One thing was true for most employees in previous generations – although their job may not always have paid well, it did pay every two weeks.
Far more Americans today work as contractors, freelancers and gig or temporary workers, or are self-employed, run small businesses or have multiple part-time jobs. Along with making their income more volatile, they often lack access to employer-sponsored health insurance. As a result, these workers are more likely to rely on Medicaid or health plans purchased on the Affordable Care Act Marketplaces.
“Low and middle-income workers rely on those other forms of coverage, because they can’t rely on access to employer coverage as companies outsource certain functions to contractors or hire more employees in roles that aren’t eligible for benefits,” said Dr. Sumit Agarwal, an assistant professor at the University of Michigan Medical School and School of Public Health. “They are the ones who will be hurt the most from changes in health policy that reduce access to the programs, such as Medicaid expansion and the ACA Marketplace, which were intended to fill in the gaps in the employer-first insurance system. Millions of people are in those gaps.”
Agarwal is the author of a new report published in JAMA Network Open that looks at the changing nature of the workplace in light of pending changes to Medicaid and ACA Marketplace coverage in 2027. More than 40 states will require millions of Medicaid enrollees to document that they are working at least at least 80 hours each month or meet other requirements to retain coverage.
Workers with volatile work arrangements will be especially susceptible to Medicaid disenrollment because of fluctuating hours and employment, even though they worked 33 to 35 hours per week, on average. Changes in Marketplace eligibility based on immigration status will follow the expiration of enhanced premium subsidies for 2026 plans.
The specific requirements and systems for reporting or automatically tracking work or other activities, or granting exemptions based on health or other factors, will vary by state.
Agarwal said he has patients covered by Michigan’s Medicaid expansion program who already are worried that their irregular work patterns will make it hard for them to meet the work requirements when they go into effect next year.
“Some of my patients are already anticipating that they will lose their coverage,” he said. “These are people who are working.”