1. Health Insurance Coverage Among US Worker Groups: The National Health Interview Survey ABSTRACT Arheart KL, McCollister KE, Lee DJ, Chung-Bridges K, Fleming LE, Christ SL, Caban Martinez A, LeBlanc WB, MJ Erard, JP West, Pitman T Sylvester Comprehensive Cancer, Department of Epidemiology and Public Health, Department of Family Medicine, Department of Political Science, University of Miami Miller School of Medicine, Miami, Florida; University of North Carolina at Chapel Hill, Dept of Sociology, Chapel Hill, NC; University of Texas at Austin, Cain Center for Nursing Research Funding provided in part by NIOSH Grant number R01 0H03915; Worker Photographs by Dr David Parker Study Website: http://www.rsmas.miami.edu/groups/niehs/niosh/index.htm OBJECTIVES Research indicates that declining health insurance coverage in the United States may be more prevalent in certain occupations, particularly among low-wage workers. In the present study, we determined the proportion of US workers with health insurance by occupation category. METHODS Data from the 1997-2004 National Health Interview Survey (NHIS) on >153,000 worker participants was used to estimate the prevalence and standard error of health insurance computed for each year for all workers, and for 13 and 41 occupational subcategories. Data analysis was performed with adjustments for sample weights. RESULTS Annual occupation-specific prevalence of health insurance ranged from 54.4%-94.4%, with blue-collar workers less likely to be insured. Most occupations showed downward trends in insurance, with uninsured US workers increasing by >406,000/yr. CONCLUSION This nationally representative sample of all U.S. workers dramatically illustrates the recent rapid decrease in worker health insurance coverage. Given the growing gap between blue- and white-collar workers, health insurance access should be considered a major worker health disparity indicator. INTRODUCTION METHODS From 1998 to 2003, the proportion of U.S. workers offered health insurance through their employer remained stable, though premiums (inflation-adjusted) increased 42%. Employment-related circumstances (e.g., changed/lost job, self-employed, no access to employer-offered health insurance) and high costs of insurance are the two factors Americans most often cite when they are asked why they lack health insurance. Research indicates that declining insurance coverage may be more prevalent in certain occupations, particularly among low-wage workers. We investigated health insurance coverage in the U.S. worker population to determine if declining coverage varied according to occupation. National Health Interview Survey (NHIS) data for 1997-2004 Employed respondents age 18-65 years reported their occupation for the week prior to interview and whether anyone in the family had health insurance over the previous 12 months. The prevalence of health insurance was computed for each year for all workers, and for 13 and 41 occupational subcategories. SUDAAN was used to apply appropriate weights and adjustments for the complex sampling scheme. SAS used to compute a regression of health insurance prevalence on year weighted by the inverse of the standard error of the prevalence. RESULTS CONCLUSION The mean annual sample size was 19,135, representing an annual average of 107,077,190 of U.S. workers from 1997-2004. The mean annual medical insurance prevalence among all U.S. workers was 84.8% (range 54.4%-94.4%), leaving approximately 16,318,564 workers uninsured annually. Among 13 occupations, Private household workers had the lowest prevalence of insurance (54.4%); among 41 occupations, Construction laborers (52.1%), Private household workers (54.4%), and Farm workers and other agricultural workers (56.9%) were the lowest. In trends over the 1997-2004 period for all U.S. workers, the significant negative slope of –0.38 indicated that the number of uninsured U.S. workers had increased by 406,893/yr. This nationally representative sample of all U.S. workers dramatically illustrates the recent rapid decrease in worker health insurance coverage. Loss of health insurance has serious implications not only for workers, but also for their families. The present analysis indicates that employment type has a profound influence on whether workers and their families were covered and the rate at which workers become uninsured. The implication is that health policy should target specific occupations to reduce health disparities.