In this brief, author Jessica Carson examines differences in health insurance coverage by workers’ income, and explores who is eligible for an employer-based plan, who enrolls in those plans, and the reasons why workers choose not to enroll. She reports that, in 2016, only 33 percent of low-income workers (those below 200 percent of the official poverty threshold) employed full time, year round reported having employer-based health insurance, compared to 57 percent of higher-income workers. Low-income workers are less often offered insurance: 40 percent of low-income workers work for employers who do not offer insurance to any employee, compared to 18 percent of higher-income workers. For those whose employers offer plans, low-income workers are less likely to enroll, citing ineligibility and cost as barriers. When higher-income workers don’t enroll, it is most often because they do not need the plan. More than 25 percent of low-income workers employed full time, year round reported having no health insurance of any kind at any time in the previous year, compared with just 8 percent of higher-income workers. She concludes that as changes to health insurance policy continue to evolve, it is critical to keep in mind that full-time employment isn’t necessarily a ticket to health insurance, and that access to employer-based health insurance is stratified by income and industry.

Publication Date

Winter 3-20-2018


National Issue Brief No. 133


Durham, N.H. : Carsey School of Public Policy, University of New Hampshire

Document Type



Copyright 2018. Carsey School of Public Policy. These materials may be used for the purposes of research, teaching, and private study. For all other uses, contact the copyright holder.





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