Researchers at Wake Forest University study North Carolina's high Affordable Care Act premiums and offer three ways to solve the problem. A study of premiums and public policy relating to health insurance outlines reasons as to why premiums have increased dramatically. According to experts, a sicker population, grandfathered insurance policies, a lack of competition, and the rejection of a Medicaid expansion are likely factors. The first fix suggested is creating a government-run public option for people in certain areas where only Blue Cross Blue Shield ACA plans are offered. They also say the state must take steps to increase competition and encourage healthier people to sign up.