NC fails to reach 1 million signups for 2025 via Obamacare

The marketplace is a high-profile component of the federal Affordable Care Act, also known as “Obamacare.”

The Centers for Disease Control and Prevention posted Friday the final enrollments totals of 24.17 million Americans.

North Carolina has 975,110 enrollees for 2025, compared with 1.03 million in 2024, or down 4.3%.

North Carolina ranked fifth in enrollment behind red states Florida (4.73 million) and Texas (3.87 million), blue state California (1.9 million) and fellow purple state Georgia (1.52 million).

For those who enroll before Dec. 16, their coverage started Jan. 1. Those who enroll before Jan. 15 start on Feb. 1.

Among the N.C. enrollees were expected to be newly eligible participants, such as a potential 22,010 DACA recipients and other immigrant groups. Those include 2,050 in the Winston-Salem metro area and 1,770 in the Greensboro-High Point metro, according to U.S. Citizenship and Immigration Services.

DACA is the acronym for the federal Deferred Action for Childhood Arrivals Act. The act prevents eligible immigrants who came to the United States when they were children from being deported and provides them with a work permit.

According to marketplace officials, 4 out of every 5 enrollees can find a plan for $10 or less per month with financial help.

Individual rates vary based on location, age, subsidy amount and plan. Subsidies are available for customers with household incomes between 100% and 400% of the federal poverty level.

Short-term health insurance plans can be sold in North Carolina with initial plan terms up to 364 days.

Outside the open enrollment period, North Carolinians who buy health insurance from the ACA may enroll in an insurance plan only if they qualify for a special enrollment period because of life events, such as having or adopting a child, losing health coverage or moving to a different service area.

However, the fate of the federal healthcare insurance marketplace beyond 2025 is in doubt.

Prospective members of the Trump administration have signaled their willingness to make significant, if not drastic, cuts to the ACA and the Medicaid expansion initiative that has nearly 610,000 North Carolinians enrolled as of Jan. 3.

Those cuts could come in the form of Congress approving and President Donald Trump signing legislation that reduces below 90% the CMS share of Medicaid expansion administration expenses.

Kaiser Family Foundation reported in a November analysis of Medicaid expansion that lowering the CMS match below 90% would serve as a means for congressional Republicans to significantly weaken the ACA rather than undertake a potentially unpopular outright repeal effort.

According to the Medicaid expansion law in North Carolina, as well as 11 other red, blue and purple states, a CMS commitment below 90% would trigger the dissolution of their respective expansion initiatives unless alternative funding sources can be secured.

The Congressional Budget Office estimated in 2022 that reducing the match rate for the expansion group would save the federal government $631 billion over 10 years.