- Associated Press - Friday, October 28, 2016

RALEIGH, N.C. (AP) - With just one insurer offering the broadly subsidized insurance policies of President Barack Obama’s health care overhaul in North Carolina, cost increases for a benchmark plan will rise by more than 80 percent in some of the state’s poorest counties, newly released data show.

Taxpayers will pick up most of that price increase by private insurers because about three-quarters of the people buying the individual policies from Blue Cross Blue Shield of North Carolina, the state’s dominant health insurer, qualify for federal tax subsidies covering much or most of the cost.

“Most individuals who are getting subsidies will not experience the full price increases,” said Caroline Pearson - senior vice president of Washington, D.C.-based health care consulting firm Avalere - on Thursday.

The subsidies are not available to North Carolinians who buy individual policies outside the health care law’s online marketplace. They will face the full increases, which Blue Cross announced earlier this month would increase in 2017 by an average of 24 percent for the range of individual plans it sells in North Carolina under the Affordable Care Act.

Republicans including U.S. Sen. Richard Burr and Gov. Pat McCrory have pointed to the increased costs and reduced options as supporting their views that the plan should be scrapped.

The Associated Press and Alvere teamed up to examine insurance provider participation in nearly every county in the nation as enrollment for the fourth year of the law opens Tuesday.

A key finding: consumers will have the least amount of choice that they’ve had in the four years that the insurance marketplace has existed.

North Carolina is one of eight states that have only one participating insurer in the majority of their counties. The others are Tennessee, Florida, Georgia, Mississippi, Arizona, Missouri and Nevada. South Carolina, Alabama, Alaska, Oklahoma and Wyoming have just one health insurer across the entire state marketplace.

In North Carolina, competition for nonprofit Blue Cross will exist in just five counties in the Raleigh area where Cigna plans to sell coverage. Insurers United HealthCare, Aetna and Humana have quit competing in recent years. Blue Cross expects to enroll about 260,000 of these ACA customers left behind by other insurers, nearly doubling its total number of the policies.

Prices for a benchmark plan - the second-lowest priced silver plan in each rating region for a 50-year-old single nonsmoker - are pegged to rise by 24 percent to nearly $800 a month in 21 eastern North Carolina counties from the Outer Banks to the coastal plain, according to data provided by Avalere. Someone younger would pay less, while smokers and those older would probably pay more.

But in Cumberland, Harnett, Hoke and five other nearby, mostly rural counties to their south, the cost for that same policy would rise by 83 percent to $856 a month - the highest price for that coverage in the state.

Blue Cross said Friday in most counties it was offering at least eight plans with different cost and coverage options, while some areas would have up to 14 plan options.

“As customers shop for the health care plan that best fits their needs, they should use all the resources available to compare plans and consider their eligibility for a subsidy,” spokesman Lew Borman wrote in an email.

Most people who don’t get insurance through their jobs are required to enroll in a plan by January 31. Failure could mean a fine of $695 or 2.5 percent of their annual income, whichever is more.

These counties aren’t alone. Premiums for similar benchmark plans rose at least 75 percent in 130 counties across six states - many with only one participating insurance issuer.

The problem is that the health overhaul has not drawn enough young, healthy people to pay into the system and balance out policy-holders who are older and sicker, said Brian Tajlili, pricing services director for North Carolina’s Blue Cross.

“On average, ACA customers tend to require more medical services than most other customers, and have more chronic conditions that are costly to treat. They also have a higher volume of emergency room visits. Many take expensive prescription drugs,” Tajlili said earlier this month.

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Follow Emery P. Dalesio at https://twitter.com/emerydalesio . His work can be found at https://bigstory.ap.org/content/emery-p-dalesio .


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