Sherry Graham never stopped helping her daughter, giving up a big chunk of her monthly pension and Social Security income to pay the younger woman's $420 health insurance bill.
The Raleigh 72-year-old said she hopes the online marketplace for private insurance, launching Tuesday as part of President Barack Obama's signature health care law, will drive down prices. But Graham said she's disappointed that the first go-around for the statewide health insurance exchange will feature only limited competition.
Watch WNCN's one-hour special on the Affordable Care Act Monday at 7 p.m.
Blue Cross and Blue Shield of North Carolina will offer more than two dozen plans on the marketplace, some in every coverage level and in every county. The only other company selling coverage on the exchange is Coventry Health Care of the Carolinas. It says it will offer plans in 39 rural and urban counties, including those that count Raleigh, Charlotte, Greensboro, Asheville and Fayetteville in their areas. That leaves more than half the state with just one provider on the exchange.
“Every year the premium rises, whereas my income does not,” Graham said. “Now along comes the exchanges, and guess who I have to choose from? Blue Cross Blue Shield and one other company. We may be looking at that other company very seriously. But I had so hoped there would be more of an alternative.”
After years of dispute over whether the health overhaul, called the Affordable Care Act, would deflate spiraling health care costs or harm the economy, consumers in North Carolina and across the country really begin kicking the tires Tuesday to see how it works.
The law requires all insurance plans to cover doctor visits, hospitalizations, prescriptions and other common features to allow apples-to-apples comparisons. Most people will be required for the first time to buy their own coverage if it's not provided by their employer. Shopping can take place online or over the phone, and in-person guidance from trained counselors is available and free. Individuals earning less than about $46,000 a year and families of four earning less than $94,000 a year qualify for tax breaks that cut their cost for coverage. Some North Carolinians with low incomes will pay no monthly premiums after the federal subsidies are applied.
Most people already have strong opinions three years after the law was passed.
About half the state believes the law will make their health care worse, according to an Elon University Poll of registered voters earlier this month. Three out of 10 believe the law will make things better, and about 20 percent don't know or don't think it'll make much difference.
The federal government will operate North Carolina's online marketplace because state officials refused, as they did in 35 other states.
That's left the task of telling people what they need to do and finding them the best deal to nonprofit and community group meetings in church congregation halls and backyard deck gatherings
Sorien Schmidt is state director of Enroll America, a nonprofit targeting 10 states with the highest rates of uninsured people, including North Carolina. She said the launch of the marketplace for individuals, families and small businesses means Obamacare is becoming a reality for most people.
“Now that the rubber's sort of meeting the road, and people are like, 'Oh, I need to go do something,' now they're thinking of their questions,” she said.
The group is sending staffers to community events and going door-to-door. Also spreading the word are counselors paid through federal grants to hospitals, physician networks, a drug and alcohol addiction nonprofit, and a community agency serving the state's seven western-most rural counties.
Opponents of the president and of the law are pushing back with television ads and their own in-person campaign. One ad recently airing in North Carolina features a two-time cancer survivor who worries that America's health care system will change for the worse. The ad is from Americans for Prosperity, the nonprofit supported by billionaire energy executives Charles and David Koch.
The state now has about 1.6 million lacking health coverage, about one out of five people under age 65. About 1.1 million live in households where one or more members hold a full-time job, according to the North Carolina Institute of Medicine, an independent agency that receives state funding.
Without insurance, people have a harder time preventing illnesses and managing chronic conditions, and they're more likely to more likely to die early and be hospitalized with preventable problems, the institute said. When they're unable to pay medical bills, those costs are shifted to everyone else who buys insurance, the institute added.
About 715,000 North Carolinians are expected to buy coverage through the exchange in 2014, growing to more than 900,000 people by 2016, the institute said in a report.
Gov. Pat McCrory's health agency this month urged county social services departments to discuss the insurance exchanges and enroll children who are Medicaid-eligible when people come in seeking food stamps or child care help. The Republican governor's administration also encouraged social services agencies to offer space as available to “navigators,” hired under federal grants to explain the plan's complexities.
“Given much of the confusion and lack of information surrounding the federal government's exchange, the administration felt it was the right thing to do,” state Health and Human Services spokesman Ricky Diaz said. The agency did not respond to a request for an interview with the official overseeing the state's coordination with the law.
The health insurance industry has a big stake in how things turn out. Barak Richman, a Duke University law professor who specializes in the economics of contracting and health care policy, calls it a make-or-break moment for the industry as new purchasers get sticker shock from the cost of coverage that they didn't have or that employers paid.
“This is going to be a real opportunity for the insurance companies to prove to the world and prove to the United States that they can produce valuable, affordable insurance products,” Richman said. “It's extraordinary how much we don't know about things that will happen very soon.