6 Years Later: How the Affordable Care Act is Working for North Carolina
The Affordable Care Act is working to make health care more affordable, accessible, and high quality for the people of North Carolina
Improving Access and Affordability
Making health care more affordable and accessible through the Health Insurance Marketplaces: Through the Marketplace, North Carolinians had the option of signing up for quality health coverage at a price they could afford. Whether they visited the simpler, faster and more intuitive website at HealthCare.gov or contacted the call center, they found more choices and competitive prices.
In North Carolina, 613,487 consumers selected or were automatically re-enrolled in quality, affordable health insurance coverage for 2016. Nationwide, nearly 12.7 million consumers selected a plan or were automatically enrolled in Marketplace coverage.
Marketplace Signups and Tax Credits in North Carolina:
- 89 percent of North Carolina consumers who were signed up qualified for an average tax credit of $399 per month through the Marketplace.
- 80 percent of North Carolina Marketplace enrollees had the option to obtain coverage for $100 or less after tax credits in 2016, and 85 percent may have the option of doing so in 2017.
Reducing the number of uninsured Americans: Nationwide, since the Affordable Care Act’s coverage expansion began, about 20 million uninsured people have gained health insurance coverage - the largest reduction in the uninsured in four decades. And recent Census data shows that the uninsured rate in North Carolina in 2015 was 11.2 percent, down from 16.8 percent in 2010.
New coverage options for young adults: Under the health care law, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old. From the time the Affordable Care Act’s dependent coverage provision took effect in 2010 through 2015, the uninsured rate among individuals ages 18 to 25 fell by 16.4 percentage points, a 52 percent decline.
Expanding Medicaid: Thanks to the Affordable Care Act, states have new opportunities to expand Medicaid coverage to individuals with family incomes at or below 133 percent of the federal poverty level (generally $32,319 for a family of four in 2016). This expansion includes non-elderly adults without dependent children, who have not previously been eligible for Medicaid in most states.
Thirty one states plus DC have expanded Medicaid under the Affordable Care Act. If North Carolina made the decision to expand Medicaid, it is estimated an additional 313,000 North Carolinians would gain health insurance coverage. As a result of Marketplace coverage and Medicaid expansion, we estimate that hospital uncompensated care costs have been reduced by $7.4 billion in 2014, compared to what they would have been in the absence of the coverage expansion. If all States fully expanded Medicaid, uncompensated care costs would be about $8.9 billion lower in 2016 than they would be if no states expanded Medicaid.
Scrutinizing unreasonable premium increases: In every State and for the first time under Federal law, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. North Carolina has received $4,984,080 under the new law to help fight unreasonable premium increases. To date, the rate review program has helped save Americans an estimated $1.1 billion in the individual market and $418 million in the small group market.
Removing lifetime limits on health benefits: The law bans insurance companies from imposing lifetime dollar limits on health benefits – freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits. Already, 3,091,000 people in North Carolina, including 1,186,000 women and 804,000 children, are free from worrying about lifetime limits on coverage. The law also restricts the use of annual limits and bans them completely starting in 2014.
Keeping Cost Down for Employer Coverage: The average premium for families with employer-sponsored health plans grew just 3.4 percent in 2016, according to the Kaiser Family Foundation and Health Research and Educational Trust survey, extending a period of unusually slow growth since 2010. The White House Council of Economic Advisers calculates that the average family premium in North Carolina was $3,300 lower in 2016 than if premiums had grown at the same rate as the pre-ACA decade.
Covering preventive services with no deductible or co-pay: The health care law requires many insurance plans to provide coverage without cost sharing to enrollees for a variety of preventive health services, such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults.
Expanding mental health and substance use disorder benefits: The Affordable Care Act increases also access to comprehensive coverage by requiring most health plans to cover ten essential health benefit categories, to include hospitalization, prescription drugs, maternity and newborn care, and mental health and substance use disorder services. The health care law expands mental health and substance use disorder benefits and federal parity protections for 170 million Americans nationwide.
Because of the Affordable Care Act, 76 million Americans with private health insurance gained preventive service coverage with no cost-sharing, including 2,266,000 in North Carolina. And women can now get coverage without cost-sharing of even more preventive services they need. Of the 76 million Americans with expanded access to free preventive services, 29.7 million are women, including 917,000 in North Carolina receiving expanded preventive services without cost-sharing.
Investing in Providers
Investing in the primary care workforce: As a result of historic investments through the health care law, Recovery Act and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the number of clinicians in the National Health Service Corps (NHSC) are near all-time highs with 10,400 NHSC and 2,000 NURSE Corps clinicians providing care to 11 million people who live in rural, urban, and frontier communities. The National Health Service Corps repays educational loans and provides scholarships to primary care physicians, dentists, nurse practitioners, physician assistants, behavioral health providers, and other primary care providers who practice in areas of the country that have too few health care professionals to serve the people who live there. As of September 30, 2015, there were 243 Corps clinicians providing primary care services in North Carolina, compared to 68 in 2008.
Increasing support for community health centers: The Affordable Care Act increases the funding available to community health centers nationwide. Health Center grantees in North Carolina have received $283,472,218 under the health care law to offer a broader array of primary care services, extend their hours of operations, hire more providers, and renovate or build new clinical spaces.
To help improve access to coverage, $17,226,492 was awarded to North Carolina health centers to help enroll uninsured Americans in the Health Insurance Marketplace. Overall, since 2013, North Carolina health centers used these funds to help more than 237,430 North Carolina residents with enrollment into affordable health insurance coverage. These investments ensure that health centers continue to be a trusted resource for assistance with enrollment in the Marketplace, Medicaid and CHIP in North Carolina.
In North Carolina, 38 health centers operate 226 sites, providing preventive and primary health care services to 471,725 North Carolinians, including 131,117 Latinos and 146,415 non-Hispanic African Americans.
A Stronger Medicare Program
Safety: Hospital readmission rates have fallen sharply as new incentives put in place by the ACA took effect. Data from the Centers for Medicare and Medicaid Services show that hospital readmissions dropped by 6.50 percent for North Carolina Medicare beneficiaries since 2010. That means that North Carolina Medicare beneficiaries avoided 2,472 readmissions in 2015, compared to if readmissions had stayed constant at 2010 rates.
Making prescription drugs affordable for seniors: In North Carolina people with Medicare have saved nearly $754,711,569 on prescription drugs because of the Affordable Care Act. In 2016, 77,458 Medicare beneficiaries benefitted from donut hole savings and saw average discount of $1,006. And thanks to the health care law, coverage for both brand name and generic drugs will continue to increase over time until the coverage gap is closed. Nationally, over 2.3 million people with Medicare have saved over $23.5 billion on prescription drugs since the law’s enactment, for an average savings of $1,025 per beneficiary.
Covering preventive services with no deductible or co-pay : With no deductibles or co-pays, cost is no longer a barrier for seniors and people with disabilities who want to stay healthy by detecting and treating health problems early. In 2016 alone, an estimated 19.6 million people benefited from Medicare’s coverage of preventive services with no cost-sharing. In North Carolina, 698,178 individuals with Medicare used one or more free preventive service in 2016.
Cracking down on fraud and abuse: The health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology. More than $29.4 billion has been returned to the Medicare Trust Funds since 1997 because of HHS and DOJ’s fraud enforcement efforts. For every dollar spent on health care-related fraud and abuse control activities in the last three years (2013-2015) the administration has recovered $6.10.