A Profile of North Carolina’s Low-Wage Uninsured Workers

The recently enacted American Rescue Plan Act of 2021 (ARP) includes new large financial incentives for states to extend health insurance coverage to low-wage workers and other adults earning less than $17,775 a year.¹ These incentives apply to regular spending in a state’s Medicaid program and offer a five percentage point across the board increase in the federal share for a 24 month period after the state extends coverage. The Kaiser Family Foundation estimates that North Carolina’s budget would see a net gain of $1.21 billion over a two-year period if the state expanded Medicaid.² Approximately 372,400 uninsured nonelderly adults, or one-third of the state’s uninsured population, would gain health insurance.³

This fact sheet examines which workers and industries would benefit from expansion of Medicaid coverage.4 Industry sectors with the largest percentage of low-wage uninsured workers are hospitality, retail, and construction, accounting for 42 percent of those working without insurance (see Table 1). The most common jobs for low-wage, uninsured workers are cashiers, cooks, freight and stock laborers, waiters/waitresses, and nursing assistants (see Table 2).


The uninsured rate for all non-elderly adult workers varies considerably across the state of North Carolina, ranging from 5.8 percent in Gates County to 27.2 percent in Avery County. This map lists the 14 counties with the highest proportion of uninsured workers, each with more than 20 percent of non-elderly employed adults lacking insurance. Hover over the map to see the uninsured rate in each county.


¹For more information on the provisions of the law, see E. Park and S. Corlette, “American Rescue Plan Act: Health Coverage Provisions Explained” (Washington DC: Georgetown University Center for Children and Families and Center on Health Insurance Reform, March 2021), available at https://ccf.georgetown.edu/2021/03/11/american-rescue-plan-act-health-coverage-provisions-explained/.
² R. Rudowitz, B. Corallo, and R. Garfield, “New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending” (Washington DC: Kaiser Family Foundation, March 2021), available at https://www.kff.org/medicaid/issue-brief/new-incentive-for-states-to-adopt-the-aca-medicaid-expansion-implications-for-state-spending/.
³ Kaiser Family Foundation, “Who Could Medicaid Reach with Expansion in North Carolina?” (Washington DC: Kaiser Family Foundation, February 2021), available at https://files.kff.org/attachment/fact-sheet-medicaid-expansion-NC.
4 Contact authors for more information on sources of data and methods. All data are from American Community Survey 2019 most from the Public Use Microdata Sample; county data calculated from American Community Survey five-year (2015-2019) prepared tables.

[See our full list of Low-Wage Uninsured Worker State Profiles here.]