Employment Instability and Health Insurance Disparities Among Low- and Middle-Income Workers

Category	Detail
Condition	Employment Instability
Key Mechanisms	Volatile employment defined by income volatility, work-hour volatility, and employment disruption affects health insurance coverage.
Target Population	Low- and middle-income workers aged 18 to 64 years.
Care Setting	Nationally representative analysis using Medical Expenditure Panel Survey (MEPS) data.

50% of low-income households reported earnings that fluctuated unpredictably in 2023.
Workers with income or work-hour volatility had significantly lower rates of employer-sponsored insurance (ESI) offers.
Medicaid coverage was more common among workers experiencing employment volatility.
Fluctuating employment may lead to Medicaid disenrollment due to documentation requirements.
Expiration of enhanced Advanced Premium Tax Credits (APTCs) may jeopardize ACA marketplace coverage.

Consider nonemployer-based coverage options for workers with volatile employment.

Workers with volatile employment are at risk of losing Medicaid coverage due to fluctuating work hours.

Adults aged 18 to 64 years with household incomes at or below 400% of the federal poverty level.

Insurance coverage options include ESI, Medicaid, and ACA marketplace plans.

Ensure access to health insurance options for workers with unstable employment.
Advocate for policies that protect coverage pathways for low- and middle-income workers.

Clinical Scorecard: Employment Instability and Health Insurance Disparities Among Low- and Middle-Income Workers