NC chooses insurance market

North Carolinians will participate in a new health insurance market starting in 2014, but much remains unclear about the extent of the changes — and how the market will be affected by politics.

As part of the 2010 Affordable Care Act, each state had to submit applications by Nov. 15 for federal funding to set up either a state-run or joint state and federal-run health insurance exchange. Another option for states was to have the federal government run the exchange.

According to HealthCare.gov, an exchange will allow small businesses and individuals to compare health care plans and determine eligibility for tax credits to lower the cost. The exchange system aims to cover more than 30 million uninsured Americans.

On Nov. 15, Gov. Bev Perdue announced her intention to set up a joint state-federal exchange.

“She chose the state-federal partnership because she wants the state to control the exchange — not the federal government,” said Chris Mackey, spokeswoman for Perdue.

The announcement made some Republican leaders uncomfortable. They argued that the decision about which type of exchange to employ should be left to Governor-elect Pat McCrory and the newly elected state legislature.

And it appears that will actually be the case.

“While Gov. Perdue made an initial decision, the final authority rests with Pat McCrory and the 2013 General Assembly,” said Jordan Shaw, communications director for N.C. House of Representatives Speaker Thom Tillis, R-Mecklenburg, in an email.

Mackey said Perdue made the announcement in mid-November to receive federal grants.

In previous years N.C. has applied for more than $12 million in federal money to begin establishing the exchange.

Jonathan Oberlander, a UNC professor of social medicine, said the state’s main rationale for having a joint program is convenience.

“It leaves some of the logistical issues to the federal government,” he said.

But Oberlander said McCrory will face political pressures from members of his own party, who might want to boycott the exchange or leave its operation solely to the U.S. government.

And uncertainty remains about how the exchange will work and affect other programs like student health insurance plans. The UNC system opened up a bidding process for a new student plan late last month.

Oberlander said a wide range of people needs to sign up with the exchange to broaden the risk pool and lower costs. Otherwise, premiums will rise.

“If only sick people show up, it cannot work,” he said. “Younger and healthier people have to sign up or else it just won’t work financially.”

Contact the desk editor at state@dailytarheel.com.