Stability of Health Care Coverage among Low-Income Working Women

Research has demonstrated that health insurance coverage improves health care for low-income adults and their children (Almeida, Dubay, & Ko, 2001; Lillie-Blanton, 1999; Salganicoff & Wyn, 1999). Yet, despite efforts by the federal government to improve low-income health care coverage through Medicaid and related program expansions in the late 1980s and 1990s, coverage for adults eroded (Holahan & Kim, 2000; Mishel, Bernstein, & Schmitt, 2001). Of the more than 44 million Americans without health care coverage in 1998, about two-thirds had incomes of less than 200 percent of the poverty level (Holahan & Kim). The implementation of welfare reforms through state Temporary Assistance for Needy Families (TANF) (P.L. 104-193) programs may exacerbate this problem, especially for women who leave welfare for jobs and exhaust transitional Medicaid benefits before they obtain employer-based coverage (Anderson & Gryzlak, 2002; Redmond, 2001). The growing prominence of female, single-parent families and the marginalization of jobs in an increasingly global marketplace also raise questions about coverage prospects for low-income working women in general (Davis, Aguilar, J Keigher & Lowery, 1998). Understanding the determinants of health coverage is critical if viable health care policies for low-income women are to be developed. In addition, because low-income women often labor in irregular or temporary jobs, measures of health care stability over time are needed to provide meaningful indicators of health coverage circumstances. This article addresses these issues by examining the relative importance of various factors to the stability of health care coverage for a sample of low-income working women, using data from the National Longitudinal Survey of Youth (NLSY). HEALTH CARE COVERAGE FOR LOW-INCOME PEOPLE About one-third of all nonelderly, low-income people have been estimated to lack health insurance (Lillie-Blanton, 1999), and three-fourths of the uninsured people are in families with at least one person working full-time (Hoffman & Scholbohm, 2000). Low-income working people lack coverage for several reasons. First, they are less likely than people with higher incomes to be employed in firms that offer coverage (Kuttner, 1999). Second, low-income people often experience employment instability (Anderson, Halter, Julnes, & Schuldt, 2000; Edin & Lein, 1997). Short job tenures limit the availability and consistency of coverage, because employer-based plans generally do not provide coverage until employees have completed probationary periods (Currie & Yelowitz, 2000; Hale, 1997; National Center for Health Statistics, 1997). Finally, many low-wage workers decline available employer-based coverage because they cannot afford the premiums and co-payments (Hoffman & Scholbohm). This problem has increased in recent years, as employers have required greater employee cost-sharing because of rising insurance premiums (Kuttner; Van Loon, Borkin, & Steffen, 2002). Research has identified many demographic, social, and employment characteristics related to the probability of receiving health insurance. For example, several studies have found that education level and health coverage are positively related, although the extent to which education operates independently of income is not clear (Currie & Yelowitz, 2000; U. S. Census Bureau, 2000). Racial differences in health coverage also have been observed, with African Americans generally faring more poorly than non-Hispanic white people, and Hispanics who are not-white having even lower coverage rates (Holahan & Kim, 2000). Women are less likely to receive employer-based health insurance than men (Currie & Yelowitz; Mishel et al., 2001), but women are slightly more likely to be covered because of spousal insurance and wider access to Medicaid (U.S. Census Bureau). Job characteristics also affect the receipt of employer-based coverage. …