These NC Counties Would Suffer Most If Insurer Subsidies Are Cut

Oct 17, 2017

President Donald Trump is expressing support for an agreement struck by two leading lawmakers to extend federal payments to health insurers.

Trump spoke at a news conference in the Rose Garden Tuesday. He commented after Sen. Lamar Alexander of Tennessee told reporters that he and Patty Murray of Washington had reached a bipartisan agreement on a plan to extend the federal payments that Trump has blocked.

Trump said the White House has been involved in what he calls a "short-term deal." He said he still thinks a system where funding is given to states through federal block grants is the best long-term plan.

On Oct. 14, the administration said it would stop reimbursing insurers for discounts on co-payments and deductibles that they are required by law to offer to low-income consumers. The reimbursements are known as cost-sharing reduction payments, or CSRs.

But if these insurer subsidies were to go away, North Carolina would feel the hurt more than almost any other state. That's because so many people here benefit from the subsidy. If this subsidy is cut, health insurance premiums are almost guaranteed to rise as insurers would need to generate more revenue to cover rising health care costs.

More than 300,000 consumers in North Carolina benefited from these payments, more than in all but three states, according to data collected by the Associated Press and analyzed by WUNC. Insurance companies in North Carolina received $580 million in total insurer subsidies to cover losses from these individuals.

Below is an interactive look at which states have the most consumers who qualify for the cost sharing reduction subsidy. States on the map are shaded by the percentage of overall Affordable Care Act customers who qualify for CSR, while the bar chart is ranked by total consumers receiving CSR.

Looking inside North Carolina shows that the most populous counties received the largest overall benefit – not surprising given how much more populated they are compared to rural counties.

However, a closer analysis shows that many rural counties could feel the loss of these subsidy payments more acutely because a higher percentage of their Affordable Care Act customers need these subsidies.

Below is an interactive look at which counties have the most consumers who qualify for the cost sharing reduction subsidy. Counties on the map are shaded by the percentage of overall Affordable Care Act customers who qualify for CSR, while the bar chart is ranked by total consumers receiving CSR.

That's true for counties that voted heavily for Hillary Clinton, like Edgecome, but also for counties that voted for Trump, like Robeson and Tyrrell. There are 15 North Carolina counties in which at least 70 percent of the voters chose Trump and at least 70 percent of ACA enrollees qualify for a cost sharing reduction subsidy.

Below is an interactive chart that ranks counties by the percentage of Trump voters (x-axis) and percentage who qualify for CSR (y-axis).

The Associated Press contributed to this report.