With Donald Trump's election, Republicans in Congress will soon be able to deliver on their promise to repeal and replace Obamacare. That's created some big questions for North Carolinians who already renewed their coverage or were planning to sign up.
One of the places people are going to try to figure all this out is the Mecklenburg County Health Department. Mark Van Arnam of Enroll America welcomed people recently as they walked in.
"Do you have a healthcare.gov account now?" Van Arnam asked. "Have you checked out your options in the marketplace before?"
Enroll America, Mecklenburg County and Legal Services of Southern Piedmont have been helping people sign up for coverage, including 55-year-old Darlene Hawes.
"I was born with heart trouble, and I also had in 2003 open heart surgery," she says. "And I had breast cancer surgery. I had a lot of medical conditions, so I needed insurance badly."
Hawes lost insurance about a year after her husband died in 2012. After going without for a few years, she got coverage on the Obamacare exchange with the help of a big subsidy.
Then the election happened and she was scared she'd lose it immediately. But someone at the enrollment event told her she can still renew next year.
"And I'm like, oh my Lord, did she just say that?" Hawes said with a laugh. "It's just like a whole load of burdens fell off my shoulder, off of my back because all the years I haven't been covered since my husband passed away - I don't want to be sad again. I was very sad."
About 550,000 North Carolinians rely on the Obamacare exchange or marketplace for health insurance. Republicans have vowed for years to junk that and the rest of the law, and they'll soon have a president who agrees.
But most health care researchers and policy experts agree not much is likely to change next year.
"Even the Republican Congress in one of their most recent bills to repeal it, they put in a two-year transition period, so that the premium subsidies and the other provisions of the law that are fundamental wouldn't be repealed for a couple of years," says Georgetown professor Sabrina Corlette.
That appears to be the plan Republican leaders are now coalescing around: repeal immediately but use a transition period to come up with a replacement.
Still, the CEO of the Obamacare exchanges, Kevin Counihan, says he can't promise that coverage will remain next year.
"It's not my place to promise anything about a new administration," he says. "But what I can tell you is not only are we moving forward, but our enrollment is higher than expected."
A federal report shows 5 percent more people nationwide have signed up during the first month of enrollment compared to a year ago. It does not show increases by state, but it does show North Carolina with the third-highest enrollment so far this year among states using healthcare.gov (the federal exchange).
Julieanne Taylor with Legal Services of Southern Piedmont is helping people sign up. She says about a third of them have asked about the election.
"But generally when we're calling, people are really excited to have their appointment and come in and look at the plans for 2017," she says. "I think they're mostly interested in how much they're going to be paying."
Premiums have soared on the exchanges the past few years. That monthly price tag is rising 40 percent for the benchmark plan in North Carolina, according to federal data. And insurance companies have dropped out, leaving Blue Cross Blue Shield as the only insurer in 95 percent of the state.
Blue Cross actuary Brian Tajlili says it's simply an expensive market that has older, sicker people who cost more to cover.
"There is continuing demand for services and continuing high utilization within this block of business," he says.
"This block of business" is an important distinction. We're talking about a small slice of the overall health insurance market, as most people are covered through work or Medicare. And within that small slice, the overwhelming majority of consumers get federal subsidies that greatly reduce what they pay.
Still, it's been a turbulent market for consumers and insurers. Over the past two years, Blue Cross has lost $400 million on that part of its business.
Amid the post-election uncertainty, Tajlili says Blue Cross is committed to offering plans next year.
"2017 will be another pivotal year for us as we look at the individual market," he says.
One of Blue Cross' new customers will be Sara Kelly Jones, who works at Letty's restaurant. She says her previous insurance company, Aetna, dropped off the exchange.
She recognizes Obamacare isn't perfect. But before the law, health insurance was a financial vise that kept tightening.
"I could not afford it at all," she says. "Every year, you get older. Especially as a female, it was going up $100 to $120, $150 a month. It got to the point where it was going to be at least $200 more a month than my mortgage."
But under Obamacare, Jones qualifies for a subsidy. Her premium will go up next year with Blue Cross. But it's still affordable.
Jones says the political debate over the law ignores people like her.
"I'm terrified," she says. "If there had been any plan outlined that wasn't just some vague, we're going to replace it with something awesome ... they have no plan! What on Earth are you going to do with all these people, myself included, that are counting on this?"
That's the big, unanswered question. Republicans have agreed for years on repealing the law, but they've yet to settle on a plan to replace it.
