Volatile Employment and Health Insurance Gaps Among Low- and Middle-Income Workers

JAMA Network

Many low-income individuals work in unstable or volatile jobs; in 2023, half of low-income households reported unpredictably fluctuating earnings. Research has shown certain workers (eg, part-time, blue-collar, temporary) have lower employer-sponsored insurance (ESI) offer and coverage rates. These studies extend only to 2017, and less evidence exists on the association between volatile employment, based on longitudinal work hours or earnings, and health coverage. New evidence could help inform expectations of the 2025 budget reconciliation bill (House Resolution 1) that will condition Medicaid eligibility on documented work hours and the December 2025 expiration of enhanced Advanced Premium Tax Credits (APTCs) which reduced Patient Protection and Affordable Care Act (ACA) marketplace affordability.Using nationally representative data, we assessed ESI offers and insurance coverage among low- and middle-income workers with volatile employment.