By Thomas Goldsmith

Despite President-elect Donald Trump’s plans to repeal the Affordable Care Act, the law still remains in effect. And people charged with aiding enrollment are urging eligible North Carolinians to join the more than half-million state residents who have already gained ACA coverage for 2017.

A report Tuesday from the Centers for Medicare and Medicaid Services showed that 533,252  North Carolina residents signed up under the federal health-insurance act between Nov. 1 and Dec. 24. However, many potential enrollees may have been confused by widespread coverage of planned repeal and replacement of ACA, according to agencies dealing with the public.

“At this point, we are advising people that the ACA is still the law and that you can qualify for financial help,” said Sorien Schmidt, state director of Enroll America, a national health care enrollment coalition. “You could also potentially be fined for not being covered. You should go and see what you are covered for and make a knowledgeable decision about what to do.”

North Carolinians who registered by Dec. 15 had their coverage begin this month, while those who sign up by Jan. 15 will be covered on Feb. 1. Those who sign by Jan. 31 will have coverage beginning March 1.

The Associated Press reported Tuesday Republican leaders who had said months or years could pass between ACA repeal and replacement have been urged by Trump to replace it within weeks of repeal.

Trump has made clear his desire for an early replacement for what he has called a catastrophic law.

“It’s a complete and total disaster,” Trump said during a news conference Wednesday.

His administration will come up with a replacement “virtually simultaneously,” Trump said.

However, there’s no apparent consensus among lawmakers about a new plan that would retain popular features such as the ACA’s protection for people with pre-existing conditions.

It’s the law; Penalties still apply

“What we tell people right now is, it seems like the 2017 benefit is set, so if they repeal it it won’t be this year,” said Gina Upchurch, director of Senior PharmAssist in Durham, a nonprofit that helps older people and those with disabilities deal with health insurance.

People insured under Medicare would also be affected by the elimination of the ACA, known as Obamacare. The ACA has been filling in the gap, known as the doughnut hole, in seniors’ prescription drug coverage, known as Medicare Part D.

Insurers have had problems enrolling enough younger, healthy people under the program to pay premiums, generating the funds to provide care for older, sicker ACA participants. Monday’s report shows only one in 10 North Carolina enrollees is between 18 and 25, while 46 percent are between 45 and 64 years old.

Then there’s the penalty for electing not to sign up for health insurance; it remains in place for 2017 and amounts to 2.5 percent of household income, or $695 per adult and $347.50 per child, whichever is higher. Some people can qualify for exemptions from the penalty because of hardship, changes in life situations, or other reasons.

Few ACA choices

Some insurance companies pulled out of statewide coverage under Obamacare for 2017, leaving only Blue Cross and Blue Shield of North Carolina available in all 100 counties.

Schmidt said there were a lot of people who had coverage this year with UnitedHealthcare or Aetna, and now will need to find a different insurer.

“There are so many different factors, you want to make sure that it’s a comparable plan,” Schmidt said. “I recommend that people use an assister. They just want to be sure they understand all the factors.The plans and the premiums change every year.”

Cigna HealthCare of North Carolina, the only other insurer this year, is offering ACA coverage in Chatham, Johnston, Nash, Orange and Wake counties, all near Raleigh.

According to this week’s CMS report, 25 percent of enrollees in North Carolina came from rural Zip codes.

Upchurch noted, with the ACA in place since 2013, some people have overlooked how Obamacare caps out-of-pocket expenses for people with insurance who have medical bills. There’s some evidence that this provision has led to a decrease in bankruptcies fueled by medical debt.

“Remember we used to have people going bankrupt?” Upchurch said. “Now the insurer is on the hook.”

Nonetheless, opposition to Obamacare likely played a role in Trump’s victory over former Secretary of State Hillary Clinton. A Kaiser Health Tracking poll conducted last month showed that 46 percent of U.S. adults generally viewed the ACA unfavorably, while 43 percent viewed it favorably.

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