Health Care Trends In North Carolina Since 2001
When it comes to the health care debate in North Carolina, four issues typically come to the forefront: affordability, access, government spending and mental health. Since 2001, North Carolina’s health care system has been faltering on all four counts.
More North Carolinians Without Health Insurance Coverage
The overall rate of uninsured and – more specifically – of children lacking coverage are both higher now than in 2001. Comparing our state to national averages is even more discouraging. In 2001, North Carolina’s uninsured rate was below the national average in both measures (overall and children), but by 2007 had climbed past the national averages.
|North Carolina Health Care Indicators||2001||Now
(or most recent data available)
|Percentage of Uninsured (overall)||14.4%
(below national average of 14.6%)
(above national average of 15.3%)
|Percentage of Uninsured Children||11.2%
(below national average of 11.7%)
(above national average of 11%)
|Percentage of North Carolinians Enrolled in Medicaid||11.6%||13.2%|
|Percentage of North Carolina Children Enrolled in Medicaid||25.4%||30.1%|
|Average family insurance premium||$7,011||$10,950|
|NC percentage increase||56.2%|
|Other State Increases:|
|U.S. Average Increase||51.6%|
|Percentage of North Carolinians Enrolled in Private Health Coverage||69.5%||64.1%|
|Percentage of North Carolina Children Enrolled in Private Health Coverage||66.2%||58%|
|Medicaid Spending (inflation-adjusted)||$2.5 billion||$3.25 billion
|Mental Health Spending (inflation-adjusted)||$720.9 million||$743 million
|Medicaid Error Rate||0.8%||4.21%|
|Recipients of Medicaid||28% increase|
|Medicaid Providers – Physicians||23% decrease|
|Medicaid Providers – Hospitals||61% decrease|
- Overall uninsured rate1:
- 2001: 14.4 percent, just below the national average of 14.6 percent
- 2007: 16.4 percent, above the national average (15.3%) by more than a full percentage point
- Children’s uninsured rate2:
- 2001: 11.2 percent, below the national average of 11.7 percent
- 2007: 12.1 percent, one percentage point above the national average of 11 percent
- The national rate for uninsured children dropped slightly from 2001 to 2007, but North Carolina’s rate increased
Growing Medicaid Dependency Has Not Reduced Number of Uninsured
Expanding North Carolina’s Medicaid and SCHIP programs has not reduced the number of North Carolinians going without coverage. The share of people enrolled in Medicaid actually increased as the rate of those lacking health coverage likewise climbed (as noted above), indicating that the government programs were not in fact helping reduce the number of North Carolinians lacking health coverage.
- The percentage of North Carolina citizens enrolled in Medicaid jumped from 11.6 percent in 2001 to 13.2 percent in 20073
- In 2001, 25.4 percent of children were enrolled in Medicaid. By 2007 that number had ballooned to 30.14
Insurance Premiums Increasing More Rapidly Than National and Regional Rates – Putting Private Insurance Out of Reach for More North Carolinians
- North Carolina’s average family health insurance premium for employer-based coverage grew from $7,011 in 2001 to $10,950 in 2006 – an increase of 56.2 percent5
- North Carolina’s premium hike (56.2%) was higher than the U.S. increase of 51.6 percent and significantly higher than the premium increases in area states such as South Carolina (46.8%), Georgia (47%), and Tennessee (40.6%)6
- Meanwhile, the rate of those covered by private health insurance has dropped noticeably. In 2001, 69.5 percent had private coverage, just two percentage points below the national average (71.5%). By 2007, the rate dropped to 64.1 percent, falling to more than three percentage points below the national average (67.5%)7
- Likewise, children covered by private health insurance in North Carolina dropped further behind the national average. In 2001, the share of children with private health coverage was 66.2 percent, 2.6 percentage points below the national average. By 2007, North Carolina’s rate had dropped to 58 percent – more than six percentage points below the national average of 64.2 percent8
Medicaid Spending Is Up Significantly While Mental Health Spending Saw Minimal Increase
While lawmakers continued to substantially expand a Medicaid program already described as a “Cadillac” system by the Lewin Group in 2001, funding for mental health was comparatively ignored.
- Inflation-adjusted state spending on North Carolina’s Medicaid program grew from $2.5 billion in FY 2001-02 to $3.25 billion in the current budget– an increase of 30 percent
- Meanwhile, inflation-adjusted spending on North Carolina’s mental health system rose just 3 percent9
Five-Fold Increase in Medicaid Waste
Fraud and waste in North Carolina’s Medicaid program costs taxpayers millions. Such wasteful spending has increased dramatically under the current leadership.
- Annual Error Rates for Claims Billed to Medicaid10
SFY 2001: 0.8%
SFY 2005: 4.21%
More than a five-fold increase.
Less Access for Medicaid Enrollees
As the number of North Carolinians enrolled in the state’s Medicaid program has increased, the number of Medicaid providers has decreased. More people seeking care from fewer doctors means less access for those in need.
- From FY 2001 to FY 2006 the number of Medicaid service recipients climbed by 28 percent
- At the same time, the number of physicians enrolled as Medicaid providers decreased by 23 percent
- Likewise, the number of enrolled Medicaid hospital providers shrank by an alarming 61 percent11
1U.S. Census Bureau
3U.S. Census Bureau, Health Insurance, “Health Insurance Coverage Status and Type of Coverage by State All People: 1999 to 2007”
4U.S. Census Bureau, Health Insurance, “Health Insurance Coverage Status and Type of Coverage by State–Children Under 18: 1999 to 2007” Note: Children enrolled in North Carolina’s SCHIP program (N.C. Health Choice) are included in the Medicaid category.
5Medical Expenditure Survey; Agency of Healthcare Research and Quality, U.S. Department of Health & Human Services “Average total family health insurance premium per enrolled employee at establishments that offer health insurance”
7U.S. Census Bureau, Health Insurance, “Health Insurance Coverage Status and Type of Coverage by State All People: 1999 to 2007”
8U.S. Census Bureau, Health Insurance, “Health Insurance Coverage Status and Type of Coverage by State–Children Under 18: 1999 to 2007” Note: Children enrolled in North Carolina’s SCHIP program (N.C. Health Choice) are included in the Medicaid category.
9Joint Conference Committee Report on the Continuation, Expansion and Capital Budgets. Sept. 2001.
*Medicaid spending includes both “medical assistance” payments and N.C. Health Choice expenditures
Joint Conference Committee Report on the Continuation, Expansion and Capital Budgets. July 2008.
Mental Health Spending has been re-named the Division of Mental Health, Developmental Disabilities, Substance Abuse Services
Inflation source: inflationdata.com (July 2001 and July 2008 as comparison dates)
10Division of Medical Assistance, North Carolina Department of Health and Human Services. “Medicaid in North Carolina” Annual Report for State Fiscal Year 2006
11Division of Medical Assistance, North Carolina Department of Health and Human Services. “Medicaid in North Carolina” Annual Reports for State Fiscal Years 2006 and 2001.