This brief provides new insights about health insurance coverage gaps among racial and ethnic minority groups, focusing on parents with employment in small firms or nonstandard employment. Compared with white parents, a disproportionate share of Latino and black parents have nonstandard employment, and Latino parents are more likely to have employment in small firms. These work arrangements increase the risk of being uninsured since they are less likely to come with an offer of health insurance compared to regular large firm employment. Few uninsured Latino parents could obtain coverage under existing Medicaid programs. Potential impacts of health reform are discussed.
The text below is an excerpt from the complete document. Read the full paper in PDF format.
A large body of literature documents the disproportionate
lack of access to employer-sponsored
health insurance (ESI) among racial and ethnic
minorities (AHRQ 2008). Public insurance closes
some of the gap, but coverage gaps remain.
Among all people living in the United States in
2008, the uninsured rate for non-Latino whites
was 10.8 percent, while it was nearly twice as
high for blacks (19.1 percent) and nearly three
times as high for Latinos (30.7 percent) (DeNavas-
Walt, Proctor, and Smith 2009). Among children,
uninsured rates were lower than for adults, but
with similar racial and ethnic patterns. While the
observed disparities in health insurance coverage
have many underlying causes, racial and ethnic
variation in parents' work arrangements may be
one important factor.
Parental work arrangements may affect health
insurance coverage through various means. In
this brief, we explore whether a disproportionate
share of racial and ethnic minority parents is
employed by small firms or in nonstandard jobs
(i.e., contingent employees and employees in
alternative work arrangements). Smaller firms
(i.e., with fewer than 25 employees) are less likely
to offer health insurance than larger firms, and
when smaller firms do offer health insurance their
employees are less likely to take it up than
employees of larger firms (Clemans-Cope and
Garrett 2006; Sommers and Crimmel 2008).
Small employers are less likely than larger employers
to offer health insurance coverage because they
typically face substantially higher administrative
loads and have fewer enrollees over which to spread
the risk of a high-cost enrollee, both of which
raise premiums. In addition, smaller firms are
more likely to have low-wage employees, reducing
the take-up of offered coverage. Low-wage
employees may prefer to take their compensation
in wages rather than as health insurance, particularly
since they are less likely than higher-wage
employees to benefit from the tax advantages of
ESI. As for nonstandard arrangements, employment
tends to be less secure and to have lower
wages and fewer benefits compared with more
traditional employment arrangements, and access
to and take-up of ESI also tends to be lower
(Ditsler and Fisher 2006; GAO 2000; Hipple
2001; Houseman 2003).
This brief provides new insights about coverage
gaps among racial and ethnic minority
groups. We begin by examining the extent to
which parents' work arrangements are associated
with the relatively high rate of uninsurance
among racial and ethnic minority parents. We
examine parents' individual and employment
characteristics by race and ethnicity, and whether
race and ethnicity are associated with parents' work
in small firms and nonstandard employment (e.g.,
temporary employees, employees of a temporary
help agency), which typically offer fewer benefits
than traditional large-firm employment.
Separating parents by employment type, we examine
whether race and ethnicity are associated with
insurance status and with access to and take-up
of ESI. We then examine eligibility for Medicaid
coverage among uninsured parents by key characteristics.
We conclude by discussing our findings'
relevance to current proposals to reform and
expand health insurance coverage.
(End of excerpt. The full paper is available in PDF format.)
Usage and reprints: Most publications may be downloaded free of charge from the web site and may be used and copies made for research, academic, policy or other non-commercial purposes. Proper attribution is required. Posting UI research papers on other websites is permitted subject to prior approval from the Urban Institute—contact email@example.com.
If you are unable to access or print the PDF document please contact us or call the Publications Office at (202) 261-5687.
Disclaimer: The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders. Copyright of the written materials contained within the Urban Institute website is owned or controlled by the Urban Institute.