Nearly 17 percent of Johnstonians 64 and younger were without health insurance in 2013, according to the American Community Survey. The percentage was lower than in the prior year but still higher than the state and national numbers.
In 2012, 20 percent of Johnston’s nonelderly population was without health insurance. In 2011, the figure was 14 percent.
In Johnston, the rate of uninsured has less to do about the number of jobs and more about the types of jobs, said Adam Linker of the N.C. Justice Center, a Raleigh-based advocacy and research group.
In June, Johnston’s jobless rate was just 5.5 percent. But most Johnstonians work in manufacturing, construction and retail, industries that don’t typically offer health insurance.
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“It’s less that people are unemployed and more that employers are not offering insurance at work,” said Linker, co-director of the Justice Center’s health-access coalition.
The long recession and slow recovery didn’t help either, said Dr. Marilyn Pearson, Johnston County’s public health director. Because of layoffs, “some people had insurance and lost insurance,” she said.
The Johnston County Public Health Department provides care for the uninsured. But that’s costly because public health departments get little to no reimbursement for their services, Linker said.
“The clinics are providing their care, and they can’t get paid by insurance companies, and they’re not getting a lot of money from low-income clients,” he said. “They’re really just providing a lot of free care and low-cost care. It’s expensive for the department and for clinics.”
Linker thinks the best way to insure more North Carolinians is to expand Medicaid, the federal health insurance program for the poor. But so far, the state has declined to do so.
Some people are eligible for Medicaid but don’t know it, Pearson said. According to a report from the Henry J. Kaiser Family Foundation, children make up the majority of North Carolinians who are Medicaid eligible but not enrolled.
“We have a number of children who may be eligible for Medicaid, but they are not aware, or families are not aware,” Pearson said. “Those are things that many of us are working on and trying to get the word out about.”
Pearson thinks the number of insured Johnstonians will climb as more residents sign up for insurance through the Affordable Care Act. Through mid-April, 637 people had done so in Smithfield, 455 in Selma, 242 in Kenly, 380 in Four Oaks, 467 in Benson, 215 in Princeton and 1,866 in Clayton, according to the U.S. Department of Health and Human Services. None had done so in Micro or Wilson’s Mills.
Under the Affordable Care Act, nearly 42 percent of nonelderly North Carolinians who are uninsured will be eligible for coverage, according to the Kaiser report. Expanding Medicaid could help even more North Carolinians, the report said.
“The ACA will help many currently uninsured North Carolinians gain health coverage, but many who could have obtained financial assistance through the Medicaid expansion will remain outside its reach,” the report said.
Pearson said she planned to follow ACA enrollment. “There have been more people applying for insurance through the marketplace exchange,” she said. “It will be interesting to see the numbers in the next year or two, to see if more people are insured.”
The Affordable Care Act provides insurance subsidies for households with incomes between 100 percent and 400 percent of the federal poverty level. In Johnston County, about 13 percent of people live below the poverty level, according to the American Community Survey.