What is happening in North Carolina Affordable Health Care (ACA)

In mid-March North Carolina legislators along with the Governor’s blessing voted to turn down Medicaid expansion and not to develop health exchanges.  So what does this mean?

            When Medicaid is expanded the  Affordable Care Acts expands coverage, this would help the Middle Class. Under the Affordable Care Act, North Carolina could expand coverage to most of  the 1.5 million people living without health insurance in our state making up to $88,000 a year for a family of four would  provide subsidies to help pay insurance premiums and caps out-of-pocket expenses. This would be reimbursed back to the state at 100% for the first three years then reimbursed back to the state each year thereafter at 90%. So North Carolina only would pay out of pocket 10% after the first three years. Guess what? If we covered those uninsured, their health would improve over the first three years because they would be able to go to the doctor for preventive  checkups rather than waiting until they were so sick and needed an emergency room visit at the cost of the tax payers.  It   was a win-win in my opinion. It is sad that NC turned this benefit down. Our state and local governments currently spend billions helping hospitals, community health clinics and other providers take care of people who don’t have health insurance. So even though North Carolina’s share of the    Medicaid expansion will be about $830 million, this is only 10% and a lot less then expansion will mean the vast majority of people will be able to pay their medical bills, and state and local governments will save millions. By refusing to expand Medicaid, North Carolina may suffer negative consequences:  While the Supreme Court said that the federal government may not revoke all of a state’s Medicaid funding for refusing to expand the program, the Centers for Medicare & Medicaid Services does have other enforcement mechanisms to encourage the expansion.

NC law makers also decided not in develop exchanges. Exchanges are like health committees where the rules and charges for services would be developed. NC has decided to leave the decisions up to the federal government in a show of distaste for the ACA law.  Since ACA is a Federal law all NC  citizens will have to obey the law by purchasing insurance or paying a penalty.  It does  not  matter how distasteful the NC government thinks it is. On our 2014 income tax form we will have to show proof that we have insurance if a  person can that they are insured there will be a fine. Citizens and legal immigrants will be required to pay penalty if they do not have qualified health insurance, unless   exempt. Sec. 1312(d), 1501, amended Sec. 1002   in Reconciliation)  Penalties: Must pay the greater of: $95/person or 1% taxable income (2014); $325 or 2.0% (2015); or $695 or 2.5% (2016), increased by cost-of living   adjustment* Certain groups are exempt from the penalties, including those who would have to spend more than 8% of their income for the lowest cost premium, or those whose   income is too low that they do not pay federal income taxes. Great things will happen in 2014 to help everyone get better healthcare services even with all this unrest in our state. We have already benefited. Because of the passage of this law insurance companies  must allow parents to cover children on their health insurance plans until  the child reaches age 26. This led to expansion of coverage to 2.5 million young adults. Insurers may not discriminate against children under age 19.

Insurers are prohibited from: Discriminating against people or charge them more based on preexisting health problems (Effective 2014; Sec. 1201) Including annual or lifetime limits for essential benefits (Sec. 1001, 10101)

Insurers are required to:

Limit the differences in premiums charged to different people based on age (3:1 variation for adults allowed), and certain other rating factors (Effective 2014; Sec. 1201) 

Most insurers must cover:

¨ Recommended preventive services with A or B recommendation from USPSTF and all recommended immunizations by ACIP, with no cost sharing. (Sec. 1001, 10406)

¨ Preventive care and screenings identified as part of Bright Futures for infants, children, and adolescents (Sec. 1001)

¨ Preventive care and screenings for women (Sec. 1001)Mental health and substance abuse parity law applies to qualified health plans in the individual and small group markets.  (Note: Parity already applies to large group plans).  (Sec. 1311(j))

All of these improved rules will help families who have children and youth struggling with mental health disabilities to get better care.


Here is an update that some of you may be interested in;

As of yesterday August 1, 2013

North Carolina insurance officials announced Tuesday that they have approved health plans that will be available with federal subsidies under the Patient Protection and Affordable Care Act.

Approval by the N.C. Department of Insurance is a big step for subsidized health care in the state. This was a strategy for those who designed Obamacare for managing  costs and providing insurance for North Carolina’s most vulnerable.

The health plans now await federal certification from the U.S. Department of Health and Human Services. The agency is expected to decide in September which insurance plans can be offered in North Carolina.

The exact details are not being shared with the general public. They will be posted online by the federal agency by Oct. 1, the date the new health care marketplace opens for enrollment.

“Coverage options will vary by county,” the N.C. Department of Insurance said in its release. “As the federal government will be operating the marketplace in North Carolina, it will make the final decision as to which plans may be sold through the marketplace in this state.”

Three insurers will be Blue Cross & Blue Shield, First Carolina Care and Coventry Healthcare of the Carolina. There will be  60 plans

Three insurance companies filed more than 60 plans between them, but N.C. insurance regulators refused to say how many plans were approved. They are claiming it is a trade secret.

So far, only Blue Cross and Blue Shield of North Carolina plans to offer subsidized coverage in all 100 counties of the state.

The other insurers ; Coventry Health Care of the Carolinas will offer subsidized plans in some parts of the state and FirstCarolinaCare will operate in just six counties.

More than 1 million North Carolinians are expected to sign up for subsidized insurance by the Jan. 1 deadline on which the policies become effective. Many will qualify for subsidies, called premium tax credits, that will average $5,000 a year for those who fall within certain income levels.

To see more info check this page out: http://www.hhs.gov/healthcare/facts/bystate/nc.html#PAGE_2



2 Responses to What is happening in North Carolina Affordable Health Care (ACA)

  1. Tonda Cunha 5 April, 2013 at 7:56 pm #

    Is ACA part of North Carolina’s Obama Care? I plan to move to NC in two months with my family. My husband should be on SSI, which automatically puts him on Medicare. I have an 18-year-old Special Needs son and a 9-year-old daughter. How can we get on insurance till I find a job?


  2. Gail Cormier 11 April, 2013 at 1:47 pm #

    ACA is part of the National Affordable Healthcare Act, also called Obamacare. At the moment you need to apply and be accepted for SSI for both your husband and son. Your daughter should automatically be eligible for Healthy kids until age 18. As of 2014,your entire family may be covered by Obamacare or ACA. The only concern is the North Carolina Legislature has decided to not expand Medicaid like the ACA law requires.

Leave a Reply