Obamacare and N.C.: A love-hate thing

Surveys and reports on health insurance and the Affordable Care Act highlight an interesting pattern:  North Carolina's elected leaders have done everything possible to avoid participating in "Obamacare,"  but significant numbers of residents are signing up for subsidized coverage.  As the News & Observer's John Murawski recently reported,  our state's 357,000 sign-ups during open enrollment ranked us fifth in the nation.

October sign-up in Charlotte

The seeming contradiction isn't limited to North Carolina.  Across the country there are signs that the act is meeting some of its goals,  with uninsured rates declining and insurance companies announcing plans to expand participation. Yet a recent health tracking poll from the Kaiser Family Foundation found unfavorable views of the Affordable Care Act rising in July, to 53 percent  (compared with 37 percent favorable).

The Brookings Institution recently offered an interesting hypothesis about political opposition and citizen participation:  Anti-Obamacare ads may  "backfire"  by increasing awareness and enrollment,  Brookings fellow Niam Yaraghi wrote in a July report.

Yaraghi

"The four states with the highest per capita spending on anti-ACA ads are Kentucky, Arkansas, Louisiana, and North Carolina,"  he wrote.  In fact,  the Kantar Media CMAG report he used as a starting point shows that the two markets with the highest spending on anti-Affordable Care Act ads are Charlotte ($967,429) and Raleigh ($707,997).  The states with high spending were those with competitive Senate races,  such as North Carolina's  Kay Hagan-Thom Tillis contest. 

"Although the volume of spending on anti-ACA ads is driven by the competitiveness of the Senate midterm elections and may be effective in reducing the votes for the targeted political figure, they may not necessarily reduce the popularity of the ACA,"  Yaraghi wrote.  "... In fact, after controlling for other state characteristics such as low per capita income population and average insurance premiums, I observe a positive association between the anti-ACA spending and ACA enrollment. This implies that anti-ACA ads may unintentionally increase the public awareness about the existence of a governmentally subsidized service and its benefits for the uninsured."