015. This progress is a testament to the success of the Affordable Care Act (ACA), which has enabled hundreds of thousands of Tar Heels to enroll in private coverage at reduced cost. But that progress has come in spite of state lawmakers’ best efforts to prevent full implementation of the law in North Carolina. Even with these accomplishments, North Carolina’s uninsured rate is too high, and it remains well above the national average.

While these Census data bring good news for many states and for the nation as a whole—the national uninsured rate is down to a historic low of 9.1 percent, thanks to the ACA—North Carolina and other states that haven’t expanded Medicaid lag behind the rest of the country. States that expanded Medicaid have seen much larger reductions of their uninsured populations, leading to improved access to care, reduced financial barriers, and better health outcomes for consumers.

In Arkansas, Kentucky, and West Virginia—fairly conservative states that all voted heavily Republican in the previous two presidential elections—lawmakers chose to close the coverage gap, reducing their uninsured rates by 6.5%, 8.3%, and 8.0% respectively. When compared to the progress in these peer states, North Carolina’s 4.5 percent reduction is simply not good enough.

What’s more, North Carolina’s refusal of federal funds to close the coverage gap leaves us with 11th highest uninsured rate in the entire country. No self-respecting North Carolinian would boast “We’re number 39!” We can do better than this.

Fortunately, it’s not too late for the State to close the coverage gap and guarantee that up to 500,000 hard-working North Carolinians can access the care they need to stay healthy and provide for their families. While we do have time, it’s not clear that North Carolina has leadership who will rise above politics and do the right thing for its residents’ health and finances, as well as the state economy.

What can NC do to lower premiums in the Marketplace? Expand Medicaid.

Earlier today, the federal Department of Health and Human Services (HHS) released a report showing that premiums for health insurance plans on the Marketplace were 7% lower in states that had expanded eligibility for the Medicaid program as called for by the Affordable Care Act (ACA). So not only would closing the coverage gap create new jobs, generate economic activity for the state, increase access to care, and improve health outcomes, but it would also lower health insurance premiums for more than half a million North Carolinians who buy coverage on the Health Insurance Marketplace.

The study controlled for many of the other factors that could affect premium rates and found that Medicaid expansion was a clear difference-maker, as noted by the accompanying press release:

“The HHS analysis uses 2015 data on plans and enrollment to assess how Medicaid expansion affects Marketplace premiums. It controls for differences across states in demographic characteristics, pre-ACA uninsured rates, health care costs, and state policy decisions other than Medicaid expansion, finding a 7 percent difference in Marketplace premiums holding these factors fixed.”

In states that fully implement the ACA, consumers with incomes below 138% of the federal poverty level (FPL) can qualify for Medicaid, while those with incomes between 138-400% FPL may qualify for financial assistance on the Marketplace. However, in non-expansion states like North Carolina, some of the would-be Medicaid enrollees end up on the Marketplace, as they can qualify for financial assistance between 100%—not 138%—and 400% FPL. Not expanding Medicaid forces these higher-cost consumers into the Marketplace risk pool, increasing premiums for other enrollees. This study shows that expanding Medicaid would be a win-win, as these consumers and 300,000 others in the coverage gap can enroll in Medicaid (where they’re considered lower risk than the traditional Medicaid population), while their neighbors enrolling in private coverage on the Marketplace can enjoy lower premiums.

With news about incoming premium hikes and issuers having trouble affording costs of Marketplace enrollees, it’s important that decision-makers here in North Carolina explore what can be done to better the circumstances for their constituents. While the conversation about how to improve the ACA may be a complicated one, closing the coverage gap by expanding Medicaid in North Carolina is a no-brainer. It would help the uninsured, boost the economy, and lower premiums for low– and middle-income North Carolinians with private coverage. How long will state lawmakers continue to cut off their nose to spite their face?

Three things North Carolina consumers need to know about Aetna’s Marketplace exit

On Monday, the health insurance giant Aetna announced it would scale back its offerings on the Health Insurance Marketplace, where consumers can shop around for individual health insurance plans and qualify for financial help from the federal government to afford their coverage. While Aetna ostensibly cites high costs as the reason it is pulling back from 15 states to only four, new evidence shows the move may well be part of an attempt to bully the federal government into approving a pending business deal.

Regardless of the cause, Aetna will not be offering health insurance plans in North Carolina’s Marketplace in 2017, meaning that consumers in 39 counties will no longer see these plans on the Marketplace next year. Currently, Blue Cross Blue Shield of North Carolina has filed to offer plans in all 100 counties, and Cigna has filed to enter into six counties in the Triangle area.

So, what does all this mean for North Carolina consumers?

  1. Your Aetna coverage lasts until the end of the year, so keep paying premiums and getting care.

While Aetna is pulling back from the Marketplace for 2017, the plans it has sold for 2016 are still valid for the rest of the year. If you’re enrolled in a plan from either Aetna or Coventry Health Care of the Carolinas (which is owned by Aetna), you should keep paying your monthly premiums and continue to access the health care services and prescription drugs you need through the end of the year.

  1. Financial help from the Marketplace will protect you from any premium increases next year.

This year, 91.5% of North Carolinians who have Marketplace plans were able to qualify for financial assistance that lowers the cost of their monthly premiums. These subsidies, called premium tax credits, change every year to make up for changes in the premiums of plans available on the Marketplace. While media coverage tends to focus on the gross change in premiums from year to year, most enrollees don’t experience big changes in premiums thanks to their premium tax credits.

  1. Starting on November 1, you can shop around for affordable coverage for 2017.

The Open Enrollment period for 2017 coverage from the Health Insurance Marketplace starts on November 1, 2016. Whether you had a plan from Aetna, UnitedHealthcare (which also will not offer NC plans in 2017), or Blue Cross Blue Shield of NC, you can go back to the Marketplace by visiting or calling 1-800-318-2596 to shop around for your new options. Thanks to premium tax credits, as well as a benefit that lowered out-of-pocket costs for two-thirds of North Carolina enrollees this year, you’ll still be able to find coverage that fits your budget and meets your needs.

Don’t forget—free, expert in-person enrollment assistance is available from navigators and other assisters. You can call 1-855-733-3711, use the Get Covered Connector, or visit your local Community Health Center to schedule an appointment with an experienced assister who can help you understand and navigate your options.

This is news? Study: Closing the coverage gap improves access and health outcomes

A new study from the Harvard School of Public Health confirmed the obvious facts that our Governor and legislature continue to ignore: when uninsured people get health care coverage, they enjoy improved health care access, fewer financial barriers to care, and better health outcomes.

Over a two-year period between 2013 and 2015, researchers compared the health care experiences of consumers living in two Medicaid expansion states with those of residents in a non-expansion state. In 2014, both Arkansas and Kentucky accepted federal funding to provide coverage to hundreds of thousands of low-income people as called for by the Affordable Care Act. On the other hand, Texas—like North Carolina—has thus far left its residents in the coverage gap, where they’re too poor to qualify for financial help on the Marketplace but make too much to qualify for Medicaid.

When Arkansans and Kentuckians gained health coverage through Medicaid expansion, they were more likely than their Texan counterparts to have a personal physician and to access preventive care through an annual checkup. Instead of being forced into the emergency room for their non-emergency primary care needs, insured patients in Arkansas and Kentucky got appropriate care at the right time and at a lower cost. On the other hand, Texans were more likely to rely on the high-cost ER as their usual source of health care. Being uninsured limited their access to a primary care provider, costing both these individuals and the larger health care system dollars that would be more wisely invested into closing the coverage gap.

Not only does expansion help increase health care system efficiency, residents in Medicaid expansion states reported improved health in comparison with their non-expansion state counterparts. What’s more, they experienced fewer financial obstacles to accessing the health care services they needed. Right now, Texans in the coverage gap are more likely to forego necessary medical care and skip out on prescription drugs because of cost concerns.

Day after day, month after month, and now year after year, the evidence keeps pouring in: Medicaid expansion would be a boon to half a million North Carolinians’ physical and financial health, and it would create jobs and boost the economy. What is Governor McCrory waiting for?