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ACA Recap: North Carolina exceeds expectations

ACA Recap: North Carolina exceeds expectations

Despite a bumpy roll-out of the federal Health Insurance Marketplace, data released last week confirm that more than 8 million people selected an insurance plan during the Affordable Care Act’s first Open Enrollment Period (including the two week extension for those who were “in-line”). These latest numbers show that the month of March boosted the number of total enrollments well beyond original expectations.

With the initial chaos of the Open Enrollment Period behind us, we now have a much firmer grasp on the success of the outreach effort nationally, as well as in the state of North Carolina where MDC Navigators worked with a statewide consortium to get individuals enrolled. We were particularly interested in a few key markers of North Carolina’s outreach and enrollment efforts:

State-by-State Enrollment Totals

North Carolina held onto its rank among the top-five states with the largest number of individuals who signed-up for a private health insurance plan. With nearly 358,000 people signed up, the state exceeded all expectations by enrolling 187 percent of the government’s estimate.

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Medicaid and Health Choice (Children’s Health Insurance Program)

An additional 74,000 individuals were determined to be eligible for Medicaid or the Children’s Health Insurance Program. Since the state of North Carolina did not expand Medicaid, these enrollments are a combination of the newly eligible (those who have benefited from the new MAGI income rules) and those who were previously eligible under the old rules, but not yet enrolled.

Financial Assistance

The vast majority, 85 percent, of individuals who selected a plan received financial assistance in the form of a tax credit to lower their monthly costs. A portion of those enrollees were also eligible to receive cost-sharing reductions to lower their total out-of-pocket costs. In North Carolina, more than 90 percent of enrollees are receiving financial assistance. Moreover, North Carolina was successful at enrolling a much higher proportion of those eligible for financial assistance (see the map below for a state-by-state breakdown).

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Age Breakdown

A disproportionate amount of media attention over the last several months has focused on the importance of the share of young-adult enrollees known as the “Young Invincibles,” individuals between the ages of 18 and 34. The justification for all this attention is that young (and presumably healthy individuals) need to pay premiums (and consume relatively fewer health services) to offset the cost of relatively older and sicker individuals who consume more health services.

Early estimates by the Congressional Budget Office indicated that approximately 40 percent of enrollees would need to be young adults. However, as health expert Timothy Jost notes, the focus on the share of young enrollees is a little overzealous. More important to the overall viability of the Marketplaces (both the federal and individual state-run marketplaces) is the overall health of the enrollee population. While there is no available data on the health status of recent enrollees, the dire warnings about the share of young adult enrollees seems to have been squashed by the surge in enrollments and the relatively balanced age profile of enrollees.

Things to come

Over the coming weeks, we will be featuring stories from MDC’s Navigators about their personal experiences working with consumers applying for health insurance coverage. Stay tuned.