Health Reform Facts: North Carolina

DEMOGRAPHY
The Patient Protection and Percent of Population in North Carolina per Race / Ethnic Group 2
Affordable Care Act (ACA) was
enacted on March 23, 2010.
Successful implementation requires
cooperation between key 3.3
stakeholders, federal and state 7.4
agencies, and reform advocacy
organizations. Because the fifty White (Non Hispanic)
states vary greatly, each state’s 21.6 Black
implementation process will be 67.2 Hispanic
unique.
Other*

In 2009, North Carolina had the

tenth largest population in the
United States, estimated to be
9,380,884.1 North Carolina is also
very diverse, which makes this
state unique in many ways, * Others include American Indian, Alaska Native, Asian, Native Hawaiian, and other
including health care needs. This Pacific Islanders.
presents a special challenge to
those trying to implement health
reform in the state.
NORTH CAROLINA AND THE UNINSURED: HOW WILL THE AFFORDABLE CARE ACT HELP?
While 84% of all North Carolinians have health insurance, over 1.4 million individuals remain uninsured, 3
including 11.3% of North Carolina’s children 4 and 20.1% of the state’s working population.5

ACA is designed to address these concerns by providing affordable access to those individuals who
would otherwise be unable to obtain health insurance, and to extend current benefits and services
provided by Medicaid (a federal and state funded public insurance program that provides health
insurance coverage for low-income and disabled individuals and families).
NEW BENEFITS UNDER ACA: ITS EFFECT IN NORTH CAROLINA
Insurance ACA establishes new requirements for private health insurers in order to make health care
Coverage plans more accessible to the public. These requirements include the following:
 Effective Immediately: Plans must cover certain preventive health services, such as

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National Coalition on Health Care July 2010
 vaccines and screenings, without a co-pay.
 Effective September 2010:
o Insurers will not be allowed to drop any insured person because he/she gets
sick or develops a chronic health condition. In addition, ACA allows individuals
to renew health insurance coverage regardless of their health status.
o Individuals up to the age of 26 can choose to be covered under their parents’
insurance plan.
 Effective January 2014:
o Under the “guaranteed issue” provision, an insurer must accept every employer
and individual in the state that applies for coverage.
o Insurers cannot exclude people from coverage because they have a pre-existing
condition (e.g., asthma, diabetes, or any other long-term condition) or past
illness.
o All insurers will be required to offer a coverage package that offers essential
benefits.
Small Effective Immediately: ACA makes tax credits available to qualifying small businesses to
Business help them afford coverage for their employees. These tax credits could total up to 50% of
Assistance a business’ health insurance premiums. In 2008, North Carolina had over 145,000 small
employers,6 which represented over 73% of the state’s employers.7
Tax Credits Effective January 2014: ACA provides a tax credit to qualified individuals so that they may
for purchase health insurance through the exchanges. Qualification for the tax credit will be
Individuals based on the individual’s household income and his/her number of dependents. A person
who earns between 133% and 400% of the federal poverty level 8 may be eligible for
individual tax credits.
Health Effective January 2014: ACA requires that states create an insurance market “exchange” –
Insurance a marketplace where people will be able to compare and shop for health insurance. This
Exchanges will make access to health plans easier and more efficient. U.S. citizens, legal immigrants,
and small businesses will be able to purchase insurance through these exchanges.
High-Risk Effective July 2010: High-risk pools are designed to provide health insurance coverage to
Insurance people who were previously uninsurable due to a pre-existing condition. North Carolina
Pools operates its own high-risk program called Inclusive Health. 9 In January 2010, this program
covered 3,400 individuals in North Carolina.10 North Carolina will run the federally funded
high-risk pool alongside its Inclusive Health program. 11
Expansion Effective January 2014: ACA contains provisions that would create new eligibility
of requirements for Medicaid. For example, adults under the age of 65 earning less than
Medicaid 133% of the federal poverty level may be eligible to apply regardless of whether they have
children. It is estimated that approximately 630,000 North Carolinians may be able eligible
to enroll in Medicaid.12

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 IMPLEMENTATION CHALLENGES IN NORTH CAROLINA
Successful implementation of ACA will require a joint effort among local, state, and federal agencies, as
well as many non-governmental organizations. The State of North Carolina will face several challenges:
 Budget 13–In the proposed budget for North Carolina's Fiscal Year 2010-2011, the General Assembly
assumed that Congress would pass enhanced Medicaid funding. Without such passage, the state's
budget gap could become $1.2 billion in 2011 and result in severe program cuts and employee
layoffs. The Assembly would have to decide how to reform the Medicaid programs that assist at-
home patients with bathing and cooking and how much to give to community mental health
programs. The limited budget in North Carolina will be a challenge for implementation.
 Health Care Workforce – With the potential increase of North Carolina's insured population, it is
important that primary care physicians and other necessary health care professionals are engaged in
health care reform. ACA provides grants and loan forgiveness to health care professionals; this will
help North Carolina ensure that it has an appropriate supply of doctors, nurses, social workers, and
other health care professionals to cover the increased demand.
 Diverse Population – North Carolina's diverse population presents a special challenge to those
implementing ACA in the state. A key concern for North Carolina residents regarding their current
health care systemis access to care. Providers must be sensitive to the state’s language, economic,
and cultural diversity. This means that access to care and the ability to understand one’s treatment
should not be threatened by one’s ethnicity, language, culture, or economic status.

1
U.S. CENSUS BUREAU, STATE AND COUNTY QUICKFACTS (2010), available at http://quickfacts.census.gov/qfd/states/37000.html (last accessed
June 2010). These figures are from 2009.
2
Ibid. These figures are from 2008.
3
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).
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=127&cat=3 (last accessed June 2010).
5
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.
6
Small businesses include employers with fewer than 50 employees.
7
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.
8
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).
9
For more information, see inclusivehealth.org.
10
NAT'L CONFERENCE OF STATE LEGISLATURES, Coverage of High-Risk Uninsurables: State and Federal High-Risk Pools, (May 27, 2010), available at
http://www.ncsl.org/?tabid=14329#2010_Pools (last accessed June 2010).
11
CAROLINA J. ONLINE, North Carolina Seeks to Expand High-Risk Insurance Pool, (June 1, 2010), available at
http://www.carolinajournal.com/exclusives/display_exclusive.html?id=6470 (last accessed June 2010).
12
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).
13
THE ASSOCIATED PRESS, Congress is Big Player for NC Budget Negotiations, June 6, 2010, available at http://www.reflector.com/state-
news/congress-big-player-nc-budget-negotiations-37507 (last accessed July 2010).

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