Health Insurance Disparities in Traditional and Contingent/Alternative Employment
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Health Insurance Disparities in Traditional and Contingent/Alternative Employment SHELLEY I. WHITE-MEANS∗
[email protected]
College of Pharmacy, University of Tennessee, Memphis, Memphis TN 38163
JONI HERSCH
[email protected]
Harvard Law School, Harvard University, Cambridge MA 02138
Relative to whites, Hispanics and blacks are less likely to have employer health insurance coverage. We examine whether ethnicity or race affects employment in traditional jobs or in contingent and alternative work arrangements, and whether ethnicity or race affects insurance offer, eligibility, and/or enrollment, conditional on employment sector. Health insurance disparities relative to whites are more pronounced for Hispanics, primarily due to disparities in employment by firms that offer coverage. Eliminating racial/ethnic disparities in offers, eligibility, and takeup would increase insurance coverage rates of Hispanics in traditional jobs and of both Hispanics and blacks in contingent and alternative jobs. Keywords: uninsured, disparities, nontraditional employment, contingent workers, alternative work arrangements JEL classification: I10, J32, J70
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Introduction
Ethnic and racial differences in life expectancy and health status are pervasive and stark. As of 2000, the life expectancy of white males is 6.6 years longer than that of black males, and the life expectancy of white females is 4.9 years longer than that of black females.1 While heart disease is the leading cause of death, rates of death from heart disease are about 30 percent higher among blacks compared to whites (U.S. Department of Health and Human Services, 2002). Similarly, disparities in the prevalence of diabetes are astounding, with prevalence rates 70 percent higher than whites for blacks and almost 100 percent higher for Hispanics (U.S. Department of Health and Human Services, 2002). Health researchers have been increasingly concerned about identifying the underlying causes of such disparities in health status by ethnicity and race. One key factor, health ∗ Correspondence Author: Professor and Chair of Health Science, Administration, Department of Pharmaceutical Sciences, University of Tennessee, College of Pharmacy, 847 Monroe Ave., Suite 205N, Memphis, TN 38163, Tel.: 901-448-7666, Fax: 901-448-3446.
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insurance status, influences health care access and eventually health status (Levy and Meltzer, 2004; Zuvekas and Taliaferro, 2003; Institute of Medicine, 2002a). Estimates indicate that one-fourth to one-half of racial differences in health care utilization is explained by racial differences in income and insurance (Weinick, Zuvekas and Cohen, 2000) and utilization in part explains reported racial disparities in health (Institute of Medicine, 2002b). Levy and Meltzer (2004) also note that the magnitude of the influence of health insurance on health varies across population groups, with economically vulnerable populations experiencing relatively greater health improvements from health insurance coverage. Most of those
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