Health insurance is a crucial part of the American workforce's well-being, with most U.S. workers relying on employer-sponsored health plans for their coverage. But a 2025 study by JPMorganChase found that nearly one-third of small businesses—firms with fewer than 50 employees—dropped health insurance coverage from one year to the next, with rising health insurance costs being a contributing factor. These firms make up 27 percent of the country’s private workforce, the study found.
Effective November 1st, a new partnership between the NC Chamber and Blue Cross Blue Shield of North Carolina aims to address this challenge through a model known as Carolina HealthWorks. “Carolina HealthWorks offers companies with as few as two to 50 employees the flexibility, convenience, and competitive rates typically enjoyed by larger companies,” says Gary Salamido, President and CEO of the NC Chamber. The program offers a variety of health plans with fixed monthly payments, a range of wellness services and numerous opportunities to save. “It’s one of many benefits available to members of the North Carolina Chamber and participating local chambers throughout all of North Carolina,” Salamido says.
At the center of Carolina HealthWorks are Multiple Employer Welfare Arrangements (MEWAs), that unite small businesses to create scale and make coverage more affordable. By pooling resources, firms participating in a MEWA can access pricing advantages and benefits previously available only to larger groups.
“This is a huge win for business,” says Julie Kruse-John, Vice President of Operations and Public Affairs at the Wake Forest Area Chamber, which is partnering with the NC Chamber to make Carolina HealthWorks available to small businesses in Wake Forest. “Legislation was passed last December that allowed for a MEWA to be created,” Kruse-John explains. The NC Chamber soon began working with BCBSNC to develop Carolina Healthworks. As a member of the NC Chamber, the Wake Forest Area Chamber qualifies under the law as a “federation chamber,” she says. “The plan is estimated to provide 40 percent lower costs than the average Affordable Care Act (ACA) market rate,” says Kruse-John.
Carolina HealthWorks is being sold through Blue Cross Blue Shield’s appointed agents, allowing businesses to continue working with their existing agents or enroll directly. Enrollment information can also be accessed online at BCBSNC or the NC Chamber.
North Carolina Insurance Commissioner Mike Causey says he often hears from small business owners about the affordability of health insurance. His office also partnered in developing the MEWA model, which he says is a first of its kind in the state. “This plan, which is available to members of the NC Chamber and affiliate local chambers of commerce only, is one option that can make health insurance more affordable for small business owners,” Causey says. He notes that the legislation was passed last year with strong bipartisan support in the NC General Assembly and signed into law by Governor Josh Stein.
The Wake Forest Area Chamber is now working to inform its members about how Carolina HealthWorks can help address access and affordability challenges in small business health insurance plans. These efforts included, among others, a free, one-hour webinar on November 25th.
“A healthy workforce is a vital competitiveness factor for our local economy, and this important new program stands to empower businesses of all sizes to offer comparable health benefits at comparable costs,” says Jason Cannon, President of the Wake Forest Business & Industry Partnership (WFBIP). “Our partners at the Wake Forest Area Chamber see Carolina HealthWorks as a game-changer for small Wake Forest firms struggling with rising health plan costs. We are honored to support the Chamber as it works to inform our business community about this new option and how it can boost their competitive position,” Cannon says. “It stands to make a difference for our local economy, too.”
