For many North Carolina residents, the Affordable Care Act isn’t a good deal or a bad deal. It’s the only deal.
More than 600,000 people in our state have enrolled in ACA plans, reducing the uninsured rate to 15.6 percent in 2015, according to the National Center for Health Statistics.
That represents a steady drop from 21.5 percent in 2012, although North Carolina remains well above the national average of 10.5 percent in the proportion of its population without medical insurance.
The rate is influenced by the state’s decision not to accept expanded Medicaid coverage offered by the federal government under the ACA. It translates to greater reliance on hospital emergency rooms and charitable care, as well as more people with untreated medical conditions.
For those who do qualify for ACA coverage, or Obamacare, the program can be a godsend. It prevents people with pre-existing medical conditions from being denied coverage and others from being dropped when they get sick. And it gives families assurance that a catastrophic accident or serious illness won’t ruin them financially.
Yet, Obamacare is still disliked by about half the population, polls indicate. The negative sentiment is driven by Republican politicians who never wanted it to succeed, including North Carolina leaders who rejected Medicaid expansion and refused to set up a state exchange. Universally, Republicans call for a complete repeal and replacement with “market” solutions — which means going back to the time when more people were left without coverage.
Costs continue to go up, as they did before the ACA was implemented. Some insurers are struggling with the law’s requirements. Blue Cross Blue Shield of North Carolina has requested an average premium increase of 19 percent for its ACA plans next year. UnitedHealthCare is exiting the North Carolina market, saying it was losing money. But Aetna, Cigna HealthCare and National Foundation Life Insurance Co. will offer 2017 plans.
Close to 90 percent of insured North Carolinians qualify for subsidies that reduce their premiums to affordable levels. Deductibles and co-pays may create hardships, but coverage of major expenses is far better than no coverage.
Costs would moderate if more young, healthy adults purchased policies rather than paying fines for not doing so. A pool of older, sicker consumers isn’t good for insurance profits. It also should be harder to enroll in a plan just before incurring high medical expenses and then dropping coverage once the bills are paid.
In a way, the ACA has sickened our national politics. President Barack Obama and congressional Democrats should have made improvements to the original law by now. But congressional Republicans hold firm to their repeal-or-nothing strategy. This has created a stalemate and ill will, infecting efforts to get other work done.
So, we’re left with what we have. It’s far from perfect, but what would 600,000 North Carolina residents do without it? Ours would be a less healthy state, as it was before. Is that really what our state’s leaders want?
