Health Insurance Coverage Among U.S. Workers: Differences by Work Arrangements in 2010 and 2015

Abstract

Introduction: For most Americans, health insurance is obtained through employers. Health insurance coverage can lead to better health outcomes, yet disparities in coverage exist among workers with different sociodemographic and job characteristics. This study compared uninsured rates among workers with different work arrangements.

Methods: Data from the 2010 and 2015 National Health Interview Survey-Occupational Health Supplements were used to capture a representative sample of the U.S. civilian, non-institutionalized population. Associations between work arrangement and lack of health insurance were analyzed, adjusting for covariates. Analyses were performed during 2016-2018.

Results: The percentage of workers aged 18-64years without health insurance coverage decreased significantly by 6.8% among workers in all work arrangement categories between 2010 and 2015. However, workers in nonstandard work arrangements were still more likely than standard workers to have no health insurance coverage. In 2015, for workers to have no health insurance the ORs were 4.92 (95% CI=3.91, 6.17) in independent, 2.87 (95% CI=2.00, 4.12) in temporary or contract, and 2.79 (95% CI=0.34, 0.41) in other work arrangements. Standard full-time workers in small establishments and standard part-time workers were also more likely to have no health insurance coverage (OR=2.74, 95% CI=2.27, 3.31, and OR=1.65, 95% CI=1.25, 2.18, respectively).

Conclusions: Important disparities in health insurance coverage among workers with different work arrangements existed in 2010 and persisted in 2015. Further research is needed to monitor coverage trends among workers.

Figure 1.

Distribution of workers by type of work arrangement. ^aStandard full time employees (work ≥30 hours per week) in medium and large establishments (≥50 employees). ^bStandard full time employees (work ≥30 hours per week) in small establishments (<50 employees). ^cStandard part time employees (work <30 hours per week) in all size establishments. ^dWork as an independent contractor, independent consultant, or freelance worker. ^ePaid by a temporary agency or work for a contractor who provides workers and services to others under contract. ^fSome other work arrangement.

Figure 2.

Distribution of workers with private health insurance, public health insurance, and no health insurance coverage. ^aStandard full time employees (work ≥30 hours per week) in medium and large establishments (≥50 employees). ^bStandard full time employees (work ≥30 hours per week) in small establishments (<50 employees). ^cStandard part time employees (work <30 hours per week) in all size establishments. ^dWork as an independent contractor, independent consultant, or freelance worker. ^ePaid by a temporary agency or work for a contractor who provides workers and services to others under contract. ^fSome other work arrangement.