The number of N.C. participants in the federal health exchange could be cut drastically if North Carolina approved expanding Medicaid coverage to between 450,000 and 650,000 residents.
However, state Republican legislative leadership has shown little, if any interest, in taking that step.
There are 39 states with some form of Medicaid expansion, with the rest mostly in the Southeast.
Eligible North Carolinians have four more ACA exchange insurer options for 2022 for a total of 10.
The new entrants are Aetna CVS Health, AmeriHealth Caritas, Celtic/WellCare and Friday Health Plans.
The returning insurers are Ambetter/Centene, Blue Cross Blue Shield of N.C., Bright Health, Cigna, Oscar and United Healthcare.
Blue Cross NC, by far the largest provider to date, said in August it would have an average 2.8% rate increase.
Blue Cross typically is the only ACA insurer to provide coverage in all 100 counties. It expects to enroll about 475,000 customers for 2022.
By comparison, Friday Health Plans Inc. debuts in 2022 with plans to cover five Triad and Northwest N.C. — Alamance, Guilford, Randolph, Rockingham and Watauga — as part of 40 counties overall.