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New data from the Kaiser Family Foundation examines who’s uninsured in North Carolina.

By Rose Hoban

As the new enrollment period for insurance under the Affordable Care Act approaches, new data from the Kaiser Family Foundation shows about 40 percent of North Carolina’s uninsured are eligible for either Medicaid or subsidized insurance but have not yet enrolled.

Pastors were encouraged to place drop boxes in their churches to collect cards from people seeking information on how to sign up for insurance.
During last year’s enrollment period, clergy were encouraged to place drop boxes in their churches to collect cards from people seeking information on how to sign up for insurance. Photo credit: Rose Hoban

The analysis found that of 1.13 million uninsured in North Carolina, 25 percent (289,000) are eligible for subsidized health care coverage on the insurance exchanges that exist as a result of the ACA, but they have not signed up.

“Believe it or not, there are still people out there who aren’t really sure how the Affordable Care Act works,” said Sean Driscoll from Legal Aid of North Carolina, a group that’s helped coordinate enrollment for many uninsured.

Last year, more than 500,000 North Carolinians signed up for coverage on the insurance exchanges during open enrollment, one of the most robust enrollment rates in the country.

Nonetheless, Sorien Schmidt, head of the North Carolina affiliate of Enroll America, a not-for-profit organization that’s coordinating sign-ups for the exchanges, said there’s a surprising number of people who still don’t know they’re eligible for coverage with a subsidy. She said the Robert Wood Johnson Foundation polled people who were uninsured this spring and found there was still confusion over the insurance marketplace.

“About half of [the uninsured] were familiar with the marketplace and had looked at it and decided they couldn’t afford it, and half didn’t know much still,” Schmidt said of the RWJF survey. “And 70 percent of all the people they talked about were still confused about subsidies and applying for coverage.”

Medicaid: eligible/not eligible

The Kaiser Family Foundation analysis also found an additional 152,000 uninsured adults and children in North Carolina could be eligible for Medicaid, but those people have not applied for coverage.

Adults in North Carolina are only eligible for Medicaid, the state and federally funded program that covers low-income people, if they have an income lower than $5,767 per year. But people with disabilities can qualify for Medicaid, and a pregnant women can get temporary Medicaid that lasts through her pregnancy and for two months after she gives birth.


Medicaid eligibility for children is looser: Kids under five years old are eligible for coverage if their household income is up to $42,189 for a family of three.

When people looking for insurance under Obamacare visit the online exchange, they’re put through an income-screening process. If that screening shows a person is eligible for Medicaid, then the application gets kicked over to the North Carolina Department of Health and Human Services to finish the process.

The Kaiser data also show about 244,000 people fall into the Medicaid “gap” created when the state legislature declined to expand the Medicaid program, as allowed for under the law. To date, 31 states and the District of Columbia have expanded Medicaid to include many working poor.

All told, about three million people are uninsured in the 19 states that have not expanded Medicaid. Among states that haven’t expanded their programs, the largest number of people in that coverage gap live in Texas, Florida, Georgia and North Carolina.

Lawmakers in the Republican majority in the General Assembly have said they’re uninterested in expanding.

“I actually think that expanding Medicaid is one of the most devastating things you can do to rural health,” Sen. Ralph Hise (R-Spruce Pine), co-chair of the Senate Health Care committee, said during a press conference at the General Assembly in mid-August.


About 13 percent, (143,000 people) of North Carolina’s uninsured are those who cannot qualify because of their citizenship status. Undocumented immigrants are ineligible for insurance under the federal law.

Another 309,000 North Carolinians are ineligible for help under the Affordable Care Act because their employer offers them insurance or their income is too high, the Kaiser analysis showed.

Schmidt said some people went to the website but decided the coverage would cost them too much. Often, that’s because they earn too much to qualify for subsidies, which taper off for people who earn more than 400 percent of the federal poverty level, about $47,000 for one person.

Many people at that income level work for an employer that offers health care coverage; but increasingly, employers are asking their workers to foot more of the bill for their insurance. If employer coverage costs more than 9.5 percent of an employee’s income, that worker could qualify for subsidies to buy insurance. But many people don’t know that, so they don’t go looking, the Kaiser analysis said.

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