Low-Wage Uninsured Workers: Who are They and Where do They Work?

Allie Corcoran and I have embarked on a new research project looking at the occupations and industries of low-wage, uninsured workers in states that have not expanded Medicaid with American Community Survey data.[1] As readers of the SayAhhh! blog know, there are 12 states that have not expanded Medicaid and have higher uninsured rates for adults and children.

The first state issue brief we released last week was Mississippi where we found that restaurants, construction, and retail trade were the top industries, collectively employing 31 percent of all low-wage, uninsured workers. (Read the blog by my colleague and co-author Margaux Johnson-Green to learn more about the Mississippi report.) Today we are releasing the findings for Alabama, Georgia, Missouri, and North Carolina.  We will complete the series over the next month or so.

As studies have pointed out, the majority of those eligible for Medicaid expansion are working. And if they are not, it is because they are in school, caregiving for others, or suffer from a health condition that makes it hard to work. But where are they working? This is the question we examine.

In the five states we have examined so far, some themes have emerged. The most consistent theme has been that rural counties or, in some instances, counties with small towns, have the highest percentages of uninsured workers in every state.[2] This is consistent with past research we and others have done underscoring the importance of Medicaid expansion to rural counties.

The second theme that has emerged is that many of the industries with the greatest number of uninsured low-wage workers have likely been hard hit by the pandemic. Restaurants, or accommodation and food services, employ the highest percent of low-wage uninsured workers – ranging from 13 to 20 percent—in all five states so far. Cashiers and cooks come up frequently as the top occupations. This data is from 2019 and we won’t have comparable data for 2020 until this fall. We can only assume things have gotten worse for these low-wage workers.

A third theme that surprised me a bit was that women are often disproportionately represented in the top industries that employ low-wage uninsured workers. The reason this surprised me is because studies have shown that men are slightly more likely to gain coverage through expansion, and because some very, very low-income parents (who are mostly but not exclusively women) are already eligible for Medicaid in these states through the parent path and should be covered. Race data varies a lot by industry and state, which is also interesting but perhaps less surprising.

We hope you will take a look at these factsheets. As the pandemic recedes, ask yourself when you go to a restaurant or a retail outlet – does the waiter or the cashier have health insurance? Especially if you are in one of the 12 states that has not expanded Medicaid, it is unfortunately very possible that they don’t.

[1] We define low-wage as citizen adults between 19-64 with income below 138% of the federal poverty line which is the group eligible for Medicaid expansion.

[2] For the county data we look at workers regardless of income or citizenship status to ensure adequate sample size.

Low-Wage Uninsured Workers: State Profiles

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.