Insurance Coverage for Non-standard Workers: Experiences of Temporary Workers, Freelancers, and Part-time Workers in the USA, 2010-2017

J Gen Intern Med. 2021 Jul;36(7):1997-2003. doi: 10.1007/s11606-021-06700-0. Epub 2021 Mar 26.


Objective: To estimate insurance disparities across non-standard employment categories and to determine how coverage disparities shifted following health reform in 2014.

Methods: We analyzed nationally representative data on working-age adults from the Medical Expenditure Panel Survey (MEPS) (2010-2012 and 2015-2017, N=79,182) to estimate insurance rates across three groups of non-standard workers (full-time temporary workers, freelancers, and part-time workers) compared to standard workers.

Results: Uninsurance decreased after health reform for all groups of non-standard workers, ranging from a 10.0- to 14.3-percentage point decline (p<0.001). Yet, uninsurance rates remained high for freelancers (30.8%), full-time temporary workers (25.1%), and part-time workers (17.9%) relative to standard workers (11.9%) in 2015-2017 (p<0.001). Residence in a Medicaid expansion state was associated with lower uninsurance rates for all categories of workers.

Conclusions: Workers in non-standard jobs continue to face challenges obtaining health insurance coverage. Our findings highlight the continued high risk of uninsurance for full-time temporary workers and freelancers.

Keywords: health insurance; health policy; non-standard workers; poverty.

MeSH terms

  • Adult
  • Employment
  • Health Care Reform*
  • Humans
  • Insurance Coverage
  • Insurance, Health*
  • Medicaid
  • Medically Uninsured
  • Patient Protection and Affordable Care Act
  • United States / epidemiology