ACA Coverage Expansions and Low-Income Workers

Executive Summary

This brief highlights low-income workers and the impact of ACA coverage expansions on this population. While low-income workers are a diverse group, unique characteristics and challenges differentiate them from their higher income counterparts. Key findings of this analysis include the following:

• Low-income workers are more likely to be young, people of color, and female than higher income workers. Low-income workers also tend to have lower levels of education and more limited access to health insurance than workers with higher incomes. Addressing the challenges that many low-income workers face could help to reduce existing economic and health disparities between demographic groups.
• Low-income workers may not have access to jobs that provide full-time, full year employment or jobs with comprehensive benefit packages, including health insurance. Low-income workers work nearly as many hours per week and weeks per year as higher income workers and are more likely to work in the agriculture and service industries and for small firms that are typically less likely to provide comprehensive benefit packages (including health insurance) as consistently as other employers.
• Medicaid plays an important role in providing health coverage for low-income workers, particularly those in families living below poverty. More than one in five low-income workers received Medicaid or other public coverage in 2014. Furthermore, one in three low-income workers in families living below poverty relied on Medicaid or other public coverage in 2014. Compared to higher income workers, low-income workers are less likely to have coverage through their employer and are more likely to be uninsured.
• Coverage expansions implemented under the ACA have produced substantial coverage gains for low-income workers and a corresponding reduction in the uninsured. From 2013 to 2014, low-income workers experienced large gains in coverage as a result of the Medicaid expansion and the availability of subsidies in the health insurance Marketplaces under the ACA. Low-income workers in expansion states were more likely to have coverage than those in non-expansion states.
• Nearly a quarter of uninsured low-income workers in non-expansion states fall into the coverage gap. Low-income workers in non-expansion states with incomes too high for Medicaid but too low for subsidies in the Marketplace do not have an affordable coverage option and will likely remain uninsured.