Covering N.C.: Health Care Reform
In the coming months, North Carolinians should count on at least one of the following: hearing a radio spot, seeing a television ad, reading an online or print newspaper article, or seeing a Facebook or Twitter post referencing the Affordable Care Act and this thing called a “Marketplace.” Years after passage of the legislation, and a Supreme Court case that upheld its constitutionality, one of the most important pieces of the law is set to launch. The Health Insurance Marketplace is a federal website designed to assist people in applying for, comparing, and ultimately enrolling in an insurance plan offered by private insurance companies. Now that the online tools are available for consumers, the real work begins: outreach and education of the public, and in-person assistance to individuals applying for coverage.
Several weeks ago, the Centers for Medicare and Medicaid Services announced grant awards to organizations that applied to become Navigators under the Affordable Care Act. MDC is part of a consortium of organizations that received the fourth largest grant from the federal government, and will soon begin work deploying paid staff and volunteers to assist North Carolinians applying for subsidized insurance and Medicaid through the federal Marketplace.
Key Health Insurance Marketplace Dates:
The time to apply for and secure affordable coverage is rapidly approaching; the open enrollment period begins October 1. Within a matter of days, North Carolina residents will be able to call the national hotline (1-800-318-2596), go online, get personal assistance from a certified Navigator or Certified Application Counselor, or complete a paper application to secure health insurance through the federal Marketplace.
Before we get into the nitty gritty of how the law may affect you (or those you know and work with), we want to briefly dig into some data on the potential impact the law may have for North Carolina’s uninsured population as a whole. Roughly 1.5 million people in North Carolina, nearly 1 in every 5 state residents is currently uninsured – comprised of three groups:
- people who are currently eligible for Medicaid but not enrolled
- people who would have been eligible for Medicaid expansion
- people who are eligible for subsidized insurance offered through the Federal marketplace
Eligibility for subsidized insurance offered through the federal Marketplace will start at roughly $24,000 and capped at $94,000 for a family of four (eligibility is largely dependent upon household size). According to statistics recently available from Families USA approximately 860,000 North Carolinians under the age of 65 (the magic number for automatic Medicare eligibility) will be eligible for new subsidized insurance offered through the Marketplace. The main reason for the large gap between the number of uninsured and those eligible for subsidized insurance is the state’s decision not to expand Medicaid eligibility. The expansion of Medicaid eligibility would have included many of the state’s lawful citizens or lawfully present immigrants up to 138 percent of the federal poverty level, just shy of $33,000 for a family of four. Instead, hundreds of thousands of North Carolinians who would have been eligible for Medicaid will likely remain uninsured, according to the North Carolina Institute of Medicine.
The two maps below show the geographic distribution of North Carolinians potentially eligible for subsidized insurance. The first map shows the number of uninsured adults potentially eligible by county; the second map shows the percent of uninsured adults (18-64) potentially eligible based on income. Predictably, the first map shows a concentration of the state’s uninsured along the I-85 /I-40 corridor, starting first in the greater Mecklenburg County region (including Cabarrus, Catawba, Gaston, Union, and Lincoln) heading north and east to include Forsyth, Guilford, Orange, Durham, Wake, and Johnston counties. Other notable counties with potentially sizeable eligible uninsured populations include Buncombe, Cumberland, and Cape Fear. The most obvious pattern in the data is the concentration of the uninsured within the largely metro counties of the state. Only four of the top 20 counties, measured by the number potentially eligible, are classified as rural counties by the USDA. More revealing is that 59 percent of the entire state’s potentially eligible people reside in only 20 counties.
(Click to view larger image.)
The second map shows county-by-county rates of potentially eligible adults. These two maps together suggest that strategies to reach out to potentially eligible North Carolinians will vary significantly by geography. While some counties have higher overall numbers of uninsured adults eligible, some counties have significantly higher percentages. For example, Duplin County has the 37th largest potentially eligible population, but has the second highest rate of adults who are likely eligible. This means that those certified Navigators and Application Counselors will need to tailor their strategies to ensure as many people as possible are able to access these resources.
(Click to view larger image.)