By Rose Hoban

North Carolina ended the Affordable Care Act insurance exchange’s open enrollment period with more than a half-million enrollees for coverage this year – still, the number represented a significant decrease from last year.

The 549,158 who signed up for North Carolina exchange coverage by Jan. 31 represents a 10.5 percent drop from the 613,487 who enrolled during open enrollment in early 2016.

2017 North Carolina 549,158
2016 North Carolina 613,487
2015 North Carolina 492,014

Nationally, open enrollment for 2017 coverage ended with more than 9.2 million plan selections in the 39 states that use the enrollment platform, from November through Jan. 31, federal health officials announced Friday. That figure is down from 9.6 million during the same period a year ago.

Proponents of the ACA pointed out that official outreach for exchange enrollment was sharply cut back after the inauguration of President Donald Trump two weeks ago. Trump and his fellow Republicans, who control Congress, are opponents of the ACA, often known as Obamacare, and they are working to repeal it.

In the last two weeks of enrollment, 413,620 fewer people nationwide signed up than during the same time period last year.

In the last week of… 2016 2017 % Difference
Charlotte North Carolina 208,622 182,958 -12.3
Greensboro-H.Point-W.Salem North Carolina 109,342 94,596 -13.5
Greenville-N.Bern-Washington North Carolina 44,373 39,429 -11.1
Greenville (SC)-Spartanburg-Asheville North Carolina 119,731 117,053 -2.2
Raleigh-Durham (Fayetteville) North Carolina 165,645 149,774 -9.6

In the final days of enrollment, spending on email blasts, television and radio advertisements dropped from about $1 million per day to less than $250,000 per day for the last four days of January. Enrollment ended on Jan 31. In addition, there were two days near the end of January when no money at all was spent on getting the word out.

Those numbers are in stark contrast to an uptick in spending on outreach that happened during previous years near the end of the enrollment period. In prior years, the push also included appearances by Pres. Barack Obama on late-night programs, comedy sketches and other aggressive measures to recruit young people to buy insurance.

Are we repealed yet?

Health policy expert Pam Silberman, from the Gillings School of Global Public Health at UNC Chapel Hill, said there are likely other reasons for the drop off, the most prominent being the inauguration of Donald Trump as president on Jan. 20.

“There’s confusion over what people understand or don’t understand about what’s happening with the Affordable Care Act,” Silberman said. “After the election. I think there were a lot of people who thought the ACA would be repealed, who didn’t know that the ACA was still in existence.”

She said that impression may have been bolstered by the fact that on his first day in office, Trump signed an executive order telling parts of the government to ease the “regulatory burdens” of the ACA. The order told federal agencies to “waive, defer, grant exemptions from, or delay the implementation of any provision or requirement” of ObamaCare that imposes a “fiscal burden.”

The order doesn’t actually repeal the law, but because repeal was part of Trump’s campaign pitch, Silberman said it might have left the wrong impression with consumers.

“I think it caused even more confusion because I don’t think people understood… what it meant,” she said.

Nonetheless, North Carolina had the third largest number of enrollees in the country. Only Texas and Florida, much larger states, had more people enroll.

Economic changes

Silberman said there’s also the possibility that with improving employment, fewer workers may be looking to buy insurance on the exchange marketplace.

“Some people are getting jobs and some of those jobs are offering health insurance coverage,” she said.

However, the reality is that for many health insurance seekers, the costs climbed this past year. With the pullout of insurance giants Aetna and UnitedHealthcare in North Carolina, only one insurer, Blue Cross and Blue Shield of North Carolina, had plans on offer in every county. Cigna had plans for sale in only six counties around the Research Triangle area, the only other insurer on the exchanges for the state.

Rates for BCBSNC plans rose an average of 24.3 percent for this year’s offerings, a steep rise, but less steep than in 2016, when rates rose an average of 32.5 percent.

The federal Centers for Medicare and Medicaid Services has not yet released numbers on how many insurance purchasers received subsidies to help defray the cost of their exchange plans. Last year, 92 percent of North Carolinians who purchased on the exchanges received a subsidy to help lower their costs.

Political takes

Anne Filipic, president of Enroll America, which helps consumers sign up for coverage, told the L.A. Times, “There is no doubt that enrollment would have been even higher if not for the uncertainty caused by political attacks on the law, and the Trump administration’s decision not to provide consumers with all of the resources and support available to help them enroll.”

But the incoming administration has had a different take.

“Obamacare has failed the American people, with one broken promise after another,” said Matt Lloyd, a political operative who has worked for Mike Pence in the past, in a communication sent to reporters. Lloyd is now a spokesman for the U.S. Health and Human Services Department.

“As noted today in a report from [the federal Centers for Medicare and Medicaid Services], premiums in the [Affordable Care Act] marketplace have increased 25 percent while the number of insurers has declined 28 percent over the past year,” Lloyd wrote. “We look forward to providing relief to those who are being harmed by the status quo and pursuing patient-centered solutions that will work for the American people.”

Benjamin Wakana, who until several week ago was spokesman for DHHS under the Obama administration, told CNBC that Lloyd’s statement was “insane.”

“The ACA covered 20 million more people than any Republican plan,” said Wakana.

Republican’s eagerness to immediately repeal and replace the ACA seemingly has slowed in recent days, as lawmakers wrestle with creating a viable replacement plan.

At a conference last week, former Vice-Presidential candidate Sen. Tim Kaine (D-VA) said he’s become more optimistic that basic principles of the ACA will remain the longer the country goes without a replacement plan from Republicans.

“Healthcare is one-sixth of the economy,” he said during the AcademyHealth conference for health system and policy researchers. Kaine’s comments were reported on Twitter and in the American Journal of Managed Care.

“You can’t inject uncertainty into one-sixth of the national economy without having spillover consequences,” he said.

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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...