New Workforce Study Points to Hidden Uninsured

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Health Insurance

The number of uninsured Americans may be greater than the commonly reported figure of 46 million, according to a new study released today by the Center for a Changing Workforce and the Iowa Policy Project (IPP).

The study, "Nonstandard Jobs, Substandard Benefits," was completed with funding from the U.S. Department of Labor and Commonwealth Fund.

In a household survey of fringe benefits available to U.S. workers in part-time, temporary, contract and on-call positions, the authors found that medical discount cards were commonly mistaken for health insurance. It also found that such "nonstandard" jobs provide few fringe benefits such as health insurance.

The study suggests that the official government survey tracking health insurance coverage nationwide understates the number of Americans without health insurance. That survey fails to identify individuals who report having insurance but in fact possess only a medical discount card.

Discount cards, as opposed to health insurance policies, offer very limited benefits and consumers are responsible for paying all claims and the full cost of services up front.

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"If the government's survey on health insurance coverage is going to remain relevant, they must find a way to include questions about new types of health insurance and non-insurance products," said Peter Fisher, research director of the IPP. Fisher co-authored the report with Elaine Ditsler and Colin Gordon of the IPP and David West of the Center for a Changing Workforce in Seattle.

"The report also shines a new light on America's hidden 'permatemp' workforce: employees who are labeled as 'temps' and 'contractors,' but who work year-round without benefits," said David West. The study estimates a minimum of 3.3 million "permatemps" working in America - long-term workers misclassified as temps, contract workers and independent contractors.

"Some employers who hire large numbers of part-time workers (Wal-Mart alone has over 300,000 part-time workers) without affordable insurance are effectively shifting the burden to other employers," said West. "Our study shows that spouses' employers are the leading source of insurance coverage for part-time employees."

With about 1 in 4 workers in a nonstandard job, nonstandard work has contributed to the decline in job-based health insurance and the increasing numbers of uninsured Americans since 2000, the survey found.

Among findings of the report:

  • Almost 1 in 5 nonstandard workers had a medical discount card and no health insurance. All but 1 percent of these workers mistakenly reported that their discount card was health insurance.

  • Workers in nonstandard jobs are far less likely to have health insurance and other fringes than are workers in traditional work arrangements. About 1 in 4 nonstandard workers is completely uninsured compared with 12 percent of traditional, full-time workers. Without access to job-based health insurance or retirement plans, such workers face greater economic insecurity.

  • About 74 percent of all standard workers had employer-provided health insurance in 2001, compared to just 21 percent of nonstandard workers. As a result, a much larger share of nonstandard workers, 39 percent vs. 11 percent,
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