PLAYING BY THE RULES AND LOSING - HEALTH-INSURANCE AND THE WORKING POOR

Using a sample of 7,734 employed adults from the National Medical Expe nditure Survey, this research compares the sources of health insurance coverage and the antecedents of employer-sponsored insurance among th e working poor to those at higher income thresholds. Concern with the working poor is warranted because they constitute the majority of the uninsured, they do not qualify for public health programs, and their h ealth insurance benefits have eroded substantially. The data reveal th at (1) the working poor are only one-third as likely to receive insura nce from their employer as are the non-poor, and are over five times a s likely to be without insurance from any source; (2) employment chara cteristics are critical antecedents of employer-sponsored insurance an d, as a set, explain variation in coverage beyond that provided by hum an capital/socioeconomic factors; and (3) most employment characterist ics have a similar effect on the odds of coverage across income catego ries, except for unionization and minimum wages. Implications for heal th care reform are addressed.