Insurance Coverage for Non-standard Workers: Experiences of Temporary Workers, Freelancers, and Part-time Workers in the USA, 2010–2017

Abstract

Objective: To estimate insurance disparities across non-standard employment categories and to determine how coverage disparities shifted following health reform in 2014. Methods: We analyzed nationally representative data on working-age adults from the Medical Expenditure Panel Survey (MEPS) (2010–2012 and 2015–2017, N=79,182) to estimate insurance rates across three groups of non-standard workers (full-time temporary workers, freelancers, and part-time workers) compared to standard workers. Results: Uninsurance decreased after health reform for all groups of non-standard workers, ranging from a 10.0- to 14.3-percentage point decline (p<0.001). Yet, uninsurance rates remained high for freelancers (30.8%), full-time temporary workers (25.1%), and part-time workers (17.9%) relative to standard workers (11.9%) in 2015–2017 (p<0.001). Residence in a Medicaid expansion state was associated with lower uninsurance rates for all categories of workers. Conclusions: Workers in non-standard jobs continue to face challenges obtaining health insurance coverage. Our findings highlight the continued high risk of uninsurance for full-time temporary workers and freelancers.