Come for the politics, stay for the snark.

Republicans seem to think life begins at the candlelight dinner the night before.

Since when do we limit our critiques to things we could do better ourselves?

If you tweet it in all caps, that makes it true!

I’d like to think you all would remain faithful to me if i ever tried to have some of you killed.

They fucked up the fucking up of the fuckup!

Consistently wrong since 2002

Infrastructure week. at last.

You can’t attract Republican voters. You can only out organize them.

If you’re pissed about Biden’s speech, he was talking about you.

Usually wrong but never in doubt

Only Democrats have agency, apparently.

Just because you believe it, that doesn’t make it true.

Nothing worth doing is easy.

I’d try pessimism, but it probably wouldn’t work.

But frankly mr. cole, I’ll be happier when you get back to telling us to go fuck ourselves.

JFC, are there no editors left at that goddamn rag?

Let’s delete this post and never speak of this again.

The revolution will be supervised.

The worst democrat is better than the best republican.

Optimism opens the door to great things.

Putting aside our relentless self-interest because the moral imperative is crystal clear.

Sitting here in limbo waiting for the dice to roll

In my day, never was longer.

Impressively dumb. Congratulations.

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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