Health Care Act

Obamacare isn’t dead. Here’s how much not having health insurance will cost you.

An October screenshot of, where residents can pick an Affordable Care Act health insurance plan.
An October screenshot of, where residents can pick an Affordable Care Act health insurance plan.

The Affordable Care Act is still the federal health care law, despite failed efforts by congressional Republicans to repeal and replace what’s commonly called Obamacare.

As a result, N.C. residents must have health insurance in 2018. Otherwise they will face a hefty tax penalty.

Meanwhile, insurance premiums in the marketplace are increasing, but most N.C. residents with those plans qualify for a subsidy that lowers that bill.

Here are five things to know about the Affordable Care Act in North Carolina.

$695 annual penalty

The Affordable Care Act requires individuals to have health insurance. If they don’t, they have to pay a fee. For the past two years that fee has been either $695 for each uninsured adult and $347.50 for each uninsured child or 2.5 percent of your household income – whichever is higher. However, if a person is only uninsured for one or two consecutive months, they do not have to pay the penalty. The penalty was a stick to force people into the health insurance marketplace, said Christina Dalton, a health care economist with Wake Forest University.

$129 monthly premium after tax credit

If the tax penalty is the stick, then subsidies are the carrot, Dalton said. The majority of N.C. residents who enrolled in an ACA plan – 496,420 consumers – get help paying their premiums through advanced premium tax credits subsidies, according to federal data. The average monthly premium for N.C. residents enrolled in ACA plans is $662 but that number drops to $129 once the tax credit kicks in. The average premium among NC consumers who receive the tax credit drops to $87 a month.

549,158 N.C. residents signed up last year

More than half a million N.C. residents signed up for health insurance through the Affordable Care Act marketplace for 2017. That is a decrease of about 64,000 people who signed up in 2016. Advocates attribute that drop in part to public uncertainty over the fate of the Affordable Care Act. That worry continues this year. The Trump administration has made efforts to undermine the federal health law by shortening the enrollment period and cutting advertising money to educate the public on open enrollment and signing up for health insurance. The Trump administration also cut money to some navigator programs who help walk consumers through signing up for an insurance plan.

552,000 more N.C. residents are insured

More than half a million North Carolina residents gained insurance from 2010-2015, including those who were able to stay on their parents insurance until they were 26 and those who have Affordable Care Act plans, according to federal data. The North Carolina uninsured rate in 2015 was 11.2 percent, or a 5.6 percentage point decrease over the five years prior. One benefit to more people having health insurance is helping people take care of their illnesses earlier instead of waiting for more costly treatment, Dalton said. Another perk of the uninsured rate being lower is more healthy people subscribing for insurance, which could lower costs.

14.1 percent average premium hike

North Carolina approved a 14.1 percent average premium increase for Blue Cross and Blue Shield 2018 Affordable Care Act health insurance plans. Blue Cross NC is the only insurance provider that offers Obamacare plans in all 100 N.C. counties and the company says it insures about 502,000 N.C. residents with those plans. Premium subsidies also increase for residents who receive them, to offset the higher costs. But for those who do not get subsidies, double-digit increases have a cumulative effect year over year. “This compounding of the increase is making the burden on middle income families grow exponentially,” Dalton said.

Cassie Cope: 704-358-5926, @cassielcope

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