North Carolina had one of the strongest enrollment numbers for the Affordable Care Act online insurance marketplace. How did that occur?
By Rose Hoban
Additional reporting by Andy Miller, Georgia Health News
North Carolina’s enrollment in the Affordable Care Act federal insurance exchange reached a level in December that was surprising given the state’s prior poor performance in signing people up.
According to federal statistics released last week, North Carolina had 107,778 people signed up by Dec. 28, up from a total of only 8,970 who had signed up by the end of November.
That’s after North Carolina’s exchange became the object of national ridicule when the state had only a handful of signups for all of October.
And when one compares North Carolina’s total to those in similarly sized states that also use the federal exchange, the results show the state has had some of the most robust enrollment activity in the country.
North Carolina’s enrollment figure exceeded Ohio’s total of 39,955, even though the Buckeye State has a larger total population, ranking seventh in the nation to North Carolina’s 10th.
And North Carolina’s enrollment surpassed that of other larger states, including Michigan, which had 75,511 completed signups, and Illinois, which had 61,111.
Both of those Midwestern states, however, have lower rates of uninsured residents than North Carolina does.
Why North Carolina enrolled many
Ben Money, CEO of the North Carolina Community Health Center Association, said many nonprofit groups in North Carolina organized early on in the run-up to the exchange launch. These organizations, he said, “have been meeting and coordinating our efforts.”
Money also cited the pent-up demand for coverage by the uninsured in the state.
Sorian Schmidt, North Carolina’s state director for Enroll America, a national nonprofit encouraging enrollment in the exchanges, said she believes the state has strong networks of health care providers who are used to working with one another, “But there’s no way to measure that compared to other states.”
The most concrete thing Schmidt could point to in explaining high enrollment numbers is a navigator appointment scheduler created for statewide use.
She said Legal Aid of North Carolina, one of the organizations that received a federal grant to assist with enrolling people into the exchanges, purchased software for scheduling appointments and then adapted it to fit its needs.
Schmidt said that navigators and in-person assisters throughout the state enter a person’s county of residence, and that person is then matched with a navigator.
She noted that North Carolina is the only state that set up such a system.
“We also have a toll-free number to make an appointment,” Schmidt said. “A person can call and get a live person when they go to make the appointment.”
She said that Legal Aid also recruited law students from all of the state’s law schools to become navigators, all of whom completed the federal 20-hour training program as well as additional online training provided by the North Carolina Institute of Medicine.
“They have something like 180 law students who’ve volunteered and done training now,” Schmidt said. “On Christmas break, some students drove up to Asheville and did an enrollment event.”
She said that many of those students will be assisting with enrollment events Monday around the state to mark the Martin Luther King Jr. holiday.
Other states create roadblocks
In North Carolina, the Department of Health and Human Services is not coordinating any enrollment activities. But Schmidt said it’s helpful that state government is not blocking the efforts of those who are attempting to get people enrolled, as is happening in other states.
Georgia, for instance, required navigators and other insurance counselors to obtain separate certification and licensing beyond the federal requirements, according to Schmidt’s Georgia counterpart, Dante McKay, the Georgia state director of Enroll America.
“North Carolina got up and running quicker than Georgia did,’’ McKay said.
And states such as Missouri, Montana, Texas and Florida have also created roadblocks for insurance-exchange navigators, in some cases restricting what navigators can ask and say in helping people to enroll, having them pay extra fees or restricting where they can work.
According to a study released last week by researchers from George Washington University, “In states with restrictive policies toward ACA implementation, health centers are confronting significantly greater outreach and enrollment challenges.”
The study listed Florida, Georgia, Indiana, Maine, Missouri, Montana Tennessee, Texas and Wisconsin as “restrictive states.” North Carolina had more than 56 percent of projected enrollees signed up for insurance; of the “restrictive” states, all but Maine had far lower percentages of eligible enrollees signing up.
In fact, North Carolina had one of the highest percentages of predicted enrollment of any state, lagging behind only Colorado, Connecticut, Maine, New York and Rhode Island.
The federal data released last week also showed that about 89 percent of North Carolina enrollees qualified for subsidies –- a higher rate than the national average of 79 percent.
Schmidt agreed with Ben Money that there was a lot of pent-up demand in North Carolina. She pointed to the example of a telephone town hall meeting on enrollment held by Rep. G.K. Butterfield.
“He had 8,000 people on a conference call for an hour,” she said. “It was incredible. People are really super-activated.”