Recent Trends in Employer-Sponsored Health Insurance Coverage: Are Bad Jobs Getting Worse?


We examine whether the decline in the availability of employer-provided
health insurance is a phenomenon common to all jobs or is concentrated only on certain
jobs. In particular, we investigate the extent to which employers have continued to
provide health insurance on what we term “core” jobs while reducing the availability of
health insurance on “peripheral” jobs. We consider two dimensions on which jobs may
be considered peripheral: if they are new (tenure less than one year) or part-time. We
consider three outcomes whose product is the health insurance coverage rate: 1) the
fraction of worker who are in firms that offer health insurance to at least some workers
(the offer rate); 2) the fraction of workers who are eligible for health insurance,
conditional on being in a firm where it is offered (the eligibility rate); and 3) the fraction
of workers who enroll in health insurance when they are eligible for it (the takeup rate).
We find that declines in own-employer insurance coverage over the 1988-1997 period are
driven primarily by declines in takeup for core workers and declines in eligibility for
peripheral workers. We also look at trends by workers’ education level, and see how
much of the decline in is offset by an increase in coverage through a spouse’s policy. Our
findings are consistent with the view that employers are continuing to make health
insurance available to their core long-term, full-time employees but are restricting access
to health insurance by their peripheral short-term and part-time employees.

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National Bureau of Economic Research Working Paper No. 6709
Working Papers