11.3% of North Carolinians lacked health insurance in 2019, including 142,000 children

RALEIGH (Sept. 15, 2020) — Newly released state-level data from the U.S. Census Bureau on health insurance coverage by state shows that 1,157,000 North Carolinians, or 11.3 percent of the state’s total population, lacked health insurance in 2019. This is an increase of 65,000 uninsured people in the state since 2018, showing that even during a period of economic growth, the weakening of the Affordable Care Act (ACA) eroded some of the gains that the ACA achieved in previous years.

These 2019 data reflect the experience of North Carolinians prior to the COVID-19 pandemic and current recession. The Kaiser Family Foundation estimated, based on May 2020 unemployment data, that 723,000 North Carolinians had become uninsured due to personal job loss and the loss of employer-sponsored health insurance or by being the dependent of someone who experienced job loss. Many of these individuals would have been  eligible for tax credits in the ACA Marketplace that would make coverage more affordable, but many would be ineligible for financial assistance and fall in the coverage gap.

Even in the face of perhaps the greatest health challenge our country has, the N.C. General Assembly still has not expanded Medicaid, which would extend health care coverage to hundreds of thousands of North Carolinians.

“This pandemic has highlighted the problems with tying health insurance to employment,” said Suzy Khachaturyan, Policy Analyst at the NC Justice Center’s Budget & Tax Center. “When people need to access health care and are financially vulnerable due to job loss, there are few places to turn in states like North Carolina that have not expanded Medicaid. It’s made even worse by the fact that we also rely on the federal government’s health exchanges with limited special enrollment periods and, as a state, have restrictive Medicaid eligibility that turns people away during their greatest time of need.”

  • North Carolina saw its uninsured population grow by 6 percent from 2018 to 2019.
  • At least half of the 1,157,000 remaining uninsured people in North Carolina in 2019 could gain coverage if the General Assembly accepted federal funds to close the Medicaid coverage gap.
  • North Carolina’s uninsured rate of 11.3 percent in 2019 was still well above the national rate of 9.2 percent due to the failure to expand Medicaid in the state.
  • 142,000 children (under 19) are uninsured in North Carolina, a 9 percent increase since 2018.
  • Despite recent losses, the number of people in North Carolina without health insurance in 2019 was still much lower than prior to the passage of the ACA. The number of people with health coverage increased by 17 percent from 2010 to 2019.

“Sabotaging the Affordable Care Act in the midst of a pandemic is not just bad policy in theory; it is literally costing people access to health care at the worst possible time,” said William Munn, Senior Policy Analyst at the Health Advocacy Project of the NC Justice Center. “If we are to defeat COVID-19 and come back a stronger state, preserving ACA is imperative. It will stop the increase in uninsured people and ensure that North Carolinians have access to the care they need to be healthy and whole.”

North Carolina is also leaving many immigrant members of our communities behind by blocking their access to affordable health care. These workers, parents, and neighbors in our communities have limited access to health insurance because of federal law, but state law has also blocked progress toward connecting more people to affordable health care.

“Much of North Carolina’s uninsured population is comprised of immigrants who are ineligible for Medicaid and for tax credits in the ACA Marketplace,” said Kate Woomer-Deters, Senior Staff Attorney at the Immigrant and Refugee Rights Project of the NC Justice Center. “In addition to the exclusion of many types of immigrants from Medicaid eligibility, the new public charge rule that took effect earlier this year — together with increased enforcement and a climate of fear for our immigrant neighbors — continues to deter many immigrants and their family members from seeking health care.”

“To meet the public health challenge and jumpstart a just recovery, North Carolina must get serious about the need for affordable and quality health care for every person in every community of our state. The roadmap for North Carolina policymakers needs to include expanding Medicaid, ensuring the transition to managed care is funded and equitable, and recognizing that a range of policies from affordable housing to school nurses matter for our health goals,” said Alexandra Forter Sirota, Director of the North Carolina Budget & Tax Center, a project of the NC Justice Center.

The NC Justice Center is a progressive research and advocacy organization whose mission is to eliminate poverty in North Carolina by ensuring that every household in the state has access to the resources, services, and fair treatment it needs to achieve economic security.

For more information, contact Suzy Khachaturyan, Budget & Tax Center Policy Analyst, at (919) 861-2211 or suzyk@ncjustice.org; or Mel Umbarger, Senior Communications Specialist, at mel@ncjustice.org.