NC Budget and Tax Center

The reality of North Carolina’s labor market and what it means for health insurance

Last week’s Prosperity Watch highlighted the strong relationship between income and health insurance—that is, the higher one’s income the more likely they are to be insured.  The problem with this relationship, beyond the fact that everyone needs insurance — not just the rich — is that it reflects an underlying challenge in our labor market that complicates access to health care.

Three fundamental challenges with the state’s labor market are holding back North Carolinians from healthy opportunities.

  1. North Carolinians with low incomes are struggling to make ends meet in low wage jobs. According to data from the Working Poor Families Project, 75 percent of North Carolinians with incomes below 200 percent of the federal poverty level (or incomes less than $51,500 for a family of four) are working.  Moreover, 1 in 9 North Carolinians who worked full-time year-round were uninsured.
  2. North Carolinians with low incomes often have to work intermittently throughout the year or with irregular hours from week to week. Nationally, analysts have found that 1 in 4 Americans who work at least 1,000 hours in a year would be at risk of losing coverage because their work hours fluctuate enough in a given month that they would fall below reporting requirements established by some states to access health care.  These reporting requirement thresholds are arbitrary and inflexible in the face of a job landscape where inconsistent work scheduling and temporary work, for example, are on the rise.
  3. Too many North Carolinians are still struggling to find jobs in many communities that have not recovered from the Great Recession (and even in those that have). The most recent county data found that 45 counties still have fewer jobs than before the Great Recession. This lack of employment opportunity is particularly pronounced in rural areas but also affects urban neighborhoods that are disconnected from their broader regional labor market.

Without exploring the underlying ways in which our current labor market matters for leading healthier lives, it is impossible to design the best policies to make sure that people are connected to the health insurance they need. Even worse, it could lead to consideration of unfixable and flawed policies that suggest reporting on work activities to qualify for health insurance coverage can solve the underlying challenges in the labor market.

Indeed, to promote healthy opportunities for every North Carolinian, our policymakers must not only ensure health insurance coverage is accessible and affordable but address the issues that make work in the current labor market fall short of delivering the security of well-being.  Doing so will lead to not just healthier outcomes but also higher incomes.

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