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650K North Carolinians Could Get Health Insurance After Biden Reopens ACA Enrollment

President Biden signs an executive order to shore up the Affordable Care Act.
President Biden signs an executive order to shore up the Affordable Care Act.

Those who missed the opportunity to sign up for Obamacare last December will soon have another chance to enroll. On Thursday, President Biden signed an executive order directing the Department of Health and Human Services to reopen enrollment in the Health Insurance Marketplace.

There are 1.2 million uninsured North Carolinians, and the health research group the Kaiser Family Foundation estimates that 650,000 could enroll in Obamacare when the exchange reopens if there’s more outreach and advertising. That’s because many are unaware they’re eligible for subsidies so significant that they’ll pay little or nothing for coverage.

Kaiser estimates about 280,000 would get insurance at no cost. That’s because they qualify for tax credits which cover the entire cost of the premium for a Bronze Plan, the lowest level of coverage available under the Affordable Care Act. This group must earn less than 250% of the federal poverty level. That’s $65,500 for a family of four.

Kaiser expects another 150,000 will qualify for some level of subsidy thatwon’t be enough to cover the full cost of the premium. It also anticipates that outreach will help convince another 220,000 to enroll who don’t qualify for any subsidy.

Not included in Kaiser’s estimates are people who are eligible for Medicare, Medicaid, or who earn 100% of the poverty level. They don’t qualify for subsidies under the ACA, because the law anticipated they’d be covered under Medicaid expansion. North Carolina is one of a dozen states that have not expanded Medicaid.

Why have so many North Carolinians gone without no- or low-cost insurance? Daniel McDermott with Kaiser says many Americans aren’t aware of the opportunity and the subsidies. The Trump administration cut spending on marketing and outreach for marketplace enrollment, and a Kaiser study found it actually left $1.2 billion for these activities unused. It estimates that’s money the Biden administration can use.

Kaiser found that most Americans who qualify for free Bronze plans but who haven’t enrolled are more likely to have a high school education or less, are working part time or are unemployed, are Hispanic, have a non-English speaker at home, live in a rural area, lack internet access, or work in arts, entertainment or construction. It thinks outreach efforts need to target these groups.

Mark Van Arnam heads the North Carolina group which helps people enroll. He says the federal government is planning a “big marketing campaign” and expects a “wave” of new sign ups. He says his organization will be ready on Feb. 15, when HealthCare.gov is expected to reopen

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Dana Miller Ervin is a reporter at WFAE, examining the U.S. health care system.