26. Health Insurance Coverage in Construction and Other Industries
In 2015, 89.9% of wage-and-salary workers in the United States had health insurance coverage, up from 83% in 2010 (chart 26a). This is likely due to Medicaid expansion, insurance marketplaces, changes to private insurance, and other provisions that were enacted after the Affordable Care Act (ACA) was signed into law in 2010.1 More than half (54.8%) of wage earners were covered by health insurance through their own employment and another 35.0% obtained health insurance from other sources such as a family member’s employer, by direct purchase, or through public sources. Industries with higher proportions of seasonal and cyclical employment, such as construction, generally provide less access to insurance. In 2015, 78.3% of wage earners in construction had health insurance, a lower proportion than any other industry except agriculture. Just 49.1% of construction wage-and-salary workers had health insurance provided by their employer or union, 22.2% purchased health insurance themselves or received it through a family member’s employer, and another 7.1% were insured by a public source. Among self-employed construction workers, 74% were covered by some type of health insurance in 2015, including a personal plan, a family member’s plan, or from other sources such as public coverage.2
Both the number and rate of health insurance coverage in construction have fluctuated over time (chart 26b). The proportion of uninsured among construction workers peaked at 36% in 2005, and then declined until 2008, indicating construction workers who lacked health insurance were more likely to lose their job during the housing market collapse.3 Following the overall trends after the ACA, the rate of uninsured in construction has precipitously dropped to 22% in 2015; a record low over the last two decades. .
In 2015, only a third (33.7%) of Hispanic construction workers who were wage earners had health insurance through their employment, while the percentage was 56.3% among their white, non-Hispanic counterparts (chart 26c). Although women are less likely than men to have health insurance through their own employment,4 women construction workers were more likely to have employer-provided insurance in general (including through their spouse’s employer) than male construction workers in 2015 (53.8% versus 48.6%, respectively).2
Unionization greatly improves the likelihood of receiving employment-based health insurance. Among production construction workers who were union members, 72.2% had health insurance through employment in 2015, compared to 38.3% among non-union workers (chart 26d). This is likely because contributions to cover health insurance in the union sector are negotiated into construction collective bargaining agreements, and contractors typically pay into a multiemployer fund. Construction workers may change employers frequently, but unionized construction workers are able to retain coverage as they move from one employer and project to the next through these funds.
The likelihood of a company providing health insurance increases with size. In 2015, only 26.4% of construction workers in companies with fewer than 10 employees received employment-based health insurance, compared to more than 70% of their counterparts working in companies with 500 or more employees (chart 26e). In general, the construction industry is comprised mostly of small companies (see page 2).
Employment-based health insurance coverage varied by occupation, ranging from 26.7% for carpet and tile installers to 75.2% for ironworkers (chart 26f). This variation reflects differences in occupational composition, such as ethnicity, unionization rates, average firm size, and independent contracting practices.
The Patient Protection and Affordable Care Act (PPACA) signed into law by President Obama in 2010 can be credited with significant decreases in the uninsured rate among construction workers.5 However, disparities in health insurance coverage still exist in the construction industry.
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1. U.S. Department of Health & Human Services. 2016. 20 million people have gained health insurance coverage because of the Affordable Care Act, new estimates show. https://www.hhs.gov/about/news/2016/03/03/20-million-people-have-gained-health-insurance-coverage-because-affordable-care-act-new-estimates (Accessed January 2017).
2. All numbers cited on this page are from the U.S. Bureau of Labor Statistics, 2016 Current Population Survey, Annual Social and Economic Supplement (or March Supplement). Calculations by the CPWR Data Center. The survey asks respondents whether they were covered by a private health insurance plan in the last calendar year. If they said “yes,” they were then asked, “Was this health insurance plan in your own name?” and “Was this health insurance plan offered through your current or former employer or union?” Respondents are also asked about health insurance coverage from public sources, such as Medicare, Medicaid, CHAMPUS (Civilian Health and Medical Program of the Uniformed Services), TRICARE (for retired members of the military), and CHAMPVA (for dependents or survivors of military veterans).
3. CPWR – The Center for Construction Research and Training. 2009. Hispanic employment in construction. CPWR Data Brief, 1(1). https://www.cpwr.com/publications/vol-1-no-1-hispanic-employment-construction (Accessed January 2017).
4. Kaiser Family Foundation. 2016. Women’s health insurance coverage. http://kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage-fact-sheet/ (Accessed January 2017).
5. CPWR – The Center for Construction Research and Training. 2015. Impact of the Affordable Care Act on health insurance coverage and healthcare utilization among construction workers. Quarterly Data Report: Fourth Quarter. https://www.cpwr.com/wp-content/uploads/publications/4th%20Quarter%20QDR.pdf (Accessed January 2017).
Charts 26a-26c, 26e, and 26f – Cover wage-and-salary workers only.
Chart 26d – Covers production workers only. Self-employed workers are excluded from the estimates.
Chart 26f – Sample sizes > 30, except ironworkers (n = 20).
Charts 26a, 26c-26f – U.S. Bureau of Labor Statistics. 2016 Current Population Survey, Annual Social and Economic Supplement (or March Supplement). Calculations by the CPWR Data Center.
Charts 26b – U.S. Bureau of Labor Statistics. 2000-2016 Current Population Survey, Annual Social and Economic Supplement (or March Supplement). Calculations by the CPWR Data Center.