Working Without Health Insurance – CEPR

The Uninsured

Tables 1 through 4 show the results of applying this framework to the last six years of ASEC data. These tables report the uninsured rate across the range of demographic groups and labor market states as defined in the preceding section.

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The top line of Table 1 shows the uninsured rate for all workers and, separately, for full-time full-year, part-time or part-year, and unemployed workers. Over the last six years, on average, 10.5 percent of workers were uninsured, meaning that they were without health insurance for the entire calendar year prior to their interview. Workers who experienced at least one spell of unemployment during the year had the highest uninsured rate (18.7 percent). The uninsured rate for part-time or part-year workers was almost as high (14.4 percent). But even full-time, full-year workers were at substantial risk of being uninsured (8.8 percent).

The remaining rows of Table 1 detail differences in uninsured rates by race and ethnicity, gender, age, marital status, and the presence of children in the respondent’s household. For ease of exposition, we focus here and later on the results for full-time, full-year workers. This group is the largest of the three types of workers analyzed, and is consistently the group that is least likely to be uninsured across the three employment types we analyze.

The share of uninsured workers varies strongly by race and ethnicity. Among full-time, full-year workers, Hispanic workers (21.1 percent) are most likely to be uninsured. Their rate is about four times higher than the corresponding rate for Asian workers (5.1 percent) and white workers (5.5 percent).¹³ After Hispanic workers, Black workers (9.1 percent) have uninsured rate that are almost double the rates for Asian and white workers.

Over the last six years, on average, 10.4 percent of men who worked full-time and full-year were uninsured, compared with 6.8 percent of women in full-time, full-year employment.

The patterns of uninsured rates by race and ethnicity for men and women separately mirror the patterns for the two groups combined. For each racial and ethnic group, men consistently have higher uninsured rates than women;¹⁴ and, for both genders, white and Asian workers have the lowest uninsured rates, followed by Black workers, with Hispanic workers experiencing a substantially higher likelihood of being uninsured.

Uninsured rates also differ substantially by age group. Rates are highest for 18-to-25 year-olds (14.0 percent for full-time, full-year workers). This group includes 19-to-25 year olds who, in principle, became eligible under the ACA for continued coverage on parental insurance plans.¹⁵ The 51-to-64 year-old age group was the least likely to be uninsured (6.2 percent), while 26-to-50 year-olds fell in between (9.0 percent).

Unmarried workers are far less likely than married workers are to have health insurance. About 12.6 percent of unmarried full-time workers are insured, more than double the corresponding 6.0 percent rate for married workers. This disparity may be related in part to the opportunity that married workers have to be covered through their spouse’s health insurance plan.

Full-time workers who live in a household without children are also more likely to be uninsured (9.9 percent) than full-time workers who live in a household where a child is present (7.6 percent). This difference may reflect the greater likelihood that households with children are eligible for Medicaid, because Medicaid eligibility is determined in part by income relative to household size.

Table 1

Notes: Those without health insurance reported having no health insurance from any source during the entire calendar year. Unemployed group composed of those who experienced any spell of unemployment during the calendar year, regardless of full-time or full-year status when employed. Racial and ethnic groups are mutually exclusive. Children indicates that the respondent’s household included at least one child.

Source: Authors’ analysis of the IPUMS extract of the Current Population Survey’s Annual Social and Economic supplement, 2019-2024.

Table 2 summarizes differences in the uninsured rate by workers’ educational attainment. Across all worker types, uninsured rates vary inversely – and strongly – with educational attainment. For full-time, full-year workers, the uninsured rate for a worker with less than a high school degree (32.3 percent) is almost 15 times higher than the rate for a worker with an advanced degree (2.2 percent). Workers with a high school degree but no additional education are six times more likely to lack insurance (13.9 percent) than a worker with an advanced degree. Workers with some college but no degree are almost twice as likely to be uninsured (8.0 percent) than those who finish college (4.0 percent).

The same inverse relationship between formal education and being uninsured holds when workers are disaggregated by gender. As is the case for the entire working population, at every education level men are more likely than women to be uninsured.

Table 2

Notes: Those without health insurance reported having no health insurance from any source during the entire calendar year. Unemployed group composed of those who experienced any spell of unemployment during the calendar year, regardless of full-time or full-year status when employed.

Source: Authors’ analysis of the IPUMS extract of the Current Population Survey’s Annual Social and Economic supplement, 2019-2024.

Table 3 presents results by workers’ wage level, defined here by wage quintile. Uninsured rates are, by far, highest for workers in the lowest fifth of the wage distribution. More than one in five (21.4 percent) full-time, full-year workers in the bottom of the wage distribution lacks health insurance, compared with less than one in 50 (1.7 percent) for workers at the top.

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As with earlier tables, disaggregation by gender does not alter the relationship seen in the aggregated data. Men at every wage quintile are more likely to be uninsured than women in the same quintile.

Table 3

Notes: Those without health insurance reported having no health insurance from any source during the entire calendar year. Unemployed group composed of those who experienced any spell of unemployment during the calendar year, regardless of full-time or full-year status when employed. Wage quintiles are based on average hourly earnings during weeks and hours worked; some unemployed workers who did not report earnings excluded from analysis.

Source: Authors’ analysis of the IPUMS extract of the Current Population Survey’s Annual Social and Economic supplement, 2019-2024.

Table 4 highlights the importance that citizenship status plays in obtaining health insurance. Full-time, full-year workers who were born outside the United States and are not US citizens are far more likely to be uninsured (28.9 percent) than workers who are US citizens – both those born in the United States (6.7 percent) and those born abroad (8.6 percent).

Lack of coverage is particularly acute for part-time or part-year and unemployed non-citizen workers: 36.0 percent of part-time workers and 39.0 percent of unemployed workers are uninsured. These rates are up to three times higher than the corresponding rates for US citizens with the same employment status.¹⁶

Table 4

Notes: Those without health insurance reported having no health insurance from any source during the entire calendar year. Unemployed group composed of those who experienced any spell of unemployment during the calendar year, regardless of full-time or full-year status when employed.

Source: Authors’ analysis of the IPUMS extract of the Current Population Survey’s Annual Social and Economic supplement, 2019-2024.