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Thursday, June 26, 2014

Medicaid Expansion Would Primarily Help Uninsured Workers

Dee Mahan

Nearly every day, you encounter hardworking people engaged in a job that you rely on—a daycare aide who cares for your child, a cashier who rings up your coffee, or a carpenter working in your neighborhood. But if you live in a state that hasn’t expanded Medicaid, there is a good chance that many of these people—even though they are employed—do not have health insurance. We recently examined data from the 24 states that have not expanded Medicaid to determine how many of those residents who could benefit from expanded health coverage are working—and which types of jobs they hold. 

Right now, 26 states and D.C. have chosen to accept federal dollars to extend Medicaid coverage to adults with incomes up to 138 percent of poverty. (In 2014, that amounts to an annual income of $27,310 for a family of three). In the 24 states that have not made that choice, a high number of adults remain uninsured without access to affordable health coverage.

So far, we’ve examined three states: Missouri, Utah, and Virginia. What we’ve found across those states has been strikingly similar: In each, the majority of people who stand to benefit if the state expands Medicaid are, indeed, working. 

How we conducted the studies

For each study, we used state-level data from the American Community Survey—an ongoing Census Bureau survey that reports state-specific data on issues such as health coverage, income, and work status. 

  • We identified the number of uninsured residents in each state who had incomes low enough to qualify them for Medicaid (we only looked at income eligibility) if the state expanded Medicaid. 
  • We filtered that group by work status and occupation. 
  • We defined a person as “working” if the survey respondent reported that he or she is currently working or had worked in the last year (this allowed us to include seasonal and contract workers, who often have gaps in employment due to the nature of their jobs). 
  • We also identified those who aren’t in the work force. This includes students, retired people, people with disabilities, non-working spouses, and people out of the workforce for more than five years. 
  • Finally, we identified individuals who were unemployed—those who have not worked for one to five years.

Our studies show that the majority of those who stand to gain health coverage from Medicaid expansion are working

In each of the three states that we examined so far, we found that the majority of those who stand to gain coverage if the state extends Medicaid eligibility are working—from nearly 60 percent in Virginia to 66 percent in Utah. 

And of those who are not working, most are simply not in the workforce. 
In each of the three states, those two categories—“working” and “not in the workforce”— account for 80 percent or more of those who could benefit from Medicaid expansion. In each state, 20 percent or fewer are unemployed.

What are the occupations of those who work but are uninsured?

For each state, we looked at the occupations of those who work but are uninsured. The occupations held by these uninsured workers form the foundation of state economies. Our accompanying infographics show top occupations for Missouri, Utah, and Virginia.

The top occupations include: 

  • Food service workers (for example, cooks and wait staff)
  • People with sales jobs (for example, cashiers and retail sales staff)
  • Construction workers (for example, painters, carpenters, and laborers)
  • People who hold personal care jobs (including barbers, child care workers, and personal care aides) 

Ongoing analysis will examine other states that haven’t expanded Medicaid 

Over the next few months, we’ll be conducting similar analyses of other states that haven’t expanded Medicaid. We’re confident that we’ll continue to find that most who could benefit if the state expands Medicaid are working. 

States can make the choice to extend health coverage at any time. If they continue to decline federal dollars for Medicaid expansion, the majority of those affected will be working adults.