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The ACA crisis in North Carolina and beyond

North Carolina is encountering a health insurance crisis for the individual marketplace. With both Aetna and UnitedHealthcare bowing out of the market, Blue Cross and Blue Shield of North Carolina has requested new rating to increase premiums.

According to BCBS CEO Brad Wilson, they are predicting that they may be taking on up to 200,000 new enrollees to absorb the pool previously held by Aetna and UHC. With that comes a broader risk pool with many more sick individuals than ever before covered by the carrier statewide.

For North Carolinians, the choice in carrier is almost entirely limited to BCBS for the 2017 plan year, with Cigna covering just five counties in the state. Here’s a visual representation provided by Forbes:

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Forbes makes a great point, however. The fault is not with the sick populations in NC. The problem is the arrangement of the ACA and how it fails to keep the carriers, taking on unprecedented risk, afloat.

There is almost a threatening tone to the encouragement put forth by Affordable Care Act experts for young people to purchase insurance. One cornerstone of the ACA’s longterm success is for younger populations to enroll rather than forgo the immediate costs and pay the yearly fine instead. The fine saves them money short-term, barring illness or injury, but paying a premium monthly as a reasonably healthy individual ensures the ACA’s longterm success, so that in the future, they will be able to access insurance even with medical conditions or extensive histories. Unfortunately, many under 30 don’t have that option, and must make the best immediate financial decision.

This individual mandate is so weak that more healthy individuals are opting out of health insurance than previously, and more sick individuals are opting in.

There’s also the three-month grace period in which the individual is free from repercussions when they fail to pay their premium. This basically allows for the individual to pay for only 9 out of 12 months of the year’s worth of health insurance premiums, but still utilize their coverage.

These are all perfectly legal and sensible ways that populations have found the ACA benefitting them, but not ones that ensures that the carriers providing these benefits don’t hemorrhage. We are watching this occur as we watch the major carriers pull out of marketplaces nationwide.