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Worry About 'Plateau' In Obamacare's Effects

More in North Carolina have gained health insurance with the passage of the Affordable Care Act.
Census Bureau
Jason deBruyn

The effects of the Affordable Care Act on the rate of North Carolinians without health insurance has started to plateau. In some counties, it has begun to reverse.

Overall, North Carolina saw the rate of those without health insurance decline, following a trend that began with the passage of the ACA, often referred to as Obamacare. But that trend slowed in 2016, and in more than a quarter of the state, actually receded, according to the latest figures released by the U.S. Census Bureau.

Across North Carolina, those who have gained health insurance has increased substantially. In 2010, the year the ACA was signed in to law, there were more than 1.5 million people in the state without health insurance. That meant close to one out of every five people in the state were not covered. By 2016, that dropped to slightly more than 1 million people without insurance, or about 12 percent of the total population.

However, the decline slowed that year, suggesting that the effects of the ACA might have neared their limits. Furthermore, these figures estimate rates of insurance in the last year of the Obama Administration. Although Congress could not repeal the law, certain provisions were knocked off during the early months of the Trump Administration. For instance, individuals will no longer face a penalty for not having health insurance coverage, and insurers no longer receive cost-sharing subsidies, which helped control premiums.

"The most important message, obviously, is that the Affordable Care Act has substantially reduced the number of North Carolinians without health insurance," said Jonathan Oberlander, a UNC-Chapel Hill professor and chair of Social Medicine. "For all the controversy surrounding the law and everything that's gone wrong, we shouldn't forget that a lot of folks in North Carolina have gained insurance coverage."

Still, he noted that even before President Trump took up residency at 1600 Pennsylvania Avenue, the "progress in reducing the uninsured was plateauing," adding that "there's some early evidence suggesting that there may be some reversal of progress in health insurance coverage."

In 28 North Carolina counties, the rate of those without health insurance increased from 2015 to 2016. Compare that to the prior year – 2014 to 2015 – in which not a single one of North Carolina's 100 counties saw an increase.

Those counties that saw increases in the rates of uninsured tended to be in economically distressed areas, though not exclusively. Granville, Iredell and Watauga all saw increases, yet they are classified as Tier 3 counties by the N.C. Department of Commerce. As for the others, 10 counties that saw an increase are classified as Tier 2 counties, and the remaining 15 are classified as Tier 3, the most distressed.

"There's tremendous uncertainty surrounding the law's future," said Oberlander. "The crystal ball is foggy, very foggy."

Jason deBruyn is the WUNC health reporter, a beat he took in 2020. He has been in the WUNC newsroom since 2016.
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