Even with a subsidy, if prices increase, so will the family’s portion. There are so many factors in play that on a broad scale it is currently difficult to assess who may be affected by additional rate increases on Jan. 1.

Perhaps the Smiths’ insurance rate will remain fairly stable, and because of the subsidy, their overall cost will go down. Perhaps the premium will rise significantly, and the subsidy will offset some or all of the increase, leaving their actual cost close to what they are paying now.

In addition, those who can gain coverage through a group policy through their employer, or their spouse’s or parent’s employer, will not be eligible for a subsidy, even if the cost to their family is less on an individual subsidized policy.

As a result, many Americans may choose to delay enrolling in insurance in 2014 while the penalty is still low. Some may drop insurance if their premium rises beyond their ability to absorb an increase into their budget.

Others may jump at the chance to be insured, especially those with lower incomes who may receive higher rates of subsidy. For those in this category, and for those who have been uninsured, have a major health condition or who have been neglecting their health because of a lack of health insurance, health care reform may work exactly as it was intended by removing the barriers to enrolling in health insurance.

There are only three health insurance carriers participating in the exchange/marketplace in North Carolina and three in South Carolina. These carriers are scheduled to release their rates by mid-September. It is expected that by late September the tools will be in place to begin evaluating each person’s situation to help them better understand their plan options, pricing, and subsidy eligibility.