Health care costs for North Carolinians enrolled in the Affordable Care Act would jump under the plan passed by House Republicans, according to an independent analysis.
Subsidies in the form of tax credits for a family making $50,000, North Carolina’s median income, would fall by as much as $14,400 a year, according to the Kaiser Family Foundation, a nonpartisan health policy research organization. In Mecklenburg County, credits would drop by $12,550.
“If this became law, there’s no question a lot of North Carolinians would lose their insurance because they wouldn’t be able to afford it,” said Jonathan Oberlander, who teaches health care policy at UNC-Chapel Hill. “There would be a pretty substantial erosion of health coverage in North Carolina.”
The American Heath Care Act would largely repeal the Affordable Care Act, known as Obamacare. Major changes are expected in the Senate.
Whatever emerges would have a big impact in North Carolina. Only three states – Florida, California and Texas – have more people enrolled in the Affordable Care Act than North Carolina’s 549,000. That’s about one out of 20 North Carolinians.
Republicans say the current program has resulted in higher premiums and less choice.
Blue Cross and Blue Shield of North Carolina is the last statewide carrier in North Carolina taking part in the Affordable Care Act exchange. This month Aetna, the nation’s third-largest insurer, pulled out of the last two states in which it was operating. They also say by repealing mandatory plans, the bill would let consumers decide what kind of coverage they want.
An Observer analysis of Kaiser’s data shows:
▪ Older couples and families with lower incomes could see an even greater increase to health care costs.
▪ A Mecklenburg family of four earning $40,000 could see subsidies fall by nearly $14,000 under the House bill.
▪ Similar earners in some rural North Carolina counties could get hit even harder. Families of four making $40,000 in Scotland County – where the median household income is $31,000 – and Bladen County – where the median income is $30,000 – will pay an extra $15,800.
The change could affect people such as Charlotte’s Lydia Roseboro. After she retired two years ago, she continued to get health insurance through her former employer. But it came at a cost she could no longer afford.
So Roseboro, 64, and her husband enrolled in the Affordable Care Act. Their monthly premiums fell from $1,000 to $14.
“You can’t imagine what a difference that made,” said Roseboro, who lives in west Charlotte. “If it had not been for Obamacare, we would have been without insurance.”
The Congressional Budget Office analysis of the House bill is expected next week. The CBO found that an earlier version of the Republican measure would increase the number of Americans with no insurance to 24 million by 2026.
Lawmakers who voted for the bill have seen protests across the country. About a dozen protesters gathered Saturday in Concord near the office of U.S. Rep. Richard Hudson, a Concord Republican who voted for the bill. About 40 people protested Tuesday at the Monroe office of U.S. Rep. Robert Pittenger, a Charlotte Republican.
The bill passed the U.S. House 217-213 this month largely along party lines. All 193 House Democrats voted against the plan, as well as 20 Republicans, including Rep. Walter Jones of Pitt County.
“People will not be able to afford (health insurance),” said Rep. Alma Adams, a Charlotte Democrat. “They’re going to get less. They’re going to pay more. And it’s going to create a lot of serious problems for folks.”
No congressional district in the state had more people enrolled in the Affordable Care Act last year than Adams’ 12th District, comprised of most of Mecklenburg County. The district had 56,400 people enrolled, according to Kaiser.
The 9th District, which stretches from southeast Charlotte to Fayetteville, had 43,500 people enrolled.
“The elephant in the room is that Obamacare is collapsing,” Pittenger said in a statement, adding that the House bill represents the first step “in a responsible, multi-step effort with the Senate to repair America’s broken health care system.
“After Obamacare’s failed experiment … we need to get the ball rolling on a return to free market, federalist principles for our health care system.”
Nationwide, average premiums are expected to go down after 2020. The Congressional Budget Office estimated 14 million people will drop their health insurance next year if the AHCA passes, and there will be 21 million fewer insured people by 2020. Many of them would be older people with high costs, so their dropping insurance would drive average costs down.
According to Kaiser, more than one in four Americans between 18 and 64 has a pre-existing condition. That includes more than 1.6 million North Carolinians.
Pittenger has drawn fire for comments on pre-existing conditions. Such conditions are covered under the ACA. But under the House plan, states could receive a waiver that would let insurers charge more to people with pre-existing conditions.
Asked about that, Pittenger told reporters that, “People can go to the state that they want to live in.”
Pittenger said if North Carolina receives a waiver from Obamacare’s community ratings provision, only those with pre-existing conditions who fail to maintain continuous coverage would be affected, and then only for 12 months. He said people with conditions such as cancer could join a high risk pool or benefit from federal aid to those with the greatest needs.
North Carolina started a high-risk pool in 2009 that lasted until the Affordable Care Act took effect. Critics said the costs were high and the maximum lifetime benefit of $1 million would fall short for many.
“What the ACA did was to outlaw insurance discrimination against people with pre-existing conditions,” Oberlander said. “What this waiver would do is re-legalize insurance discrimination.”
Consuella Harge, 34, of Charlotte suffers from both lupus and a pulmonary disease that requires her to wear a device that provides oxygen to her lungs. She was on the ACA until qualifying for Medicare this year. A single mother, she’s going back to school in hopes of becoming an actuary.
With two pre-existing conditions, she understands the concerns of people like her.
“The last thing they want to worry about is these medical costs,” she said. “What they’re worried about is trying to live.”
Politifact North Carolina contributed.