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Obamacare in N.C.: A missed opportunity

There will be problems. There may be a lot of them. There may not. Beginning this week, Americans will start signing up for health insurance at exchanges across the country – the most sizable federal endeavor since Social Security. No one is sure what the impact of Obamacare will be.

Not even the insurance commissioner of North Carolina.

But Wayne Goodwin knows this: He would be more confident about the Affordable Care Act in North Carolina had state lawmakers not refused this year to participate in a state-based insurance exchange, as Obamacare encouraged states to do.

Instead, the Republican-led legislature passed Senate Bill 4, which opted North Carolina out of running a state-based exchange. As a result, North Carolinians who enroll beginning Tuesday will do so through an N.C. exchange run by the federal government, and that will affect competition, pricing and the quality of information citizens get about their health care options.

“I would feel a lot better today if we had a state-based exchange,” Goodwin told the editorial board Friday.

So might North Carolinians who discover that they’re paying more on average for insurance than residents of most states. N.C. families of four with incomes of $50,000 will pay $880 a month for the mid-range federal plan if they don’t qualify for subsidies. That’s $106 more than the national average.

Participating in a state-based exchange would have allowed the state to create more opportunities for competition, as the N.C. Rate Bureau does for auto insurance companies. “With a state-based exchange, we would’ve been in control over discussions that would’ve incentivized companies to participate,” Goodwin said.

More competition, of course, could have resulted in better pricing and insurance choices, as it has with the 166 companies participating in auto insurance in the state. With Obamacare, only two companies are participating in the N.C. exchange, leaving North Carolinians with an average of 22 qualified health care plans to choose from, less than half the national average.

Don’t know what the best option is for you? Again, the legislature has made things more difficult, turning down a $27 million federal grant for outreach regarding the Affordable Care Act. Goodwin estimates in the next six months alone, tens of thousands of calls will come into state offices with questions about Obamacare, but state law requires his employees to forward people to the feds if they start asking for help with enrollment.

The grant also would’ve helped his office proactively meet at least some of the uncertainty and misinformation surrounding Obamacare. “I had two emails this morning,” he said. “To me that’s frustrating, because it’s going to cost individuals and families money.”

That not stopping anytime soon, as Republicans in Washington continue to stoke fears about the law. Perhaps, as millions of Americans begin to realize Obamacare’s core benefits, Republicans will bow to the law’s inevitability and fix its problems, not kill it.

Closer to home, that will mean revisiting the issue of who should run the state’s insurance exchange. Maybe then, N.C. Republicans will finally decide to do what’s best for North Carolinians.

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