Above photo: ep_jhu/Flickr.
As Congressional Republicans weigh major cuts to Medicaid and the Affordable Care Act (ACA), a new research paper reveals troubling disparities in how workers obtain health insurance in the United States.
The new paper from the Center for Economic and Policy Research (CEPR) – A Complicated Maze: How Workers Navigate the US Health Care System – finds major gaps in the availability of employer-based insurance. The complicated public and private system that attempts to fill those gaps, however, falls short of providing universal coverage – and Congress is considering changes that threaten to end coverage for millions of workers.
Employer-based coverage is by far the most important source of health coverage for workers and their families, with over 70 percent of US workers enrolled in employer-based plans. But access to employer-based plans is highly unequal, with the most disadvantaged workers least likely to be covered. Almost 9 of every 10 workers at or near the top of the pay scale (the top 20 percent of earners) have employer-based coverage, but less than half of workers in the bottom 20 percent have coverage through an employer.
The second most important source of health insurance for workers is Medicaid, which currently covers over 16 million US workers.
These differences by pay have a disparate effect on workers of color, younger workers, and immigrant workers:
-Only 53 percent of Hispanic workers and 66 percent of Black workers have employer-based coverage, well below the 77 percent rate for white workers.
-Only 64 percent of workers between 18 and 25 have employer-based coverage, a rate that is ten percentage points below the 74 percent rate for workers 51 to 64.
-Only 68 percent of immigrant workers who are US citizens have employer-based coverage, compared with 74 percent of US-born citizens. Only 45 percent of immigrant workers who are not citizens have employer-based insurance.
The most important stopgap for workers without employer-based insurance is the Medicaid program, which covers one of every ten US workers:
-Among the lowest paid 20 percent of workers, more than one in five (21 percent) depend on Medicaid to fill the insurance gap.
-12 percent of all working women are covered by Medicaid.
-More than one in eight workers (13 percent) in households with children have insurance through Medicaid.
-16 percent of Hispanic workers and 15 percent of Black workers obtain their health insurance through Medicaid.
-14 percent of younger workers (18 to 25) and 11 percent of workers 26 to 50 rely on Medicaid for coverage.
-12 percent of immigrant workers who are citizens and 16 percent of immigrant workers who are not citizens obtain their health coverage through Medicaid.
Congress is currently debating several policies that would greatly reduce the number of workers eligible for Medicaid. One of the most discussed options would end federal subsidies to states that raised the income ceilings for Medicaid eligibility. The CEPR report estimates that 12.8 million workers could lose coverage if these federal subsidies are ended.
A second looming threat to coverage is the scheduled expiration at the end of 2025 of COVID-19-related subsidies to low- and middle-income households who purchase health insurance through the ACA exchanges. The CEPR report estimates that ending these subsidies, which triggered a large increase in ACA enrollment, could lead an additional 1.1 million workers to lose their ACA health insurance.
“Medicaid is, after employer-based health insurance, the second-most important source of health insurance for the US workforce. One of every ten US workers gets their insurance through Medicare, primarily because their employer coverage is too expensive for many low- and middle-wage workers, or because their employers don’t make it available at all,” said report co-author Emma Curchin, CEPR’s Domestic Outreach and Research Assistant.
The new CEPR report is a follow up to a January report, Chronic Condition: Working Without Health Insurance, which found that 10 million full-time workers were uninsured. Similar disparities exist among the uninsured; for instance, almost one of every four Hispanic workers (23.2 percent) lacks any form of health insurance.
