Sign advertises Obamacare signups.
Sign at a lonely crossroads in Duplin County advertises insurance under the Affordable Care Act. Rose Hoban / North Carolina Health News

By Rose Hoban, North Carolina Health News

New data released this week by federal health officials show that North Carolina had continued strong enrollment on the federal health insurance marketplace during the most recent signup period – but it was a squeaker.

The data show that close to half of North Carolina’s 519,803 signups for insurance available under the Affordable Care Act (also known as Obamacare) took place during the final week of enrollment.

“Always the last week is really the time when people come out and they get enrolled,” said Mark Van Arnam, co-director of the North Carolina Navigator Consortium, which helped coordinate enrollment last year. “People are naturally procrastinators. We know that.”

But even as signups in the final week may have been strong in prior years, they didn’t provide the surge seen during the final week this year, which closed on Dec. 15, when fully 48 percent of consumers clicked “purchase.”

In contrast, about 35 percent of enrollees finalized their plans during the final month of the 2016-17 enrollment period.

This year’s open enrollment period was half the length of prior years’, which Van Arnam said may have added some urgency.

“It seemed like people were aware that there was a shorter time,” he said. “We had done a lot of work to make sure the people were aware that they didn’t have until the end of January, that they had to act.”

Enrollment remained strong despite less spent on outreach and advertising, something noted by the federal Centers for Medicare and Medicaid Services in a press release Tuesday.

“The agency spent $10 million on marketing and outreach, which is just over $1 per enrollee by funding only the most efficient tactics and increasing direct response outreach,” the statement said. “In comparison, last year CMS spent $11 per enrollee, totaling approximately $100 million to enroll nearly the same number of individuals that were enrolled this year.”

There’s a likelihood that consumer awareness was also heightened as the result of multiple high profileCongressional battles over repeal of the plan that took place throughout 2017.


For the 2017 enrollment period, signups in North Carolina were down about 5.5 percent from the year before, and in the state, just about 27 percent of people signing up for coverage were new.

“There’s automatically going to be some churn, and there will be new consumers every year,” Van Arnam said. In prior years, new enrollees have made up a greater share of consumers, the high number of re-enrollments could be a sign that the marketplaces are starting to mature.

Blue Cross and Blue Shield of North Carolina, which covers the vast majority of marketplace enrollees in the state announced earlier this year that the company had seen that marketplace consumers were “healthier than expected” and also saw the number of claims stabilizing in mid-year. As a result, the company reported higher than expected income for the whole of 2017, largely because it broke even on ACA and individual plans for the first time in five years.

All told, ACA consumers make up fewer than 15 percent of BCBSNC’s enrollees.

For at least the fourth year in a row, about nine in 10 enrollees qualified for a tax credit, which lowered their out-of-pocket premiums. So, even as overall premiums climbed by about 30 percent to an average of $768 per month, consumers only saw a fraction of that, paying $134 on average for their premiums.

And many of those people receiving subsidies also qualified for cost-sharing reductions which lowered their out-of-pocket costs for expenses such as co-pays.

Uncertainty looms

Tuesday’s report comes at the same time as the results of a survey done by the Kaiser Family Foundation which found that nine out of 10 people purchasing insurance on the individual marketplace intend to continue buying insurance, despite Congress’ repeal of the individual mandate, which was part of the ACA.

Van Arnam said that’s what North Carolina’s navigators have been hearing from consumers.

“I think people are starting to realize more and more now the value of having insurance and that’s important to have … some sort of health coverage,” he said. “There’s a value in having the peace of mind of being able to take care of yourself if there’s an accident or an illness.”

But despite consumers’ professed desire to purchase insurance, more than half the respondents to the Kaiser survey said they believed that marketplaces were “collapsing,” and six in 10 marketplace enrollees said they worried about not having insurance options in their areas next year.

This year, Blue Cross and Blue Shield of North Carolina was the only carrier offering plans in all of the state’s 100 counties, and the company picked up about 200,000 enrollees after Aetna and UnitedHealthcare pulled out of the state.

The Kaiser survey found that about six in 10 marketplace enrollees reported being either very or somewhat satisfied with the choices available to them.

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