Nearing enrollment's end, lots of North Carolinians still uninsured

With two weeks left to enroll in health insurance for 2014 through the Affordable Care Act, tens of thousands of uninsured residents in North Carolina could face penalties if they don’t meet the March 31 deadline.

Despite a horrendous roll out – with the federal marketplace website malfunctioning for almost two months – about 4 million people nationwide had signed up by the first of February. That included more than 150,000 in North Carolina, the fifth-highest among states for enrollment.

Enrollment numbers through the end of February are expected to be announced this week. So far, they have been well below the Obama administration’s expectations. Problems with HealthCare.gov slowed enrollment in the 36 states – including North Carolina and South Carolina – that chose to rely on the federal site instead of creating their own.

The goal of the new law – often referred to as Obamacare – is to reduce the number of uninsured, estimated at 1.5 million in North Carolina, 49 million nationally last year. The law provides federal premium subsidies to make insurance more affordable for many.

“Can it work? Will it work? I don’t know,” said Michael Matthews, associate professor of health care management at Winthrop University. “It will take some political will and people wanting it.”

March 31 is the last day to buy insurance for 2014 and meet the law’s mandate that most Americans have coverage. Individuals who don’t comply will face a fine of $95 or 1 percent of household income, whichever is greater, when they file their income taxes next year. For families, the fine is $285 or 1 percent of income, whichever is greater. Fines will increase in subsequent years.

Some uninsured people are exempt from the insurance mandate and won’t face penalties. They include undocumented immigrants, prisoners and people with incomes below the threshold required for filing taxes ($10,000 for an individual, $20,000 for a family.)

No official source has estimated how many North Carolinians may face penalties. But given enrollment so far, and allowing for a variety of exemptions, it’s possible that a couple hundred thousand could owe fines if they don’t meet the deadline. Penalties will be collected by the Internal Revenue Service from income tax refunds.

“If you don’t have a refund, they can’t throw you in jail. They can’t put a lien on your property,” said Timothy Jost, a law professor at Washington and Lee University. But unpaid penalties could remain on a person’s record for years to come. “I think it’s going to be learning process,” Jost said.

In Charlotte, Brian Burnaby, 61, met with an insurance agent last week to check out the federal marketplace, but he left without signing up. “I decided I might as well pay the penalty for this year.”

Burnaby has been uninsured since he was laid off in 2008 from his auto parts sales job. This year, he expects to earn about $14,000 from part-time jobs, making his penalty about $140. Based on his income, the agent told him he’d be eligible for a $200 deductible plan with a subsidy that would make his premium $10.66 a month, or $128 a year. He compared $328 in insurance costs to the $140 penalty and chose the latter.

He thought he’d wait to buy insurance in 2015. By then, he will have turned 62 and begun collecting Social Security, raising his income to $25,000. In that year, his penalty for not having insurance would increase to $500.

After reviewing the numbers with an Observer reporter, he said he’ll meet again with the agent. “Maybe I should think about this a little more,” he said.

After March, the federal marketplace will be closed until Nov. 15 unless consumers experience a qualifying life change, such as marriage or divorce. In North Carolina, two insurance companies, Blue Cross and Blue Shield of North Carolina and Coventry Health Care of the Carolinas, sell plans through the marketplace for 2014. Together, they offer 51 different options, but not all are available in every county.

“We really want people to take advantage of this,” said Dr. Marcus Plescia, director of the Mecklenburg County Health Department. “They don’t have access to care if they don’t have any way to pay for it.”

Plescia and other advocates for the federal law made a final push for enrollment during a recent news conference at Legal Services of the Southern Piedmont, one of 15 county locations where consumers can get enrollment help.

They showcased some success stories, including Jennifer Busco, who had been without insurance since 2010 when she left a full-time job as a bartender at the Westin hotel to start a business, NoDa Yoga.

With help from a Legal Services navigator, Busco bought a Coventry policy with a monthly premium of $449. Based on her income, she qualified for a federal premium subsidy of $422, and pays only $27 a month for insurance.

“Now I can sleep at night,” said Busco, who has a 2-year-old son. “I’m not tied to one employer for health insurance.”