The Growing Share of Uninsured Workers Employed by Large Firms

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Workforce Issues; Insurance


A generally unreported phenomenon in recent years is the increasing number of U.S. workers in large firms who lack health insurance. Although large employers are much more likely than small ones to offer health coverage, recent evidence suggests that large-firm workers and their dependents comprise a significant and growing share of the working uninsured.

A combination of factors seems to be responsible for falling health coverage rates within large firms: the decline in manufacturing jobs and unionization rates, restrictions placed on benefit eligibility and higher employee premium contributions, as well as service industry trends and the changing structure of large corporations. Because it is likely to persist, this trend has important implications for policies designed to reduce the number of uninsured Americans.

This report profiles uninsured workers in large firms, compares their characteristics with other groups of uninsured, and assesses health coverage trends in small, mid-sized, and large firms. It also analyzes labor market changes that could affect this pattern.


Funder: Commonwealth Fund.

Open Access