Millions of Americans have signed up for health insurance with their companies in recent weeks. But for some full-time workers, especially in certain industries like construction, work-based coverage is not an option for them.
This divide was even more evident as the labor market bounced back to life in 2021 after sharp losses at the start of the Covid-19 pandemic.
Although the number of full-time, year-round workers aged 19 to 64 jumped by 10.4 million last year, the uninsured rate for that group also rose, up 0.6 percentage points to 9.1 %, according to data from the Census Bureau.
This is partly due to the fact that the occupations that had the largest increase in the share of full-time workers last year was services and construction, which are less likely to provide work-based health benefits. Only about 62% of service workers and 56% of construction workers have employer-sponsored insurance.
At the same time, the share of people employed in professional and managerial occupations – which have the highest workplace coverage rates of 89% and 85% respectively – fell slightly last year. This also contributed to the decline in coverage among all full-time and year-round workers.
Overall, just over half of Americans have health benefits through their employer or a family member’s job, according to the Census Bureau. Among workers aged 19 to 64, the share is 71%, although it varies by industry.
In 2021, a greater share of full-time, year-round workers had public coverage, such as Medicaid, but that has not yet fully offset the decline in private coverage, which includes work-based health benefits, the Bureau of Labor Statistics found. census.
More of those workers were able to participate in Medicaid last year because of Congress’s 2020 pandemic relief package, which gives states additional federal funds for Medicaid but prohibits them from disenrolling beneficiaries even if their incomes are too high to to meet the usual conditions. Enrollment had risen to 90 million as of July, but is expected to drop by about 15 million after the federal government ends the public health emergency.
Increasing Medicaid enrollment helped reduce the nation’s overall uninsured rate to 8.3 percent in 2021, among the lowest on record.
Although employer-sponsored coverage is generally considered the gold standard, some of the luster has worn off.
“There’s already been a quiet crisis in employer-sponsored insurance for quite some time, especially for lower-income workers and workers in certain industries,” said Sabrina Corlett, co-director of the Center for Health Insurance Reform at Georgetown University’s McCourt School of Public Policy.
Fewer employers offer coverage and the policies they do provide are less robust, she said. This is especially true among smaller companies that are not subject to the Affordable Care Act mandate that requires larger employers to offer affordable coverage.
Only 32 percent of private sector employers with fewer than 50 workers offered health insurance last year, according to federal data. That’s down from a high of 47% in 2000.
Meanwhile, only 69 percent of eligible full-time workers at smaller companies that offer health benefits opted into coverage last year. That compares with a peak of nearly 84 percent in 1997, according to federal data.
Among larger private sector employers, offer rates have been in the mid-to-high 90% range since enrollment began in 1996. But only 72% of eligible full-time workers enrolled last year, compared with a high of 88% in 1998.
For some of these employees, even monthly premiums that equate to 5 percent or 6 percent of their income may be too expensive for them, Corlett said.
Many of those with coverage through work still struggle to pay for medical care, a recent study by the Commonwealth Fund found. About 29% of people with work-based health benefits are considered underinsured because their out-of-pocket costs and deductibles are high relative to their income.
The nonprofit considers Americans underinsured if their deductibles are 5 percent or more of household income, or if their out-of-pocket expenses in the past year were at least 5 percent or 10 percent of household income, depending on family income .
“That’s a big concern — that people see their health plans as not allowing them to get the health care they need,” said Sarah Collins, Commonwealth’s vice president of health coverage and access.