Health insurance enrollment is declining in industries with large minority workforces

Industries with large numbers of minority workers are trailing those dominated by white employees in the percentage of workers enrolling in employer-paid health insurance, and the gap is widening, according to a new study supported by the Agency for Healthcare Research and Quality (HS09521). The study, which was based on Census Bureau data on 197 industries between 1988 and 1997, compared health insurance enrollment across industries and over time.

The study was conducted by Lisa A. Cubbins, Ph.D., of Seattle's Battelle Memorial Research Institute and Penelope Parmer, M.A., of the University of Cincinnati. Their study also revealed that since 1988:

• Workers are less likely to receive health benefits in industries with higher proportions of small firms, a trend that grew during the past decade. In the opinion of the researchers, rising health care costs were a contributing factor.
• Higher levels of full-time employees (35 hours or more a week) in an industry increased the likelihood of health benefits, although the magnitude of this effect declined during the decade.
• Lower unemployment rates and increased demand for labor during the past decade seem to have contributed to an increase in the percentage of workers receiving health benefits in industries with proportionately more part-time labor. According to the researchers, this may be because the high demand for labor in the mid-1990s led employers to use different incentives, such as health benefits, to attract part-time workers.
• The gap in health benefit levels between retail trade and nonprofessional service industries versus other types of industries widened, contributing to the long-term decline in employer-based health insurance.
• There was no change in the impact of union activity on the level of health benefits, but the researchers hypothesize that as the labor movement extends its membership to include groups of workers who lack health benefits, the effect of unions on health benefits may become stronger.

Simulations conducted by the researchers suggest that the decline in employer health benefits may be less dramatic over the next few years than it has been in the last two decades. They project that the average proportion of workers provided health benefits across industries by 2007 will be 47.8 percent compared with 50.3 percent in 1997.

Details are in "Economic change and health benefits: Structural trends in employer-based health insurance," by Dr. Cubbins and Ms. Parmer, in the March 2001 Journal of Health and Social Behavior 42, pp. 45-63.

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