Plans approved for NC ACA Marketplace

The N.C. Department of Insurance has approved 67 plans from 3 insurers that will be for sale with income-based subsidies on the federally run North Carolina insurance marketplace starting October 1, 2013. As reported earlier (but now confirmed by the N.C. Department of Insurance), only Blue Cross Blue Shield of North Carolina will offer at least 1 plan in all 100 counties (this is a relevant fact for the nascent Medicaid reform proposed by the Governor).

The big idea behind the ACA’s private health insurance marketplaces (they used to be called exchanges and is called a connector in Massachusetts) is for insurance companies to compete for the business of consumers, driving down premiums and improving choice and quality under the reality of the ending of pre-existing conditions excluding coverage.

North Carolina will be on the low-end of the competition spectrum, which is not particularly surprising given the dominance of Blue Cross Blue Shield in the State. A key feature of the marketplace/exchange approach is that insurance companies cannot be forced to sell in a given state. Most Blue Cross Blue Shield plans are operating in their State, but other companies are doing so in only selected states. It would be hard for individual market consumers to have less choice than they now have in North Carolina, but the number of companies selling in the State is a key issue going forward.

Interestingly, the premiums to be charged have not leaked out in North Carolina, and they are not being released by either the companies, nor the Insurance Department as they are viewed as proprietary information. However, the premiums have leaked or otherwise been made available in most other states, often with the political realities of states influencing how the premiums have been released (releasing the full premium without accounting for subsidies for example make the rates sound scarier than doing so with income based subsidies taken into account). Will the blackout last until October 1?

One thing arguing for the information remaining under wraps unless leaked is that the Insurance Commissioner in North Carolina is a Democrat who is positively predisposed to the ACA, while the Governor and General Assembly are controlled by Republicans, so they would likely not be able to agree on whether they wanted to splash the release of the rate information in a positive or negative light.

In any event, the rubber will meet the road of October 1 and we will see how many people sign up.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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