In North Carolina, the two largest remaining insurance companies on the Obamacare exchange are requesting average premium increases of more than 18 percent.

Blue Cross Blue Shield is requesting an average premium increase of 19 percent for customers on the exchange or who buy directly from the company. That's smaller than the year before, when Blue Cross raised rates 33 percent.

Head actuary Brian Tajlili says the company is still adjusting to what's essentially a new market.

"We set rates in 2014 and 2015 really based on little to no experience on this previously uninsured block of customers," he said on a conference call with reporters. "2016 we needed a rate correction. That correction has been effective, therefore the amount we need to increase to make up costs in 2017 is not as substantial."

Tajlili says Blue Cross needs the additional increase because of rising drug costs and the relative age and health of the exchange population. Although the federal government reports a higher percentage of young people signed up nationally this year, "the age breakdown of Blue Cross' ACA customers is nearly identical to last year," Tajlili said. That means North Carolina companies are dealing with an older, sicker pool of people who cost more money.
 

Aetna is requesting a rate increase for its Obamacare customers of 25 percent. UnitedHealth is dropping off the North Carolina exchange next year, while Cigna plans to join.

Roughly 90 percent of exchange customers receive a federal subsidy. That means the premium spikes have very little effect on what they actually pay. 

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