Americans spend more on health care than comparable countries, according to a recent analysis.
So it’s probably no surprise that the Pew Research Center found health care to be a top concern of voters, or that North Carolina politicians are talking about it ahead of the midterms.
This November, Democrats hope to break the Republican supermajority in the state legislature. Among them is D. Cole Phelps, an attorney running for state Senate in northeastern North Carolina’s District 1 against Republican state Rep. Bob Steinburg.
On Labor Day, Phelps claimed in a Facebook post that health care premiums in North Carolina are among the most expensive in the country.
"Health care premiums in North Carolina are now among the five highest states in the country — and rural health care is struggling," Phelps posted on Sept. 1. "Our opponent is protecting insurance company profits — not his constituents. As your state senator, I will fight for every person in Senate District One, including people with pre-existing conditions."
Are health insurance premiums in North Carolina higher than those in 45 other states? PolitiFact reached out to Phelps for the source of his information.
To support his claim, Phelps cited a recent WalletHub story, "The Best and Worst States for Healthcare." WalletHub, which looked at all 50 states and Washington, D.C., ranked North Carolina’s health care system 47th for overall care. The Tar Heel State ranked 45th for average monthly insurance premiums.
But there’s a key piece of information that’s buried in the WalletHub story and that Phelps doesn’t mention in his Facebook post: WalletHub only looked at health care plans through the Affordable Care Act, also known as Obamacare.
It didn’t take into account premiums for insurance plans acquired through employers.
More than 55 percent of Americans have employer-based health insurance plans, according to 2016 estimates by the U.S. Census Bureau. In North Carolina, employer-based plans covered 52 percent of all non-Medicare recipients during 2016, according to an analysis by the Kaiser Family Foundation, a nonprofit health analysis organization.
So, with that in mind, we wondered whether North Carolinians are paying some of the highest premiums for health insurance plans across the board. Here’s what we found for both customers in the ACA markets as well as on employer-sponsored plans.
True, for ACA premiums
When it comes to premiums for people with plans through the Affordable Care Act, Kaiser found that North Carolina had the seventh-highest average benchmark premiums in 2018. In 2017, NC had the second-highest. More than 478,000 people enrolled in such plans in 2018, KFF reports.
However, the average benchmark isn’t an accurate reflection of what most customers pay, said Craig Palosky, KFF communications director.
Though the benchmark shows the full sticker price, it’s "not what people who get tax credits would end up paying," Palosky said. " The distinction is important because the vast majority of marketplace customers do get tax credits – 87 percent nationally and 94 percent in North Carolina."
The Centers for Medicare and Medicaid Services, known as CMS, is a part of the U.S. Department of Health and Human Services. David Anderson, a research associate for the Duke University Center for Health Policy, noted that the CMS risk adjustment formula found high average premiums in NC for 2017.
At $501 a month, North Carolina in 2017 had the fourth-highest average premium in the individual market, Anderson noted.
Erik Wengle, a research analyst for the Urban Institute Health Policy Center, said premiums for North Carolina’s most popular ACA plans are "frequently" among the highest in the country. North Carolina’s silver and gold ACA plans were both the fifth-most expensive in the country, he said.
"We’ve found that competition is a large driver associated with lower premiums. NC hasn’t had as robust competition as other states," Wengle said.
Blue Cross Blue Shield is the only insurer to offer ACA plans in all 100 NC counties, while Cigna offers plans in Wake, Johnston, Orange, Chatham and Nash counties. Another insurer, Centene, is expected to enter the Wake and Durham markets next year.
Not true for employer-based insurance
While North Carolina’s government-subsidized plans are on the expensive side, PolitiFact couldn’t find any evidence that NC’s non-ACA premiums are among the highest in the country.
KFF statistics from 2016 (the most recent year available) show that the average annual premium for a single employee was $5,717 — one of the lowest averages in the country. Add a "plus one" (spouse or child) to the employee’s coverage, and North Carolina still had one of the lowest average premiums in the U.S.
Meanwhile, KFF found that premiums for employer-based family plans in NC were middle-of-the-road.
Statistics from the 2017 MEPS show that the average employer-plan premium for an employee in North Carolina is slightly below the national average. For those plans, the annual North Carolina average was $6,348 a year while the national average was $6,368.
So Phelps’ claim appears to be true for about 520,000 of North Carolinians on an ACA plan, according to CMS. Going by the latest Census estimates, that’s only 5 percent of North Carolina’s population.
Phelps said health insurance premiums in North Carolina "are now among the five highest states in the country." He has a point when it comes to premiums for ACA plans. Those plans, however, only affect a fraction of North Carolina’s population. Millions of North Carolinians have plans on the private market, and data show that private plans in NC aren’t among the most expensive in the country. On balance, we rate Phelps’ claim Mostly False.
This story was produced by the North Carolina Fact-Checking Project, a partnership of McClatchy Carolinas, the Duke University Reporters’ Lab and PolitiFact. The NC Local News Lab Fund and the International Center for Journalists provide support for the project, which shares fact-checks with newsrooms statewide.