A Profile of North Carolina’s Low-Wage Uninsured Workers by Joan Alker and Alexandra Corcoran April 2021 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 The Georgetown University Center for Children and Families (CCF) is an 372,400 uninsured nonelderly adults, or one-third of the state’s uninsured independent, nonpartisan policy and population, would gain health insurance.3 research center founded in 2005 with a mission to expand and improve high- This fact sheet examines which workers and industries would benefit quality, affordable health coverage for from expansion of Medicaid coverage.4 Industry sectors with the largest America’s children and families. CCF is percentage of low-wage uninsured workers are hospitality, retail, and based in the McCourt School of Public construction, accounting for 42 percent of those working without insurance Policy’s Health Policy Institute. (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). Table 1. Top Industry Sectors for Table 2. Top Occupations for Low-Wage, Uninsured Workers Low-Wage, Uninsured Workers Accommodation and food services 16.0% Cashiers 5.6% Retail 15.4% Cooks 4.6% Construction 10.9% Laborers and freight, stock, and material movers 3.7% Administrative, support, and waste management 10.3% Waiters and waitresses 2.9% services Nursing assistants 2.6% Manufacturing 10.2% Landscaping and groundskeeping workers 2.5% Health care and social assistance 9.2% Janitors and building cleaners 2.5% Other services (except public administration) 6.0% Construction laborers 2.4% Maids and housekeeping cleaners 2.3% Note: Workers with no occupation are not listed. Stockers and order fillers 2.2% Source: Georgetown University Center for Children and Families analysis of US Census Bureau American Community Survey (ACS) 2019 Public Retail salespersons 2.1% Use Microdata Sample (PUMS). Driver/sales workers and truck drivers 2.1% CCF.GEORGETOWN.EDU North Carolina’s low-wage, uninsured workers Demographics of uninsured Figure 1. Race of Low-Wage, Uninsured Workers in Top Industry Sectors low-wage workers Accommodation 52.8% Our analysis finds that women make up a and food services 31.3% disproportionate share of low-income, non- elderly North Carolinians (58 percent). In North Retail 64.0% 28.1% Carolina, 59 percent of uninsured, low-income non-elderly citizens are White, 32 percent are Construction 67.2% Black, and the remainder describe themselves 15.9% in other categories including American Administrative, 51.9% support, and waste White Indian, Asian/Pacific Islander, or multi-racial. management services 40.2% Approximately 6 percent of uninsured, low- 46.8% Black Manufacturing income non-elderly citizens are Latino.5 As 47.7% Figure 1 illustrates, different areas of the Health care and 53.4% economy have somewhat different racial social assistance 41.3% compositions for low-wage uninsured workers Other services 74.1% but in every industry, except for manufacturing, (except public 20.0% the majority of low-wage, uninsured workers administration) who would gain coverage through Medicaid Source: Georgetown University Center for Children and Families analysis of US Census Bureau American expansion are White. Community Survey (ACS) 2019 Public Use Microdata Sample (PUMS). Estimates for the share of low-wage workers in each occupational sector who are American Indiana/Alaska Native, Asian/Native Hawaiian or Pacific Islander, and Two or More Races/Some Other Race are suppressed due to small sample sizes and low-reliability. Which parts of the state have higher proportions of uninsured workers? The map on the right shows that 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. Table 3 lists the 14 counties with the highest proportion of uninsured Uninsured Rate for Non-Elderly Workers workers, each with more than 20 percent Above 20% of non-elderly employed adults lacking Between 10-20% insurance. All of these counties are rural Lower than 10% counties underscoring other research Note: Includes all workers ages 19-64 regardless of income or citizenship status. findings that Medicaid expansion would Source: Georgetown University Center for Children and Families analysis of U.S. Census Bureau American disproportionately benefit rural areas.6 Community Survey (ACS) 2015-2019 Table DP03. Table 3. North Carolina Counties Uninsured Rate for Uninsured Rate for County County Where More than 20 Percent of Non-Elderly Workers Non-Elderly Workers Non-Elderly Workers are Uninsured United States 11.0% Clay 23.2% North Carolina 13.8% Swain 22.9% Note: Includes all workers ages 19-64 regardless of Avery 27.2% Greene 22.4% income or citizenship status. Tyrrell 26.6% Sampson 22.2% Source: Georgetown University Center for Children Graham 26.1% Yancey 22.1% and Families analysis of U.S. Census Bureau American Community Survey (ACS) 2015-2019 Table DP03. Hyde 26.0% Macon 21.7% Cherokee 25.1% Transylvania 20.5% Duplin 23.9% Montgomery 20.4% April 2021 CCF.GEORGETOWN.EDU North Carolina’s low-wage, uninsured workers 2 Endnotes 1 For 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. 5 The American Community Survey measures race and ethnicity as two separate facets of an individual’s identity. Hispanic/Latino individuals can be of any race. 6 J. Hoadley, J. Alker, and M. Holmes, “Health Insurance Coverage in Small Towns and Rural America: The Role of Medicaid Expansion” (Washington DC: Georgetown University Center for Children and Families, September 2018), available at https://ccf. georgetown.edu/2018/09/25/health-insurance-coverage-in-small-towns-and-rural-america-the-role-of-medicaid-expansion/. April 2021 CCF.GEORGETOWN.EDU North Carolina’s low-wage, uninsured workers 3