To evaluate employer-sponsored insurance (ESI) offers and insurance coverage among low- and middle-income workers with volatile employment.
Approach:
Study Design: Cross-sectional analysis using the 2022-2023 Medical Expenditure Panel Survey (MEPS) data.
Participants: Adults aged 18 to 64 years with household incomes at or below 400% of the federal poverty level.
Volatile Employment Indicators: Defined by income volatility, work-hour volatility, and employment disruption.
Statistical Analysis: Binary logistic regression for ESI offers and multinomial logistic regression for insurance coverage.
Key Findings:
Workers with income volatility had a 14.9 percentage-point lower likelihood of receiving ESI offers compared to stable workers (P < .001).
Workers with work-hour volatility had a 14.4 percentage-point lower likelihood of receiving ESI offers (P < .001).
Employment disruption was associated with an 18.9 percentage-point lower likelihood of ESI offers, though not statistically significant (P = .12).
Volatile employment groups had significantly lower rates of ESI coverage, with differences ranging from 19.6 to 24.1 percentage points (P < .001).
Medicaid coverage was more common among volatile workers by 12.2 to 18.9 percentage points (P < .001).
Workers with income and work-hour volatility had greater likelihoods of ACA marketplace coverage, with differences of 5.0 percentage points (P < .01) and 4.3 percentage points (P < .05), respectively.
Limitations:
Self-reported data may affect accuracy of the findings.
Contemporaneous unwinding of continuous Medicaid coverage may limit generalizability of the results.
