Uninsured Women in North Carolina

North Carolina

Health insurance is critical to ensuring women receive the preventive and acute medical care they need to achieve and maintain good health. Coverage has been shown to promote positive health outcomes, increase appropriate use of health care services and offer financial protection against high medical expenses. Those without insurance will often rely on emergency departments to receive care, which costs more and is less efficient. 

Compared with insured women, uninsured women have more health challenges, including:

• Inadequate access to care.
• Lower quality of care.
• Higher rates of avoiding or delaying needed medical care due to cost.
• Lower use of recommended preventive services, such as mammograms and Pap tests for cancer screening.
• Poorer health outcomes, such as higher rates of cancer mortality and greater risk of a late-stage cancer diagnosis.

Since the implementation of the Affordable Care Act in 2010, the proportion of women of reproductive age who are uninsured has declined, and their health coverage stability has improved. States that expanded Medicaid have shown greater progress in reducing their uninsured population. In 2018, the proportion of uninsured women in Medicaid expansion states was 8%, compared with 17% in states that did not expand Medicaid. 

According to KFF estimates, the uninsured rate is higher among:

• Single mothers compared with mothers in two-parent households.
• Hispanic and American Indian/Alaska Native women compared with Asian and white women. More than 1 in 5 Hispanic and American Indian/Alaska Native women are uninsured.
• Women with incomes below 200% of the federal poverty level, compared with women who have higher incomes. 
• Women living in the United States without U.S. citizenship compared with citizens.

Common reasons for being uninsured include being unable to afford insurance, lack of knowledge about eligibility for free or reduced-cost insurance and falling into the coverage gap. In 2020, an estimated 2 million uninsured women were eligible for Medicaid but were not enrolled, and 1 million women were in the Medicaid coverage gap, meaning their incomes were too high for Medicaid eligibility but still below the poverty level. Medicaid expansion under the Affordable Care Act increases eligibility for nearly everyone in this group, but not all states have adopted the expansion. 

Policy changes that have been effective at reducing the rate of uninsured women include:

• Expanding Medicaid to bridge the coverage gap: This government-sponsored health insurance program has made significant strides in increasing access to and quality of care for low-income women and those who would otherwise lack coverage. Expansion of Medicaid eligibility will decrease the proportion of uninsured women. 
• Pregnancy-related Medicaid: Pregnancy care through Medicaid covers maternity care, delivery and postpartum care for 60 days after childbirth, and is available in all 50 states. Women can enroll in pregnancy-related Medicaid at any time during pregnancy but must meet their state’s income requirements to be eligible. The National Health Law Program provides answers to frequently asked questions regarding eligibility for pregnancy-related Medicaid. States now have the option to expand Medicaid postpartum coverage from 60 days to 12 months through provisions in the American Rescue Plan Act of 2021.

Healthy People 2030 has several health insurance-related objectives, including increasing the proportion of people with health insurance and reducing the proportion of people who can’t get medical care when they need it.

Increasing access to and coverage of high-quality maternal health services is one of five goals in the White House Blueprint for Addressing the Maternal Health Crisis, released in June 2022. The document outlines strategies the federal government should take to improve U.S. maternal and infant health outcomes. 

Buettgens, Matthew, and Urmi Ramchandani. “The Health Coverage of Noncitizens in the United States, 2024.” Brief. Washington, D.C.: Urban Institute, May 2023. https://www.urban.org/sites/default/files/2023-05/The%20Health%20Coverage%20of%20Noncitizens%20in%20the%20United%20States%202024.pdf.

Drake, Patrick, Jennifer Tolbert, Robin Rudowitz, and Anthony Damico. “How Many Uninsured Are in the Coverage Gap and How Many Could Be Eligible If All States Adopted the Medicaid Expansion?” Issue Brief. KFF, March 31, 2023. https://www.kff.org/medicaid/issue-brief/how-many-uninsured-are-in-the-coverage-gap-and-how-many-could-be-eligible-if-all-states-adopted-the-medicaid-expansion/.

Garfield, Rachel, and Kendal Orgera. “The Uninsured and the ACA: A Primer — Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act.” KFF, January 2019. https://www.kff.org/report-section/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act-how-does-lack-of-insurance-affect-access-to-care/.

Gomez, Ivette, Usha Ranji, Alina Salganicoff, and Brittni Frederiksen. “Medicaid Coverage for Women.” Issue Brief. KFF, February 17, 2022. https://www.kff.org/womens-health-policy/issue-brief/medicaid-coverage-for-women/.

Gunja, Munira Z., Sara R. Collins, Michelle M. Doty, and Sophie Beautel. “How the Affordable Care Act Has Helped Women Gain Insurance and Improved Their Ability to Get Health Care: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016.” Issue Brief. The Commonwealth Fund, August 2017. https://doi.org/10.15868/socialsector.28134.

Sugar, Sarah, Joel Ruhter, Sarah Gordon, Amelia Whitman, Christie Peters, Nancy De Lew, and Benjamin D. Sommers. “Health Coverage for Women Under the Affordable Care Act.” Issue Brief No. HP-2022-09. Washington, D.C.: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, March 21, 2022. https://aspe.hhs.gov/sites/default/files/documents/9082fc42757552c429d8b1c3c8949595/aspe-womens-coverage-ib.pdf.

Tolbert, Jennifer, Kendal Orgera, Natalie Singer, and Anthony Damico. “Key Facts about the Uninsured Population.” Issue Brief. KFF, December 19, 2022. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/.

“White House Blueprint for Addressing the Maternal Health Crisis.” Washington, D.C.: The White House, June 2022. https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf.

Zhao, Jingxuan, Xuesong Han, Leticia Nogueira, Stacey A. Fedewa, Ahmedin Jemal, Michael T. Halpern, and K. Robin Yabroff. “Health Insurance Status and Cancer Stage at Diagnosis and Survival in the United States.” CA: A Cancer Journal for Clinicians 72, no. 6 (November 2022): 542–60. https://doi.org/10.3322/caac.21732.