The Affordable Care Act goes into effect today across the nation

As the Affordable Care Act’s health care marketplaces open for enrollment today, Piedmont Health Services, a community health center with a branch in Carrboro, is working to inform regular patients about their new insurance options.

“We’ve sent out letters to over 9,000 patients who are uninsured,” said Chiffon Jenkins, patient account manager at the center.

She said the letters gave patients information about their health insurance options.

As part of the federal law, which passed in 2010, North Carolina will have a federally-run online marketplace where people without insurance can shop for health care plans and learn their options for subsidies and tax credits.

Uninsured North Carolinians above the poverty level can shop for plans through Coventry Health Care of the Carolinas, which will participate in exchanges in 39 counties, or through Blue Cross Blue Shield North Carolina, which will participate in all 100 counties. Coverage will go into effect Jan. 1.

According to the U.S. Census Bureau, 17.2 percent of North Carolina’s population did not have health insurance at any point last year — ranking North Carolina among the bottom 15 states with the most uninsured.

Jonathan Oberlander, a UNC professor of social medicine, said many of the uninsured in the state are from working familes.

Providers will have plans categorized depending on the amount of medical expenses they cover. Bronze plans will cover 60 percent of expenses, with silver plans covering 70 percent, gold plans covering 80 percent and platinum plans covering 90 percent of all medical expenses.

Catastrophic plans, which require people to cover their own expenses up to a point to help keep costs low for essential health benefits, will also be offered for those younger than 30 or who receive a hardship exemption.

“There’s going to be enough choices so it could be confusing,” Oberlander said.

Four N.C. organizations have received about $3 million in federal money to serve as navigators to teach people their options. Kirsti Clifford, spokeswoman for the N.C. Department of Health and Human Services, said in an email that the department will ask County Social Services Agencies to work with navigators.

“Given much of the confusion and lack of information surrounding the federal government’s exchange, the administration felt it was the right thing to do,” she said.

As insurance coverage increases and large numbers of people enter the system for the first time, many experts are still wondering how health care might change in the state.

Jenkins said the changes could lead to more people getting care outside the clinic if they have medical emergencies.

Still, there are some who will still not have access to affordable care, said Pam Silberman, president of the N.C. Institute of Medicine. In 2012, the U.S. Supreme Court ruled the federal government could not force states to expand their Medicaid programs. In February, the N.C. General Assembly passed a bill rejecting Medicaid expansion.

Silberman said many people who are below the poverty level will not qualify for tax credits or subsidies or for Medicaid.

“If they are childless, not disabled and not elderly then they will not qualify,” she said.

Despite these changes, Piedmont Health said it will continue to provide health care, regardless of whether its patients have insurance.

“If they’ve been getting care with us all this time, they’re already familiar with the doctors, they’re familiar with the staff,” Jenkins said. “I think they’re just going to continue to come back.”

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