EBSINS Blog Health Care in North Carolina

May 23, 2017

Health Care in North Carolina

March 23, 2010


Passed by the House of Representatives on May 4, 2017


  Overall approach
  • Require most U.S. citizens and legal residents to have health insurance.

  • Create state-based health insurance exchanges through which individuals and small businesses can compare plans, apply for financial assistance, purchase coverage.

  • Provide refundable premium tax credits, based on income and cost of coverage, for individuals/families with income between 100-400% of the federal poverty level.

  • Impose new insurance market regulations, including requiring guaranteed issue of all non-group health plans during annual open enrollment and special enrollment periods; limiting rating variation to 4 factors: age (3 to 1 ratio), geographic rating area, family composition, and tobacco use (1.5 to 1 ratio); prohibiting pre-existing condition exclusion periods; prohibiting lifetime and annual limits on coverage; and extending dependent coverage to age 26.

  • Require ten essential health benefits be covered by all individual and small group health insurance

  • Require plans to provide no-cost preventive benefits and limit annual cost-sharing.

  • Expand Medicaid to 138% of the federal poverty level at state option and require a single, streamlined application for tax credits, Medicaid, and CHIP.

  • Extend CHIP funding to 2015 and increase the match rate by 23 percentage points up to 100%.

  • Close the Medicare Part D doughnut hole and enhance coverage of preventive benefits in Medicare.

  • Reduce Medicare spending by reducing payments for Medicare Advantage plans, hospitals, and other providers.

  • Establish the Independent Payment Advisory Board and the Center for Medicare and Medicaid Innovation (CMMI).

  • Repeal ACA mandates (2016), standards for health plan actuarial values (2020), and, premium and cost sharing subsidies (2020).

  • Modify ACA premium tax credits for 2018-2019 to increase amount for younger adults and reduce for older adults, also to apply to coverage sold outside of exchanges and to catastrophic policies. In 2020, replace ACA income-based tax credits with flat tax credits adjusted for age. Eligibility for new tax credits phases out at income levels between $75,000 and $115,000

  • Retain private market rules, including requirement to guarantee issue coverage, prohibition on pre-existing condition exclusions, requirement to extend dependent coverage to age 26.  Modify age rating limit to permit variation of 5:1, unless states adopt different ratios, effective 2018. Retain prohibition on health status rating with state option to waive for individual market applicants who have not maintained continuous coverage.

  • Retain health insurance marketplaces, annual Open Enrollment periods (OE), and special enrollment periods (SEPs).

  • Impose late enrollment penalty for people who don’t stay continuously covered.

  • Establish State Patient and State Stability Fund with federal funding of $130 billion over 9 years, and additional funding of $8 billion over 5 years for states that elect community rating waivers.  States may use funds to provide financial help to high-risk individuals, promote access to preventive services, provide cost sharing subsidies, and for other purposes. In 2020, $15 billion of funds shall be used only for services related to maternity coverage and newborn care, and mental health and substance use disorders.  For 2018-2026, $15 billion is allocated for Federal Invisible Risk Sharing Program (reinsurance) grants to states.  In states that don’t successfully apply for grants, funds will be used for reinsurance program.  For 2018-2023, $8 billion shall only be used by states electing community rating waivers to provide assistance to reduce premiums or other out of pocket costs for individuals who are subject to higher premiums as a result of the community rating waiver.

  • Repeal funding for Prevention and Public Health Fund at the end of Fiscal Year 2018 and rescind any unobligated funds remaining at the end of FY2018.  Provide supplemental funding for community health centers of $422 million for FY 2017

  • Encourage use of Health Savings Accounts by increasing annual tax free contribution limit and through other changes


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