Health Care Coverage Profile:

North Carolina

HEALTH COVERAGE AT A GLANCE 1

Fewer North Carolinians get their insurance from employer sponsored insurance plans (49.8%) than the
national average for this type of insurance (52.3%).

Additionally, North Carolina has an above average number of uninsured residents, with 16% of uninsured
residents, as compared to the national average of 15.4%. Despite this higher than average number of
uninsured residents, fewer North Carolinians are covered under Medicaid when compared to the nation at
large. Only 13.8% of North Carolina residents get their health insurance through Medicaid. Moreover,
13.2% of North Carolina residents are Medicare beneficiaries and 5.1% obtain health insurance coverage
through individual plans. Still, 16% of North Carolina's children remain uninsured.

Health Insurance Coverage of the

Total Population of North Carolina Compared to United States

Employer
United 4.7 12.4 15.4
52.3 14.1 1.2 Individual
States
Medicaid
Medicare
North 5.1 13.2 16
49.8 13.8 2.2 Other Public
Carolina
Uninsured

0% 20% 40% 60% 80% 100%

CHANGES IN INSURANCE COVERAGE TYPE IN NORTH CAROLINA 2

Although fewer North Carolinians get their insurance by way of their employer, the percentage of
uninsured North Carolina residents is on the decline. Between 2007 and 2008, the number of uninsured
North Carolinians decreased by 1.2%. Furthermore, Medicaid enrollment has expanded by 1.5% during
that period while those with employer sponsored insurance planes decreased by 0.7%.

The table below strongly suggests that North Carolina's Medicaid program has been an invaluable safety
net to residents who have lost their employer sponsored insurance plans. As a result, North Carolina's
Medicaid expenditures have risen by 5.5% between 2004 and 2007 compared to the national expenditure
growth of 3.6%. 3

Health Care Profile: North Carolina Page 1 of 3

National Coalition on Health Care July 2010
 North Carolina: Percent Change Among Non-elderly by Coverage Type, 2007-2008 4
North Carolina U.S.
Employer Sponsored Insurance -0.7% -1.2%
Individual Market 0.7% -0.2%
Medicaid 1.5% 1.0%
Other Public -0.3% -0.2%
Uninsured -1.2% 0.2%
THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA) AND HEALTH INSURANCE COVERAGE 5

Individual Mandate
Starting in January of 2014, all individuals will be required to have a certain minimum level of health
insurance. Failure to purchase a minimum level of health insurance will result in a penalty of no greater
than $695 for an individual or $2,085 per family. The individual mandate is expected to help decrease the
number of uninsured in North Carolina.
Health Insurance Exchanges and Federal Subsidies
Each state will create and administer a health insurance exchange. There will be two separate exchanges,
one for individuals seeking to purchase insurance on the individual market and another for employers. The
Department of Health and Human Services (HHS) will establish a minimum benefit package that insurance
companies must offer if they wish to be included in the exchange. North Carolina residents who earn
between 133% and 400% of the federal poverty level 6 may be eligible for individual tax credits.
Employer Coverage
As of 2007, 20.1% of North Carolina's working population was uninsured.7 Generally, small businesses
cannot afford to offer health insurance; thus, only 38.2% of private businesses with fewer than 50
employees offered health insurance, while 98.1% of private businesses with more than 50 employees
offered health insurance. 8 In order to help small business employees gain access to employer-based health
insurance coverage, ACA provides a tax credit to qualifying small businesses that offer health insurance.
Additionally, while ACA does not require employers to provide health insurance to employees, employers
with 50 or more employees will be assessed a fee of $2,000 per full-time employee (excluding the first 30
employees) if they do not offer coverage and if they have at least one employee who receives a premium
credit through an exchange.
Medicaid Expansion
Medicaid will be expanded to all individuals under age 65 with incomes up to 133% of the federal poverty
level. This will establish a minimum eligibility threshold throughout the 50 states and will eliminate a
limitation on the program that prohibits most adults without dependent children from enrolling in
Medicaid. The new legislation may make approximately 430,000 previously uninsured North Carolinians
eligible to join Medicaid.9

Health Care Profile: North Carolina Page 2 of 3

National Coalition on Health Care July 2010
1
THE KAISER FAMILY FOUNDATION, statehealthfacts.org. Data Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured
estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic
Supplements), available at http://www.statehealthfacts.org:/comparetable.jsp?ind=125&cat=3 (last accessed June 2010).
2
Unless otherwise cited: THE KAISER FAMILY FOUNDATION, statehealthfacts.org. Data Source: Urban Institute and Kaiser Commission on
Medicaid and the Uninsured estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual
Social and Economic Supplements), available at http://www.statehealthfacts.org/comparetable.jsp?ind=165&cat=3 (last accessed July
2010).
3
The Kaiser Family Foundation, statehealthfacts.org. Data Source: Urban Institute and Kaiser Commission on Medicaid and the
Uninsured estimates based on data from HCFA/CMS-64 reports, available at
http://www.statehealthfacts.org/comparetable.jsp?ind=181&cat=4 (last accessed June 2010).
4
THE KAISER FAMILY FOUNDATION, statehealthfacts.org. Data Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured
estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic
Supplements), available at http://www.statehealthfacts.org/comparetable.jsp?ind=165&cat=3 (last accessed July 2010).
5
Unless otherwise cited: The Kaiser Family Foundation, Summary of New Health Reform Law (2010), available at
http://www.kff.org/healthreform/upload/8061.pdf (last accessed June 2010).
6
The federal poverty level for the 48 contiguous states is $10,830 for a single individual. ASSISTANT SEC'Y FOR PLANNING AND EVALUATION, U.S.
DEP’T OF HEALTH & HUMAN SERVS. THE 2009 HHS POVERTY GUIDELINES (2010), available at http://aspe.hhs.gov/poverty/09poverty.shtml (last
accessed June 2010).
7
COVER THE UNINSURED, ROBERT WOOD JOHNSON FOUNDATION, U.S. UNINSURED WORKERS, available at
http://covertheuninsured.org/uninsured_workers#map (last accessed June 2010). These figures are from 2006-2007.
8
U.S. DEP’T OF HEALTH & HUMAN SERVS. MEDICAL EXPENDITURE PANEL SURVEY (2008), available at
http://www.meps.ahrq.gov/mepsweb/data_stats/summ_tables/insr/state/series_2/2008/ic08_iia_f.pdf (last accessed June 2010). These
figures are from 2008.
9
JOHN HOLAHAN & IRENE HEADEN, KAISER COMMISSION ON MEDICAID AND THE UNINSURED, MEDICAID COVERAGE AND SPENDING IN HEALTH REFORM: NATIONAL
AND STATE‐BY‐STATE RESULTS FOR ADULTS AT OR BELOW 133% FPL 41 (2010), available at http://www.kff.org/healthreform/upload/Medicaid-
Coverage-and-Spending-in-Health-Reform-National-and-State-By-State-Results-for-Adults-at-or-Below-133-FPL.pdf (last accessed June
2010).

Health Care Profile: North Carolina Page 3 of 3

National Coalition on Health Care July 2010