Despite high participation in the Affordable Care Act in the most recent enrollment window, North Carolinians have seen a 27 percent increase in premium costs.
Because Medicaid is less supportive in North Carolina, low-income enrollees with health problems are driving up healthcare premiums, said Pam Silberman, director of the executive doctoral program in Health Leadership at the Gillings School of Global Public Health.
“Those folks don’t have any help at all and in North Carolina that’s over 300,000 people," she said.
Of those enrolled in the program by Dec. 26, Silberman said 88 percent received subsidies — lowering their monthly premiums by 80 percent to an average of $104 per month.
The Affordable Care Act was passed with the intent that all states would expand Medicaid, a program that helps low-earners with health insurance, she said. But because of Supreme Court precedent, states have the right to choose whether to expand it.
North Carolina is not included in the more than 30 states who have chosen to expand the program.
The state could have received Medicaid funding for all low-income adults, she said. But since it chose not to do so, citizens earning between 100 and 138 percent of the poverty line do not qualify for any aid.
“And just so you can put that into context,” Silberman said. “138 percent of the federal poverty guideline for a family of four is about $33,500 a month, so we’re not talking about a lot of money — we’re talking about people living at pretty low incomes.”
She said political ideology was one reason state legislators rejected Medicaid expansion.
Potential expansion would have cost the state money beginning in 2020, as the federal government would only cover the first three years of total funding. Silberman said legislators did not believe the government would hold up their end.
But Silberman said she believes in the promise of expanded coverage and cited a Jan. 2016 study by Wake Forest University's Mark Hall and Edwin Shoaf — which found the benefits of expansion to be worth the costs.
“The question, then, for the people and the leaders of North Carolina, is whether a small cost and a small risk are prices worth paying to provide insurance coverage to several hundred thousand people who cannot afford coverage on their own, even though the majority of them are working," the study said.
Katherine Restrepo, a Health and Human Services policy analyst at the conservative-leaning John Locke Foundation, said another reason for the increase in N.C. premiums is that insurance companies might have originally underestimated the cost brought on by the act.
She said Blue Cross Blue Shield has taken a $400 million hit over the last two years because of the Affordable Health Care Act, just a fraction of their overall value.
“(Insurance companies) are taking losses,” Restrepo said. “But their overall losses from the Affordable Care Act, this is offset by other exchanges.”
There are temporary provisions in place created to stabilize the insurance companies, but they will end at the end of 2016, she said.
“It’ll be interesting to see what happens — I guarantee that premiums will be increasing next year again once those temporary provisions go away,” she said.
Restrepo said consumers are seeing the costs of dealing with a government run health care program.
Nicole Dozier, co-director of the Health Access Coalition at the North Carolina Justice Center said those who receive subsidies for the ACA will continue to be protected from increasing premiums.
“People are doing just what we want them to do,” she said. “(They are) seeking primary, preventive and other necessary care which will likely lead to better outcomes and less use of the ER for non-urgent care for example.”
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