A surprising number of working Americans can't get health insurance-even though they work for companies that offer health coverage-because their employers have policies such as waiting periods for new employees and exclusions for part-time employees. In addition, high employee contributions for health insurance often deter low-income workers from signing up for coverage even when they are eligible. The research, published in the July/August issue of Health Affairs provides new information about the effect of workplace eligibility policies on employees' health insurance coverage.
In "Embraceable You: How Employers Influence Health Plan Enrollment," Jon Gabel, Jeremy Pickreign, and Heidi Whitmore of the Health Research and Educational Trust (HRET), and Cathy Schoen of The Commonwealth Fund conclude that the most important ways for employers to improve coverage rates would be to eliminate or shorten waiting periods, include part-time workers or lower hours worked thresholds for eligibility, and reduce the cost to employees of participating in the plan.
"Looking beyond offer rates, employer eligibility policies play an important role in coverage," said Jon Gabel, vice president for health systems studies at HRET. "Nearly one of four employees working for firms that offer benefits is ineligible. Removing barriers to participation could significantly increase coverage rates for working families." Most new employees face a waiting time before they become eligible for their workplace health plan: only one of three (31%) has coverage that starts immediately. Among employers offering health plans, eleven percent of all employees face waiting times of four months or more. Those working for small or midsize and low-wage firms are most likely to experience such long waiting times.
Restrictions on part-time worker eligibility also restrict participation. Only two of five (41%) part-time workers are eligible to join a health plan that is available to their full-time co-workers. Firms with fewer than 1,000 workers are the least likely to cover part-time workers: about one of four part-timers in small (27%) and medium-size (25%) firms is eligible for health benefits, compared with over half (58%) of part-time workers in large firms.
The study finds that requiring large employee contributions for premiums discourages participation, particularly in low-wage firms. Take-up rates fall sharply as the employee premium shares increase; the drop-off is steepest among firms with concentrations of low-wage employees.
"Eligibility and premium policies help explain how it's possible for offer rates to increase while uninsured rates remain high among low and modest wage workers." said Cathy Schoen, executive director of The Commonwealth Fund Task Force on the Future of Health Insurance. "Waiting periods, weekly hour requirements, and temporary worker status all erect eligibility barriers. Basic affordability concerns then set in where employers require sizeable premium payments-all contributing to the high rates of uninsured among lower-wage working Americans."
