Your job decides whether you have health insurance

Being uninsured is associated with **poorer health, difficulty getting
preventive services, and difficulty obtaining care — especially for chronic
disease.** Ask which Americans are uninsured and the usual answers are about
income or state. This asks about the job.

**More than a quarter of workers in four occupational groups had no health
insurance.** The spread from 2.7% to 37.0% is nearly fourteenfold (p<0.001).

The overall number improved, and the gap did not close

Between 2013 and 2014, **the uninsured rate among all workers fell from 16.0%
to 12.7% — a 21% decline — and declines occurred in every demographic group.**

The occupational range in 2013 was 3.6% (architecture and engineering) to
37.9% (farming, fishing and forestry). In 2014 it was 2.7% to 37.0%.

Both ends moved a little; the distance between them barely changed. Whatever
lowered the national figure did not reach the occupations at the bottom.

What the four highest have in common

Cleaning, food service, farming and construction: **manual, often seasonal or
casual, frequently employed through small businesses or contractors**, and —
this is the part that makes it a health issue rather than only an economic one
— physically hazardous. The jobs most likely to injure someone are among
the least likely to insure them.

What the numbers are

Behavioral Risk Factor Surveillance System, 2013 and 2014, in the **17
states** that asked every respondent about coverage and asked the employed
about industry and occupation — occupation only became available as an optional
module in 2013.

Coverage means any of **health insurance, prepaid plans such as HMOs,
government plans such as Medicare, or the Indian Health Service.**

Two exclusions shape the result: people aged 65 and over are left out
because they are presumed Medicare-eligible, and active military duty is
excluded. And one piece of context for the 2013→2014 fall: **12 of the 17
states expanded Medicaid eligibility in 2014** to people at or below 138% of
the federal poverty level; five did not.

**Identifying the factors behind these differences might help target
interventions** — which is the report's way of saying that a difference this
large, between jobs in the same economy, is not explained yet.

Source: Centers for Disease Control and Prevention, MMWR.