AUDIE CORNISH, HOST:
As Republicans in Congress get to work on their pledge to repeal Obamacare, people are continuing to use the program's insurance exchange to renew or buy policies and a lot of them are nervous. Michael Tomsic of WFAE reports from North Carolina.
MICHAEL TOMSIC, BYLINE: Darlene Hawes lost insurance about a year after her husband died in 2012.
DARLENE HAWES: I was born with heart trouble. And I also had in 2003 open heart surgery, and I had breast cancer surgery so I needed insurance badly.
TOMSIC: She's now 55 and last year bought insurance on the Obamacare exchange with help from a big subsidy. Then the election happened, and she was scared she'd lose it immediately. But an enrollment specialist told her she could still renew with the subsidy for 2017.
HAWES: And I'm like, oh, my lord, did she just say that? (Laughter). It's just like a whole load of burdens just fell off my back because all the years that I haven't been covered since my husband passed away. I don't want to be sad again, you know? I was very sad.
TOMSIC: 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 Donald Trump campaigned on it. But not much is likely to change in 2017. Republican leaders are trying to repeal it immediately, but also assure the public there will be a smooth transition. Still, the CEO of the exchanges, Kevin Counihan, says he can't promise that coverage will remain through 2017.
KEVIN COUNIHAN: It's not my place to promise anything about a new administration, but what I can tell you is that not only are we moving forward, but our enrollment is higher than expected.
TOMSIC: Indeed, enrollment surged at the end of 2016. And North Carolina has the third-highest enrollment so far among states using healthcare.gov. In some ways, North Carolina is in tough shape. Premiums are up, and Blue Cross Blue Shield is the only insurance company in 95 percent of the state. Blue Cross actuary Brian Tajlili says people who signed up for coverage tend to be older and sicker, and for that reason use more medical care.
BRIAN TAJLILI: There is continuing demand for services and continuing high utilization within this block of business.
TOMSIC: By this block of business, he means the small slice of the overall health insurance market that Obamacare covers. Most people get insurance through work or Medicare. And for those half a million people on the exchange, about 90 percent get federal subsidies that greatly reduce what they pay. Subsidies that are now on the chopping block, but Tajlili says Blue Cross is committed to offering plans through the year.
TAJLILI: 2017 will be another pivotal year for us as we look at the individual market.
TOMSIC: One of Blue Cross' new customers will be Sara Kelly Jones. Through the door to the back patio out Letty's restaurant in Charlotte, where Jones works, she says Obamacare isn't perfect, but before the law health insurance was a financial vice that kept tightening.
SARA KELLY JONES: 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.
TOMSIC: But under Obamacare, Jones qualifies for a subsidy. Her premium is up this year, but she can still afford it with that help. Jones says the political debate ignores people like her.
JONES: I'm terrified. If there had been any plan outlined that wasn't just some vague, we're going to replace it with something awesome, but they have no plan. What on earth are you going to do with all these people, myself included, that are counting on this?
TOMSIC: About 20 million people got insurance through Obamacare. Republicans haven't settled yet on a plan to replace it. For NPR News, I'm Michael Tomsic in Charlotte.
CORNISH: This story is part of a partnership with Kaiser Health News. Tomorrow, we talk to a woman who hopes Trump will make health insurance less expensive.
(SOUNDBITE OF A TRIBE CALLED QUEST SONG, "LUCK OF LUCIEN")