NC General Assembly building
Lawmakers return to Jones St. this week for the short legislative session. Photo credit Rose Hoban

With the reelection of President Obama, there seems to be little question that his hallmark Affordable Care Act will move forward to being implemented, but how the law will be implemented is being largely left to individual states. And how implementation will look in North Carolina is still not clear.

By Rose Hoban

As deadlines loom for states to tell the federal government their plans for implementing the Affordable Care Act (known as Obamacare), big questions still remain about how the law will look in North Carolina.

The most immediate question is what choice the state will make for running a health benefits exchange – an online marketplace where state residents can go to shop for insurance options.

Last week, the Obama administration delayed until mid-December a deadline for states to tell the federal government whether they plan to run their own exchanges.

States that choose not to run their own exchanges will be defaulted to a federally run exchange, something many North Carolina legislators have said they would prefer not happen. During the 2011 session, the state House of Representatives passed a bill expressing that intent, but the bill did not make it through the state Senate.

“Speaking for myself personally, I would hope that the governor would make the indication to the federal government of the state’s intent to pursue a state health benefit exchange,” Rep. Nelson Dollar (R-Cary) told the legislative health and human services oversight committee this week. Dollar co-chairs the committee.

Dollar said the decision is in Governor Perdue’s hands, but the decision was actually made in the General Assembly during the last session, when legislators did not authorize a state exchange.

“Folks wanted to see what the outcome of the Supreme Court case was going to be as well, frankly, as the outcome of the election,” Dollar said.

According to Pam Silberman, head of the North Carolina Institute of Medicine, since the General Assembly didn’t authorize a North Carolina exchange, management of the exchange will revert to the federal government – for now. She said states can plan for their own exchanges to kick in in 2015 or later.

A third option for states is to run a hybrid “partnership” exchange, where federal planners create and run the exchange, but states run the consumer support portion of the program. Silberman said by all appearances, this is what North Carolina will be doing in the short run. She said the state Department of Insurance has robust consumer support and ombudsman programs, and it would be possible to beef those up to support consumers who’ll be buying insurance through the exchange.

A spokeswoman from the state Department of Insurance indicated this is where her department is headed, but said details are still being worked out.

Lawmakers said there’s probably not much other choice, since the legislature will not reconvene until mid-January.

“Nothing can move forward without legislative approval, which will not go in until we’re here in January,” said Ralph Hise (R-Spruce Pine).

“Even if we were in session it’s not a decision that’ll take a month, or a month and a half, this is something the legislature is going to have to focus on – if we’re under this system – on what’s the best for North Carolina,” Hise said.

In a letter sent to state governors last Friday, Secretary of Health and Human Services Kathleen Sebelius said that for states planning partnership exchanges, her department would accept blueprints for how the partnerships would look until mid-February.

UPDATE 11/15:

Governor Bev Perdue announced on Nov. 15 her decision to have North Carolina participate in a state-federal partnership exchange.

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...

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