The Work/Health Insurance Nexus: A Weak Link for Mexican-origin Men.

In 2007 nearly forty-six million U.S. residents, or over 15 percent of the population, had no health insurance coverage, and many more had only episodic or inadequate coverage (DeNavas-Walt, Proctor, and Smith, 2008). The failure of our health care financing system to cover everyone has serious implications for the health of the most vulnerable among us, who consist disproportionately of minority group members, the poor, and children (Quadagno, 2005). The large number of uninsured has far-reaching negative implications for individuals, families, and entire communities (Institute of Medicine, 2001; Pagan and Pauly, 2006). In this paper we investigate the role of employment in explaining the lack of health insurance coverage among employed Mexican-origin adult males, and compare their patterns of employment-based coverage to those of African-American and non-Hispanic white adult males. The comparison is intended to identify unique health insurance coverage vulnerabilities of Mexican-origin workers and is motivated by several considerations. In addition to having the lowest rates of health insurance coverage of any racial or ethnic group, the Mexican-origin population is the largest Hispanic subgroup and has persistently been the most likely to be uninsured (Fronstin, Goldberg, and Robins, 1997). Although recent migration has dispersed this population to states in which there were very few Hispanics just two decades ago, for the most part it is concentrated in specific labor markets and sectors where health insurance coverage is limited. In addition, the Mexican-origin population has an immigration experience that is distinct from that of other Hispanic groups such as Puerto Ricans, who are U. S. citizens by birth, and Cubans, who arrived as political refugees. We confine the analysis to men since women’s labor force experiences are fundamentally different than those of men and require separate analyses that include issues related to child care and other gender-based factors (see Harrington Meyer and Pavalko, 1996). As part of the analysis we describe the employment characteristics of Mexican-origin workers and identify the ways in which these characteristics might affect health coverage. We draw upon the literature on health insurance coverage among Hispanics even though much of it does not differentiate among specific subgroups. We justify this choice because much relevant work does not differentiate among subgroups and the fact that Mexican-origin individuals comprise the majority of Hispanics. Statistics for the Hispanic population as a whole are heavily influenced by the Mexican-origin component. In what follows we refer to “Hispanic” when the findings we discuss pertain to the combined subcategories. We use the term “Mexican-origin” to refer to the group of citizens and non-citizens with Mexican roots. The Mexican-origin population has particularly low rates of coverage at all ages (American College of Physicians, 2000; Amey, Seccombe, and Duncan, 1995; Angel and Angel, 2007; Santos and Seitz, 2000; Trevino et al., 1991; Valdez et al., 1993). In 2006 while 18 percent of non-Hispanic blacks and 13 percent of non-Hispanic whites under 65 were uninsured, fully 39 percent of Mexican-origin individuals had no coverage (Adams, Lucas, and Barnes, 2008). Data from the Current Population Survey also show that the Mexican-origin population has the lowest rate of health insurance coverage among Hispanics (Angel, Angel, and Lein, 2008). Many potential explanations for these low rates of coverage have been suggested. These include a large number of non-citizens who do not have access to coverage (Angel and Angel, 2007), low access among recent immigrants (Bastida, Brown, and Pagan, 2007), language and cultural barriers (Brown et al., 2000), bureaucratic barriers (Lein and Schexnayder, 2007; Mechanic et al., 2005; Reschovsky, Hadley, and Nichols, 2007), and employment in jobs in which coverage is not offered or offered only at premiums that poor working families cannot afford (Angel and Angel, 1996; DeNavas-Walt, Proctor, and Smith, 2007; Schur and Feldman, 2001). In this paper we focus specifically on the labor force explanations and examine the extent to which low rates of coverage among Mexican-origin workers reflect the characteristics of the employment sectors, industries, and occupations in which they are employed, in addition to family and personal characteristics. The focus on occupations is motivated by the fact that minority Americans, including the Mexican-origin population, are more likely than majority Americans to be employed in occupations that do not offer health insurance coverage (Angel and Angel, 2007; Hall, Collins, and Glied, 1999).