How to increase health care enrollment for N.C.’s immigrants

UNC study underscores the potential of the Affordable Care Act to reach many N.C. immigrants

(CHAPEL HILL, N.C. – Sept. 12, 2014) — Sixty-one percent of immigrants in North Carolina have no health insurance coverage, yet the average monthly premium for insurance available through the Affordable Care Act’s health insurance marketplace is within the price range many immigrants thought would be affordable for themselves or their families, according to a new report from the University of North Carolina at Chapel Hill.

The Carolina Population Center study, “Implementing Health Care Reform in North Carolina: Reaching and Enrolling Immigrants and Refugees,” also shows that immigrants who participated in focus groups believe that health insurance is a necessity they would not give up if they could afford it.

“Most people felt they could afford a premium between $50 and $70, so it was a wonderful coincidence when we looked online at health insurance premium rates and found that the average, with subsidies, was $69,” said co-author Krista Perreira, a professor of public policy and associate dean for undergraduate research in UNC’s College of Arts and Sciences and a Carolina Population Center fellow. “That’s right in that sweet spot of affordability.”

In 2013-2014, authors completed more than 100 interviews with state and county community leaders and conducted 11 focus groups with nearly 100 immigrants in the Charlotte metropolitan area, the Piedmont Triad, the Research Triangle and the eastern region of the state. Ninety-four percent of focus group participants said they knew little if anything about the ACA. The next N.C. enrollment period is Nov. 15, 2014 to Feb. 15, 2015.

Key recommendations include:

  • Statewide groups should partner with local community leaders to develop translated materials and community-based information sessions where immigrants can receive personalized enrollment assistance. In the past 12 months, there has been a concentrated effort toward making videos, brochures and website information accessible in multiple languages. Future written materials should be succinct, straightforward and have colorful graphics.
  • Short text messages providing brief information — such as a phone number to call for more information or a reminder that enrollment season is open — should be developed.
  • Public awareness campaigns urging immigrants to enroll should emphasize the following themes: financial security, family responsibility and protecting personal health for work. They should stress that premiums are affordable.
  • Health providers and community-based organizations that serve immigrants should continue to work together to promote Medicaid expansion in N.C.

“Many immigrants are eligible to participate in the health insurance marketplace, yet they remain one of the most hard-to-reach population groups,” said Jonathan Oberlander, professor and vice chair of social medicine in the UNC School of Medicine and a professor of health policy and management in the UNC Gillings School of Global Public Health. “To further reduce the number of uninsured in North Carolina, outreach to immigrants is critical.”

Local and community leaders are eager to engage in outreach to immigrants about health care coverage, but there’s no one-size-fits-all medium to get the word out to them. Perreira said organizations should concentrate enrollment efforts on the five counties where nearly 50 percent of noninsured citizens live — Durham, Forsyth, Guilford, Mecklenburg and Wake.

UNC researchers say N.C. is a compelling case study to increase enrollment because:

  • It is one of 34 states that has not implemented a state-run health insurance marketplace.
  • It has chosen not to expand Medicaid.
  • It has had one of the fastest-growing immigrant populations in the United States. (Between 1990 and 2012, the foreign-born population in N.C. increased by 550 percent.)

The report, which can be found online at, was supported by the Robert Wood Johnson Foundation and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Note: Perreira can be reached at (919) 962-6152,; Oberlander can be reached at (919) 843-8269,

College of Arts and Sciences contact: Kim Spurr, (919) 962-4093,

UNC Communications & Public Affairs contact: Thania Benios, (919) 962-8596,

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