The ACA: A mixed bag in Robeson County

Everyone I’ve ever spoken with wants all Americans to have health insurance. The question debated in the media is whether the Affordable Care Act is a policy that will best accomplish that goal.

We’ve all read the national news stories ranging from “Obamacare allowed me to quit my job” to “ObamaCare will hasten income inequality, union report says.” This column is about the effect of the ACA here in Robeson County.

Let me begin by offering the caveat that this column is not the result of a scientific study but only a collection of anecdotes primarily from my own encounters with students in Robeson and Cumberland counties. Keep in mind that most of the few dozen students who have sought out my advice are not young people. In one of my classes this semester, I have three grandmothers and a great-grandmother.

Let’s begin with the good news. My own assessment of the ACA is that there is one group who clearly benefits from this legislation. These are the people who did not have employer-sponsored insurance and were either shut out of or only offered exorbitant premiums for coverage because of pre-existing health conditions.

One such person is former Robeson County resident Mark Frazier, who has a chronic illness. Mark works as a musician 25 hours each week and makes other income from music lessons and performances. In 2013, he had a policy with a $1,000 deductible that cost $544 a month. Under the ACA, Mark was able to purchase a policy with a deductible of $1,300 for $351 a month. With tax credits, his premium was reduced to $266 a month.

Another aspect of the ACA that has been widely popular is the requirement that parents can continue to cover their children up until age 26. For parents who are already paying for another child, the additional cost to add the older child for most policies is zero. However, as two staff members where I work learned, because they only had one child — or one child under the age of 26 — the cost to add that child under the State Employee plan is an additional $273 a month.

Robeson County has a high percentage of people who already qualify for Medicaid, so the biggest effect is what the union report mentioned above has found. This legislation is going to create greater income inequality in our county. It will disproportionately hurt low-income individuals. Several students have explained to me that they had a full-time job at places such as Kangaroo or Bojangles, but their hours have now been reduced to 30 per week. Consequently, although they may be paying less for health care, they are struggling to make their mortgage or rent payment.

In addition to the unintended consequence of job loss, the second most common experience reported to me is sticker shock. Many people in Robeson County attend UNCP. A rate increase in any given year is never a function of any single factor, but as the University of North Carolina system plans were brought in to compliance with the ACA, the premium increase was 63.4 percent. Most students haven’t even noticed these outsized increases because they have become numb to the overall increases in higher education.

For those who are not students, the sticker shock has been the increase in premium caused by the cancellation of the policy they were happy with. When they went to the exchange, they found the lowest level of coverage, the so-called “catastrophic” insurance offered by Blue Cross through the exchange to Robeson County residents costs $590.64 before tax credits for a family. Many were paying in the $200s and $300s per month for policies that were not compliant with ACA because they didn’t have mental health coverage or they had a lifetime maximum, for example. If they were poor enough to qualify for subsidies, the $590.64 is reduced, but many people are reporting hundreds of dollars in monthly premium increase.

Next month we’ll continue to look at the effect of this legislation locally, including the results of my interview with Thomas Johnson, CFO of Southeastern Health.


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