All people in North Carolina live in communities with access to comprehensive, high quality, affordable health insurance.

Why Is This Important?

Access to quality health care services is critical to achieve and maintain health, prevent and manage disease, and achieve health equity. Lack of health insurance can make health care inaccessible and unaffordable. HNC 2030, p. 84

Story Behind the Curve

In 2019, nearly 14% of North Carolina’s 8.4 million nonelderly lacked health insurance, ranking North Carolina 46th among US states. Approximately 55 percent of the population held employer-sponsored insurance. Another 8% had individual plans (primarily through the ACA Marketplace). More than one-in-five (21%) had public health insurance (Medicaid, NC Health Choice, or Medicare). Adults with low incomes who do not currently qualify for Medicaid fall into a coverage gap and have high rates of uninsured individuals. When viewed through an explicit race equity lens, conditions are more dire for people of color across the state. Of the nearly 1,845,000 non-elderly African Americans in North Carolina, almost 232,000 or 13% lacked health insurance. Hispanic-Americans are uninsured at higher rates among ethnic groups; about 270,000 (29%) of 937,000 non-elderly are without health insurance. This can likely be attributed to the ethnic group’s propensity to be locked into essential work that does not pay a living wage or offer health coverage. Comparatively, 10 percent or 509,000 (out of nearly 5,085,000) non-elderly white North Carolinians are uninsured. People in rural areas are less likely to have health insurance than their urban peers. The 80 rural counties (as defined by the NC Rural Center) make up 38 percent of the state’s non-elderly population but account for 42 percent of its uninsured. Expanding Medicaid in North Carolina would support the 2030 goal to decrease the uninsured rate for people under 65 to 8%, reaching more people of color and rural people all over the state. HNC 2030 pp. 84-85, revised

American Heart Association
Down Home North Carolina
Equality North Carolina
Foundation for Health Leadership & Innovation (FHLI)- NC Oral Health Collaborative (NCOHC)
Foundation for Health Leadership & Innovation (FHLI)- NC Rural Heath Leadership Alliance (NCRHLA)
Legal Aid of North Carolina
NC Child
NC DHHS Community Health Workers (CHW)
NC DHHS Office of Rural Health
NC Rural Center
North Carolina Association of Free & Charitable Clinics (NCAFCC)- Camino Clinic
North Carolina Association of Local Health Directors (NCALHD)
North Carolina Community Health Center Association (NCCHCA)
North Carolina Healthcare Association (NCHA)
North Carolina Justice Center
What Works
  • Expand Medicaid eligibility criteria
  • Increase publicity and navigator funding for open enrollment
  • Increase public education about insurance options
  • Support bans or limitations on short-term health plans
Description of Indicator Data

US Census Bureau - Small Area Health Insurance Estimates (SAHIE) Program

Additional Data Needed at Local Level
  • Impact of Covid-19 pandemic on employer sponsored insurance
  • Estimates of underinsured/uninsured at the county level
  • Major employer insurance benefits available in area
  • Analysis of support/opposition by elected officials to Medicaid expansion
  • Stories from consumers/residents and their experience
Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy