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.