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North Carolina health insurance exchange

NC exchange has third best enrollment, third carrier will offer plans

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In late June, United Healthcare filed paperwork to become the third carrier offering individual health insurance in the North Carolina exchange, joining Blue Cross Blue Shield of North Carolina, and Coventry Health Care of the Carolinas.  The two existing carriers are still seeking rate increases for the 2015 open enrollment period that begins in November, but the addition of United Healthcare – which already has a strong market share in North Carolina – will certainly increase competition and keep prices lower than they would otherwise be.

The 2014 Obamacare open enrollment period ended in April, but enrollment has continued to grow in the North Carolina exchange due to qualifying events that trigger special enrollment periods, and the fact that Medicaid enrollment runs year-round).  As of April 19, North Carolina’s exchange had the third highest enrollment among the 36 states where HHS is running the exchange, and was fifth highest for the whole country.  357,584 people had finalized their private plan selections, and another 73,898 were eligible for existing Medicaid, even with its strict eligibility guidelines (NC is not expanding Medicaid under the ACA).  In terms of the rate that the uninsured population is enrolling in new plans, North Carolina is by far the leader among states that have generally resisted implementing the ACA.  The private plan enrollment total in the North Carolina exchange is nearly double what HHS projected before open enrollment began.  By early July, the uninsured rate in North Carolina had dropped from 19.6 percent last year, to 16.7 percent.

So why is North Carolina doing so much better than other states where lawmakers have not embraced the ACA?  Although many of North Carolina’s political leaders have been less than enthusiastic about the ACA, the state already had an excellent Medicaid managed care program – Community Care of North Carolina.  This public-private collaboration of health care providers, social services workers and other community leaders took an all-hands-on-deck approach, and has been steadily working for the last six months to enroll as many of their patients and residents as possible.

North Carolina’s legal aid program has also been very instrumental in getting people enrolled, and has established a phone number (855-733-3711) where residents can call to get help with their insurance questions.  These grass-roots programs have demonstrated that even in the absence of political leadership, states can have successful enrollment if they have a solid framework of community and health care leaders who are focused on getting people covered.

North Carolina accepted President Obama’s proposal that individual policies slated for termination at the end of 2013 be renewed into 2014, and Blue Cross and Blue Shield of North Carolina had opted to do so.  Residents with individual BCBS plans that were effective before October 1 were allowed to renew those plans into 2014, but with rate increases that average at least 16 percent.  Policies effective October 1 or later terminated at the end of 2013 and needed to be replaced during open enrollment.  There is some concern that renewal of 2013 plans might have contributed to an older-than-expected mix of enrollees in the exchange.  Blue Cross – one of the two carriers offering policies in the exchange – has said that only 32 percent of their enrollees are under the age of 35, while they had originally expected that demographic to account for about half of their enrollments.

North Carolina’s path towards ACA implementation was a complicated one that covered all bases.  The state took official actions toward each one of the options for a health insurance marketplace: state-run, partnership, and federally operated. In June 2011, North Carolina passed a law stating an “intention” to develop a state-run health insurance exchange. The House at one point authorized a state-run exchange, but the Senate did not. Outgoing Gov. Bev Perdue announced in November 2012 that the state would partner with the federal government to run the marketplace. Finally, new Gov. Pat McCrory announced in February 2013 that North Carolina would default to the federal marketplace.

While the federal government is running the marketplace in North Carolina via, the state department of insurance reviewed the rates proposed by insurers who want to sell policies in North Carolina through the federal exchange.  Much to the dismay of state Insurance Commissioner Wayne Goodwin, this is the only involvement that the state has with the exchange.  North Carolina also rejected federal funds to expand Medicaid.  Support for the ACA in North Carolina is relatively low, no doubt a result of the clear opposition to the law voiced by the state’s leaders.

North Carolina is not doing any marketing or outreach to explain the insurance marketplace to state residents. Instead, the federal government and insurers themselves have taken on that responsibility. Blue Cross and Blue Shield of North Carolina currently dominates the individual insurance market in the state, and the organization is taking a lead role in promoting the marketplace. Its outreach efforts include operating retail stores and taking a trailer to fairs, farmers markets, and other community events across the state.

Historically, competition within the individual insurance market in North Carolina has been limited, and that is still be the case in the exchange in 2014. United Healthcare is joining the exchange in 2015, but just two insurers are offering policies in the exchange in North Carolina this year: Blue Cross and Blue Shield of North Carolina and Coventry Health Care of the Carolinas (plans from Coventry are available in only 39 of the state’s 100 counties).  FirstCarolinaCare Insurance Co. had initially planned to participate and submitted policies to the exchange in 2014, but later withdrew.  The marketplace for small businesses is even more limited, with only Blue Cross and Blue Shield of North Carolina participating.

In a move that could hinder the success of the official exchange, the North Carolina Chamber of Commerce launched its own private health insurance exchange in mid-October, designed to appeal to workers whose employers stop offering health insurance coverage (the Chamber expects a lot of this, but it remains to be seen whether this will be a significant issue going forward or not).  The Chamber exchange will not be affiliated with the state’s official health insurance exchange, and consumers should be aware that no premium or cost-sharing subsidies are available for plans purchased outside of the official exchange.  In June, after the first open enrollment period for individual health insurance had ended, Blue Cross Blue Shield of North Carolina announced that it was creating a private single-carrier exchange for employers with at least 50 employees, and would add a private small group exchange later this year.

According to the North Carolina Institute of Medicine, more than 1.5 million of North Carolina residents under age 65 are uninsured.

North Carolina health insurance exchange links

State Exchange Profile: North Carolina
The Henry J. Kaiser Family Foundation overview of North Carolina’s progress toward creating a state health insurance exchange.

North Carolina Institute of Medicine (NCIOM)

Health Insurance Smart NC
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
Toll free: 1-877-885-0231

Managed Care Patient Assistance Program
Serves consumers who are members of managed health benefit plans.
(919) 733-6272 / Toll-Free: 1-866-867-6272 (in North Carolina only)

Community Care of North Carolina

Legal Aid of North Carolina (855-733-3711)