North Carolina does lack a competitive exchange, since just two insurers are participating (Blue Cross and Blue Shield and Coventry Health Care). Sufficient competition will most likely not arise. Blue Cross and Blue Shield has roughly 85% of the individual market and is the only insurer operating in all 100 counties of the state. Coventry offers Obamacare plans in just 39.
North Carolina faces higher premium percentage increases than other states because its pre-Obamacare individual insurance market was more de-regulated. In other words, premiums were lower for individual policyholders in North Carolina than for consumers in other states that had already imposed regulations like guaranteed issue and community rating. Take New York, for example. New York has more than a dozen insurance companies competing within its state based exchange. But because of Obamcare’s individual mandate, premiums are now dropping for New Yorkers. Prior to Obamacare, New York had tighter community rating ratios than Obamacare enforces (a limit on where insurers can individually price consumers based on age, gender, and health status), and already exercised guaranteed issue for those with pre-existing conditions.
