For North Carolina businesses with 50 or fewer employees, the healthcare landscape has historically been challenging to navigate, with many business owners facing a choice between costly Affordable Care Act (ACA) health insurance plans or not offering the benefit at all.

“To try to maintain a reasonable price and premium, the result has been to move our deductibles up and up and up,” said John Lockhead, president of Brand It, a Durham-based promotional products distributor.

But things changed in November 2025, when the NC Chamber launched Carolina HealthWorks, a multiple employer welfare arrangement, or MEWA, that gives small businesses large-group purchasing power.

A partnership with Blue Cross and Blue Shield of North Carolina and participating local chambers of commerce, the program is now providing healthcare coverage to more than 1,600 small businesses and more than 14,000 employees and their families.

For Lockhead and his six employees, switching to Carolina HealthWorks meant better coverage with lower deductibles and max out-of-pocket rates.

“We investigated it and it worked for us,” he said. “I was like, ‘Hallelujah.’ There’s finally a little bit of positive news here.”

He’s not alone. Benefiting businesses are seeing an average savings of about 20% compared to ACA rates.

Bringing Carolina HealthWorks to fruition required legislative changes from the NC General Assembly, as well as approval by the NC Department of Insurance. It’s a project the NC Chamber worked on for more than a decade.

“Small businesses are the backbone of North Carolina’s economy, but for too long, they have had few choices and little control when it comes to insurance benefits,” said Gary Salamido, president and CEO of the NC Chamber. “In a business climate where healthcare costs are a key determinant and measurement of competitiveness, Carolina HealthWorks levels the playing field for small employers and allows them to take care of their people.”

Businesses with two to 50 employees are eligible if they are members of the NC Chamber or a local chamber of commerce that is part of its Federation. They must also be headquartered in the state.

Brand It joined the Durham Chamber of Commerce for the purpose of accessing Carolina HealthWorks, but the business has since deepened its involvement.

“The chamber has been a pleasant surprise,” Lockhead said. “Three times this year, I’ve had meetings downtown and swung by the chamber office, camping out with my laptop for an hour or two. I’ve been to networking events. I’ve realized I’ve got existing customers who are members of the chamber. I enjoy that kind of networking opportunity.”

Connecting more small businesses with their local chambers of commerce has been an added perk of the Carolina HealthWorks program.

In addition to local chambers of commerce, businesses can join the NC Chamber’s Small Business Council to access Carolina HealthWorks. Since launching along with the program last year, the Council has grown to more than 120 members.

As both programs move into their second year, the NC Chamber is expanding its supports for small businesses with more programming and resources to help entrepreneurs succeed.

To stay up-to-date on the latest developments, subscribe to the Chamber’s monthly Main Street Matters newsletter.