Come for the politics, stay for the snark.

You are so fucked. Still, I wish you the best of luck.

He imagines himself as The Big Bad, Who Is Universally Feared… instead of The Big Jagoff, Who Is Universally Mocked.

They love authoritarianism, but only when they get to be the authoritarians.

Many life forms that would benefit from greater intelligence, sadly, do not have it.

Republicans: slavery is when you own me. freedom is when I own you.

It may be funny to you motherfucker, but it’s not funny to me.

Damn right I heard that as a threat.

If you still can’t see these things even now, maybe politics isn’t your forte and you should stop writing about it.

A sufficient plurality of insane, greedy people can tank any democratic system ever devised, apparently.

Only Democrats have agency, apparently.

Let me eat cake. The rest of you could stand to lose some weight, frankly.

The worst democrat is better than the best republican.

“woke” is the new caravan.

It’s a doggy dog world.

Make the republican party small enough to drown in a bathtub.

Do not shrug your shoulders and accept the normalization of untruths.

Their freedom requires your slavery.

They think we are photo bombing their nice little lives.

Whatever happens next week, the fight doesn’t end.

“When somebody takes the time to draw up a playbook, they’re gonna use it.”

In short, I come down firmly on all sides of the issue.

Not so fun when the rabbit gets the gun, is it?

Putin dreamed of ending NATO, and now it’s Finnish-ed.

Within six months Twitter will be fully self-driving.

You are here: Home / Anderson On Health Insurance / AHCA impact in North Carolina

AHCA impact in North Carolina

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North Carolina is a high cost state for health insurance.  Under the Affordable Care Act, people who receive subsidies on Healthcare.gov are shielded from price increases because the subsidy is tied to the cost of the second least expensive Silver plan on Exchange and the individual pays a fixed amount dependent on their income.  The personal contribution amount is fixed based on the person’s income defined by the Federal Poverty Level.  That means a 21 year old who is subsidized will pay the same post-subsidy premium to the insurer as a 64 year old with the same income.

The American Health Care Act (AHCA) bill that was released on Monday night changes the subsidy formula.  Subsidies are no longer tied to the cost of insurance or the individual’s income.  Instead any qualified individual who makes less than $75,000 per year receives a fixed subsidy amount determined by age.  A 21 year old receives a $2,000 subsidy.  A 64 year old receives a $4,000 subsidy.  In the ACA premiums are allowed to be three times higher for a 64 year old compared to a 21 year old.  In the proposed AHCA, premiums are allowed to be five times as high for a 64 year old than for a 21 year old.

Since the subsidy grows far slower than the premium, this means the 64 year old, for a given deductible, will pay far more for their coverage.  I’ve used the 2017 Exchange data to see how much a 60 year old in each county in North Carolina would have to pay after their subsidy every month to buy the least expensive Bronze plan currently offered.  Bronze plans tend to have deductibles of at least $6,500 with out of pocket maximums of $7,150. The circles are larger for counties with more enrollment as of 1/31/17.
NC least expensive Bronze 2017

60 year old residents in Nash County are the best off.  They would only pay $439 per month after the newly revised subsidy is applied. Currently, someone earning $20,000 a year in Nash County would pay nothing for the least expensive Bronze plan and only $31 a month for a low deductible Silver plan.

60 year old residents in Bladen, Cumberland, Harnett, Hoke, Richmond, Robeson and Scotland counties are the worst off by this change.  They would pay $754 for a Bronze plan under the AHCA fixed age based subsidies.  Under the ACA, someone earning $20,000 a year would pay the same as a Nash county resident.  Someone who is age 60 and earning $40,000 a year would pay $110 a month for a Bronze plan and $283 per month for a Silver plan under the current ACA income and plan cost based subsidies.

High cost states with a large number of older residents will be significantly worse off under fixed age based subsidies.

There is one caveat. I’ve intentionally underestimated the costs for all counties.  I used the current 3:1 age band for premiums instead of the 5:1 premiums as that change is unlikely to survive in the Senate under current legislative rules.  If 5:1 premiums are used, all figures should increase by approximately 20 to 30%

Data: Enrollment data from Charles Gaba  sourced by Kaiser Family Foundation

Pricing data from CMS

Subsidy data from the legislative text

 

Reader Interactions

20Comments

  1. 1.

    Baud

    I take it that, because there would no longer be minimum health benefits, the ban on discrimination for preexisting conditions doesn’t mean much.

  5. 5.

    debbie

    Does the act indicate who will pay when uninsured people seek care? Will it revert to the old system where hospitals/doctors jack up everyone else’s costs to pay for the people without insurance?

  6. 6.

    Sab

    Thanks for the post. I am going to call my supposedly moderate senator when his office opens at nine.

  7. 7.

    Chris

    I am in one of those super high cost counties…50 y.o. male…860/month for a silver from those nice people at bcbs. Mighty white of em I gotta say….

  8. 8.

    bupalos

    Am I right in thinking that the income levels mentioned are per individual or are they per household?

  10. 10.

    bupalos

    Just so I don’t seem like such an idiot, I can see it says “an individual earning” but I guess the question would be how it works for a household filing jointly. Is the total income just divided by the number of people? If so, this thing just looks immoral on a bunch of levels. There could be couples with a couple low-earning young adult children on their plan making 250k getting $10,000 in subsidies while people making 25k are getting kicked off medicaid and sent back to the ER?

  14. 14.

    David Anderson

    @WereBear: Yes, this is the age tax that the AARP is complaining about with the talking squirrel and lumber jack.

    @bupalos: Income limit for a married couple filing jointly is doubled for the subsidy before it phases out.

    However premiums will also double so 2 60 year olds in Sullivan County would be paying 17,000+ a year for a policy with a $14,000 annual deductible

  16. 16.

    guachi

    That $754 amount is crazy.That amounts to 45% of the individual’s income.At a 5:1 ratio that would increase to 59% of income.

  19. 19.

    StringOnAStick

    The mango Moron is trying the keep the stink off himself by not being too closely involved, which means it will be even easier to hang this on the rethug MOC’s necks. This hideous thing is all theirs, every last bit. Make them own it.

  20. 20.

    Juju

    @Chris: Holy cow!! I’m in a high cost county as well, but your policy is more expensive than mine, and you’re younger than I am. My silver policy is $725 a month and I’m in my mid 50s.

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