A recent report from the Urban Institute and the Robert Wood Johnson Foundation underscores that when it comes to health insurance provided on the job, the less you make the less you get. Take a look at the chart below which illustrates the decline in employer-sponsored coverage by income level. The lowest paid workers – those with incomes below 138% of the FPL – had one of the sharpest declines over the ten-year period – from 38% to 29%. Not a lot there to begin with and now it is even harder for these workers to get coverage on the job. The highest earners saw a much smaller decline – from 92% to 90%.  This decline illustrates why the Medicaid expansion included in the Affordable Care Act is so important. These folks really don’t have many options for coverage at work.

I was also interested in this new report because I have been working on another paper for the Kaiser Commission on Medicaid on the feasibility of premium assistance in Medicaid come 2014. The expansion of Medicaid might make premium assistance a more attractive option because the whole family will now be eligible for coverage subsidies rather than direct coverage – making cost-effectiveness that much easier to prove. But this new report underscores the inherent limits to premium assistance for a low-income population – employer-sponsored insurance is dwindling for this population.