North Carolina: Here's the ~459,000 residents who could lose coverage, by county

As I noted when I crunched the numbers for Texas, it's actually easier to figure out how many people would lose coverage if the ACA is repealed in non-expansion states because you can't rip away healthcare coverage from someone who you never provided it to in the first place.

My standard methodology applies:

  • Plug in the 2/01/16 QHP selections by county (hard numbers via CMS)
  • Project QHP selections as of 1/31/17 based on statewide signup estimates
  • Knock 10% off those numbers to account for those who never end up paying their premiums
  • Multiply the projected effectuated enrollees as of March by the percent expected to receive APTC subsidies
  • Then knock another 10% off of that number to account for those only receiving nominal subsidies
  • Whatever's left after that are the number of people in each county who wouldn't be able to afford their policy without tax credits.

In the case of North Carolina, assuming 626,000 people enroll in exchange policies by the end of January, I estimate around 459,000 of them would be forced off of their policy upon an immediate-effect full ACA repeal.

As noted in the graphic, it's also important to note that newly-elected Democratic Governor Roy Cooper has officially started the process of fully expanding Medicaid to around 650,000 North Carolina residents. However, this is gonna be a nail-biter for two reasons: First, because there's a 10-day process before the request can be reviewed/approved by the HHS Dept. (it was filed on January 6th, so that leaves just 4 days for the HHS Dept. to review/approve/deny the request before Donald Trump takes office). Second, Cooper's move directly challenges a law passed by the NC Republicans which specifically precludes him from doing just this; Cooper is challenging the law's validity.

Assuming the Medicaid expansion survives, it would likely be a few months before it was actually implemented (I assume there's various legal stuff which has to take place first at both the state and federal level), during which time there's the possibility of Congress repealing the ACA anyway (or at least crippling it), which, of course, is the whole point of this blog post in the first place. I have no idea what the county-by-county breakout of that 650K figure is, however.