Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD, 20852, USA.
J Gen Intern Med. 2021 Jul;36(7):1997-2003. doi: 10.1007/s11606-021-06700-0. Epub 2021 Mar 26.
To estimate insurance disparities across non-standard employment categories and to determine how coverage disparities shifted following health reform in 2014.
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.
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.
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.
评估非标准就业类别中的保险差距，并确定 2014 年医改后覆盖差距如何变化。
我们分析了来自医疗支出面板调查（MEPS）（2010-2012 年和 2015-2017 年，N=79182）的具有代表性的成年工作者数据，以估计三类非标准工作者（全职临时工、自由职业者和兼职工作者）与标准工作者相比的保险率。
医改后，所有非标准工作者群体的未参保率均有所下降，降幅在 10.0-14.3 个百分点之间（p<0.001）。然而，在 2015-2017 年，自由职业者（30.8%）、全职临时工（25.1%）和兼职工作者（17.9%）的未参保率仍高于标准工作者（11.9%）（p<0.001）。居住在医疗补助扩大州与所有工人类别的未参保率降低相关。
从事非标准工作的工人在获得医疗保险覆盖方面仍然面临挑战。我们的研究结果突出了全职临时工和自由职业者未参保的高风险仍然存在。
