Impact of the Affordable Care Act on North Carolina's uninsured population

NC ACA

The Impact of the Affordable Care Act on North Carolina's Uninsured Population

Tens of millions of Americans are uninsured in regard to their health, many at least partly because of rising health care costs. Spending on healthcare has outpaced the growth in the rest of gross domestic product by 2.5 percentage points annually throughout the past four decades and has doubled every decade and, at that rate, health spending will absorb 40% of GDP by 2050 (Reinhardt, 2010). Currently healthcare related bankruptcies are the leading driver of personal bankruptcies in the country because many families have fallen victim to overwhelming health care related financial burdens. There is an estimated one million six hundred thousand individuals (about seventeen percent) in North Carolina that currently do not have health insurance. This analysis will look at how the Affordable Care Act will affect this population.

The Affordable Care Act

The healthcare industry in the United States has been subject to a vast number of changes in recent years that are primarily driven by the Affordable Care Act. This legislation has greatly expanded the number of citizens who are able to purchase affordable health insurance in the Healthcare Marketplace and in most cases there is a government subsidy to help offset the costs to families.

Under the ACA, people with incomes between 100% and 400% of poverty may be eligible for premium tax credits when they purchase coverage in a Marketplace; the tax credit is based on income and the cost of insurance, and tax credits are only available to people who are not eligible for other coverage, such as Medicaid/CHIP, Medicare, or employer coverage, and who are citizens or lawfully-present immigrants (Kaiser Family, 2014).

The U.S. Census Bureau broke down rates of uninsurance by state in 2013 and found based on a survey that in North Carolina, about 1.58 million people were uninsured in 2012, but by the time of the 2013 survey, that number had dropped to 1.509 million (Hobban, 2014). According to these results, the rate of uninsured in North Carolina has already dropped from 16.5% in 2012 to 15.5% in 2013. Although this could be seen as significant progress, it also illustrates how far North Carolina still has to go to cover more of its population. Furthermore, some have argued that this improvement had more to do with the recovering of the economy than the effects of the new legislation.

The Affordable Care Act can also have significant indirect implications for many different demographics in the community. For example, Affordable Care Act made provision for more than $14 million to be awarded to 45 school-based health centers across the country allowing the number of children served to increase by nearly 50%, HHS Secretary Kathleen Sebelius has announced (HRSA Press Office, 2011). Therefore there will be some demographics that could benefit from the legislation indirectly through publicly funded provisions that were included in the legislation that was passed.

North Carolina was one of the state's that opted not to expand their Medicaid programs which will not help some of the lowest income earners that do not qualify for Medicaid or any tax credits available from the Affordable Care Act. The U.S. Supreme Court ruling last year allowing states to opt out of the Medicaid expansion -- and then the choice by states to pass on the expansion -- created a gap that the report has found an estimated 42% of people who have been uninsured over the past two years will fall through (Covington, 2013).

Figure 1 - Gap in NC Coverage (North Carolina Justice Center, 2014)

Conclusion