There's good news to report about the new individual health insurance exchanges that are now operating under the Affordable Care Act.
Nationally, just under 3.3 million people enrolled in individual insurance plans through the state- and federally-run exchanges during their first four months of operation, according to figures from the U.S. Department of Health and Human Services. In North Carolina, just over 160,000 people had selected an individual plan.
Although NC is 10th among states in population, it was 5th among states in private, individual health insurance enrollments during the first four months of the insurance exchanges. An additional 48,000 people were assessed as being eligible public insurance for Medicaid or the State Children's Health Insurance Program.
To put the figures in context, approximately 1.7 million North Carolinians lacked health insurance prior to the exchanges opening.
The high levels of enrollments aren't the only good news.
The plans are enrolling young people. Among NC enrollees, 25 percent were 18-34 years old; 17 percent were 35-44 years old; 22 percent were 45-54 years old; and 30 percent were 55 years old or older. The age distribution of NC enrollees is similar to the national age distribution.
The enrollment of young people is important to the sustainability of the private plans. The Kaiser Family Foundation has estimated that the plans would remain profitable so long as the proportion of 18-34 year-olds was at least 25 percent. As younger people are more likely to purchase insurance near the end of the open enrollment period than the beginning, the profitability threshold is likely to be met.
Also, an extraordinarily large proportion of NC enrollees--72 percent--have elected for coverage under a "silver" plan.
The exchange plans very in cost and coverage from the lowest-cost and most minimal coverage "catastrophic" plans through progressively higher cost and better coverage "bronze," "silver," "gold," and "platinum" plans. Nationally, 62 percent of enrollees opted for "silver" plans. Only about one-sixth of NC enrollees chose "catastrophic" or "bronze" plans, compared to one-fifth of enrollees nationally.
The ACA mandated minimum standards for health insurance plans, including coverage for prescription drugs, coverage for maternity care, requirements to insure people with pre-existing conditions, and annual caps on out-of-pocket expenses. These mandates led to the cancellation of many bare-bones plans. The logical choice for people who truly prefer bare-bones plans would be one of the "catastrophic" or "bronze" plans. The fact that so few have chosen these plans suggests either that the number of cancelled plans was more modest than originally thought or that people preferred and are now able to obtain better coverage than they could under the old system or possibly both.
The high levels of enrollments also come despite constant disparagement from the state's elected officials, despite the lack of state cooperation in establishing or running the health insurance exchange, and despite exchange plans that offer fewer choices and higher costs than the national average (due in no small part to the lack of state cooperation).
All-in-all, the enrollments suggest that there was substantial pent-up and unmet demand for health insurance in the state prior to the implementation of the ACA. Politicians who would return North Carolinians to that regime would cause tremendous harm.
