For American workers, the last few years have been a time of increasingly unstable health insurance coverage. Fewer and fewer employees are able to get coverage through the employer health plan, while higher premiums, copayments, and deductibles are diminishing the value of health benefits when they are offered.
But what about the one of four workers in America who work under contract or work part-time or temporary jobs? According to new research sponsored by The Commonwealth Fund, such "nonstandard" workers are often excluded from job-based health coverage. The uninsured rate among these workers stands at a whopping 24 percent.
In the report, On the Fringe: The Substandard Benefits of Workers in Part-Time, Temporary, and Contract Jobs, researchers at the Iowa Policy Project, a nonpartisan research organization, analyzed data from the Contingent Work Supplement (CWS), an addendum to the U.S. Census Bureau's Current Population Survey, to compare insurance trends between nonstandard workers and full-time employees. They also conducted a survey of nonstandard workers in late 2003 and early 2004 to fill in gaps in the census data.
According to the report, in 2001, most standard workers (74%) had health insurance through their jobs, but only 21 percent of nonstandard workers did. Nonstandard workers relied on government insurance at five times the rate of regular workers and were insured through a spouse's health plan at three and one-half times the rate of regular workers.
Nonstandard workers were also found less likely to take up employer coverage when available. About 87 percent of regular full-time workers were offered health insurance, compared with 40 percent of nonstandard workers. Among nonstandard workers eligible for an employer health plan, 54 percent elected to enroll. In comparison, the enrollment, or “take-up,” rate for standard workers was 85 percent. Nonstandard workers who declined coverage said they had coverage through another source or the plan was too expensive.
Families of nonstandard workers are also affected by insurance instability. Nearly one of five family members of nonstandard workers were uninsured (18% of children and 16% of spouses). A substantial share—10 percent of children and 6 percent of spouses—relied on public health insurance for coverage.
"A healthy workforce is vital to our economy, but far too many workers and their family members are shut out of our system of employer-sponsored health insurance," notes Fund president Karen Davis. "With about one-quarter of the U.S. workforce in non-traditional work arrangements, we need new strategies for affordable, comprehensive benefits to cover this large sector."
The authors suggest several policies to give nonstandard workers an "on-ramp" to group-based health insurance. In particular, they point to "play or pay" employer mandates, such as those proposed in several states and localities that require employers either to provide health coverage or pay into public health insurance programs. In Maine, the Dirigo Health Plan is providing uninsured workers and others access to group insurance pools; on the federal level, nonstandard workers could be allowed to buy into the Federal Employees Health Benefits Program.
The authors conclude that seamless access to group health coverageÔfor nonstandard workers and others—depends on transparent employer-employee relationships, secure and portable employment-based care, and tax-subsidized access to alternative insurance pools for those left behind.