Association for Public Policy Analysis & Management

This study examines the role of health reforms in facilitating access to insurance coverage for vulnerable populations of workers in the United States. We focus on part-time workers, who have been more likely than full-time workers to be uninsured historically. Recent findings from the Medical Expenditure Panel Survey indicate that 27.5% of part-time workers were uninsured throughout the first half of the year, on average, compared with 17.4% of full-time workers.

In our analysis, we first present new estimates of insurance gaps for part-time workers relative to full-time workers before the recent reforms. We then estimate interrupted time series models to measure post-2014 changes in outcomes separately for full-time and part-time workers and in states that did and did not expand Medicaid. Our study uses nationally representative data from the Medical Expenditure Panel Survey – Household component (MEPS-HC, 2010-2015), which is well suited for this analysis since the MEPS-HC collects detailed information on employment (especially work hours of current main jobs), insurance coverage, socioeconomic and demographic characteristics, and state identifiers.

Preliminary findings indicate significant gains in insurance for part-time workers coincided with implementation of the main Affordable Care Act coverage reforms. Part-time workers who live in states that expanded Medicaid gained coverage through public insurance programs, while part-time workers in states that did not expand Medicaid gained coverage from Marketplace plans. Among full-time workers, we observed similar but more modest changes in coverage. We further found that the increase in public coverage in expansion states among part-time workers was partially offset by a decrease in employer-sponsored insurance coverage. Despite fears about employers dropping coverage for part-time workers, our findings show that the eligibility of part-time workers for employer-sponsored insurance did not decline in a widespread fashion, at least through 2015. On the other hand, eligibility among full-time workers increased, and was associated with an increase in employer-sponsored coverage among full-time workers in expansion states.

One important goal of recent expansion efforts was to increase insurance coverage for workers in jobs that historically did not have health benefits, such as part-time jobs. Our research highlights the importance of stratifying workers by work hours and examining both offer and take-up when studying the effects of health insurance reforms on employer-sponsored coverage.