North Carolina enrollments for health insurance surged to 357,000 as tens of thousands of residents signed up for subsidized coverage in the final weeks of eligibility, the U.S. Department of Health and Human Services said Thursday.
The late rush of insurance enrollments under the Affordable Care Act elevates North Carolina to the fifth-highest slot in the nation, surpassing most expectations for the law’s first year of enrollment, particularly in a Republican-controlled state that did not run its own insurance exchange.
Enrollments here represent a third of the state population eligible for health insurance, and are expected to take a significant chunk out of North Carolina’s uninsured population, which was 17 percent in 2012. Almost all of North Carolina’s enrollments came with federal subsidies for the applicants, suggesting that many of those signing up had been unable to afford coverage in the past.
“It’s an indicator that we made tremendous inroads with regards to the uninsured,” said Lee Dixon, Raleigh-based project director for the N.C. Navigator Consortium, which coordinated insurance outreach activities statewide. “It’s going to cut it (the uninsured population) significantly.”
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Nationwide, more than 8 million have signed up for insurance under the new law, with several states doubling their enrollment totals in the last weeks of the open enrollment period.
North Carolina’s surge boosted enrollments from about 200,000 in February to 357,584. The total represents the number of people who have selected a plan but haven’t necessarily taken the final step of submitting a payment.
Blue Cross and Blue Shield, the state’s biggest health insurer, next week plans to announce the total who have paid and are insured. The company in past months said some enrollees never make a payment, and their applications lapse.
The deadline for 2014 enrollments closed March 31 but was extended to April 19 for those who had started their applications by the March deadline. After a disastrous rollout marred by malfunctioning software, enrollments didn’t get underway until December, emboldening critics to declare the Affordable Care Act a failure.
The sign-up period for next year runs Nov. 15 through Feb. 15, 2015. But special enrollment is open year-round to people who have a significant life event, such as a divorce, job loss or moving.
The law requires most Americans to buy health insurance unless they fall below a certain income level or qualify for other exemptions. Since most are insured by their employer, Medicare or Medicaid, the law mostly affected people who buy individual insurance.
Last year, North Carolina had about 435,000 people with individual insurance and more than 1 million without coverage who were eligible under the Affordable Care Act.
Under the law, failure to enroll carries a fine – $95 per uninsured person or 1 percent of household income in the first year – that will be taken out of tax returns.
The new law bars insurance practices that had been common for years, such as rejecting applicants with preexisting conditions, charging women more than men, or charging older applicants more than three times as much as younger applicants.
Young enrollees key
Federal data issued Thursday show that 28 percent of North Carolina’s enrollees are 18 to 34 years old, the coveted demographic that is considered essential to the law’s success. The national average for that age bracket was also 28 percent, ranging from 45 percent in the District of Columbia to 19 percent in West Virginia.
Blue Cross officials have warned in recent months that early indications suggest that North Carolina enrollments are tilting toward unhealthy patients who are driving up health care costs.
Adam Linker, a health policy expert with the N.C. Justice Center, said the surprisingly high enrollment totals for the state probably mean that Blue Cross won’t be flooded with sickly and costly applicants.
“The younger and healthier people probably enrolled late,” Linker said. “So we’ll see a much stabler, larger insurance pool than Blue Cross expected.”
The federal data show that North Carolina has one of the nation’s highest rates of enrollments for subsidized insurance. Whereas 85 percent of national enrollments were subsidized, North Carolina’s subsidization rate is 91 percent, tying Wisconsin and Florida.
Only Wyoming and Idaho had higher subsidization rates, 93 percent and 92 percent respectively.
North Carolina’s heavy subsidization for health insurance is attributed to the state’s enrollment activities being coordinated by social service nonprofits, such as Legal Aid Society, Alcohol and Drug Council, CapitalCare Collaborative, and CommunityCare of North Carolina, which provide services to low-income clients.
“The assumption is that people who are applying for this insurance are largely uninsured,” said Nyi Myint, navigator program coordinator at the Alcohol and Drug Council in Durham.