Fewer workers are getting health insurance from their employers in North Carolina, but the number of uninsured people in the state is holding steady, as government programs such as Medicaid fill the gap.

Nearly one in six North Carolinians, or 16 percent, had no health insurance coverage in 2005, according to figures released Tuesday by the U.S. Census Bureau.

Nationally, the proportion of uninsured people increased slightly, to 15.9 percent. Seventeen states had a greater amount of uninsured people than North Carolina. Texas had the most people uninsured, at 24.6 percent, while Minnesota had the lowest amount, at 8.7 percent.

"It seems like we're just treading water," said Adam Searing, director of the N.C. Health Access Coalition, a consumer advocacy group.

But last year's stable results mask a growing trend that's shifting health care costs from employers to taxpayers. The percentage of people receiving health insurance from their employers dropped about 1 percentage point to 57.2 percent in 2005, while the amount of people receiving care from Medicaid rose a similar amount, to 13.3 percent.

N.C. Health Choice for Children also took up some of the slack, said Mark Holmes, vice president of the N.C. Institute of Medicine. Medicaid and N.C. Health Choice are funded by state and federal governments for low-income patients.

The trend raises questions about the viability of the current system, he said. "For 50 years, our health care system has been built on employer coverage, and as that continues to erode, we need to rethink our model," Holmes said.

The changes are particularly rapid at businesses with 25 to 100 employees. Holmes' analysis of the census figures shows that less than two-thirds of those workers were insured through their employers last year, down from 73 percent in 2004 and 82 percent in 2000.

A task force sponsored by the Institute of Medicine suggested in April that the state introduce subsidized health insurance for small employers, start an insurance pool for people who can't find coverage due to pre-existing medical conditions, and expand Medicaid to provide limited coverage for families with incomes below 200 percent of the poverty level. Current eligibility stops between 100 percent and 185 percent.

But Joseph Coletti, fiscal policy analyst for the conservative John Locke Foundation, says the solution isn't more government involvement, but less.

The government has created the employer cutbacks by imposing rules on insurers that increase the cost of coverage and broadening the eligibility for state programs, giving incentive to drop the group plans, he said.

"The trends of the uninsured are something everybody worries about," Coletti said. "It comes back to wanting to make sure we're asking the right questions."

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