Decline in North Carolina ACA Enrollment Threatens Health Coverage

North Carolina has recorded a substantial decline in Affordable Care Act (ACA) enrollments, leading the U.S. with a 22% reduction, according to the Centers for Medicare & Medicaid Services. By 2026, the state is projected to have approximately 214,000 fewer enrollees, bringing totals down to 761,457. This trend contrasts sharply with a national enrollment increase, which now totals 22.9 million participants. HealthCare.gov, the primary platform for ACA access, added over 2.5 million new enrollees nationwide, despite these state-level decreases.

The expiration of enhanced ACA subsidies following a government shutdown contributed significantly to rising premium costs in early 2023. The resulting increase in out-of-pocket expenses has affected affordability for many consumers in North Carolina, where the poverty rate has remained steady at 12.8%, impacting more than 1.3 million residents. In October, Insurance Commissioner Mike Causey sanctioned considerable rate increases for individual ACA policies, with hikes ranging from 16.88% to 36.4% and an average rise of 28.6%. These adjustments were prompted by escalating healthcare costs and the withdrawal of federal subsidies.

U.S. Representative Greg Murphy voiced concerns about temporary subsidy measures from the American Rescue Plan and the Inflation Reduction Act. These measures, initiated during the COVID-19 pandemic, aimed to expand health insurance access. Since 2019, benchmark premiums have surged by 75%, and Murphy suggests that the end of COVID-19 state emergencies may have exposed enrollment irregularities. He estimates that 6 to 12 million individuals may be fraudulently enrolled in ACA plans without making claims, leading to inefficient use of federal funds by insurance carriers.