Part-time workers saw substantial coverage gains from the ACA

Part-time workers saw their uninsured rates decline twice as much as full-time workers did following the implementation of the Affordable Care Act (ACA).

Enrollment in Medicaid or Marketplace insurance plans drove a decrease of around 12 percentage points in uninsured rates among part-time employees between 2013 and 2015, according to a study published in the October issue of Health Affairs. For full-time employees during the same period, uninsured rates declined just six percentage points.

The ACA’s focus on improving insurance coverage for lower-income individuals suggested that the legislation’s implementation would provide a net benefit for part-time workers, according to study co-author Terceira Berdahl, a social science analyst in the Division of Research and Modeling Center for Financing, Access, and Cost Trends at the Agency for Healthcare Research and Quality (AHRQ).

“We just weren’t sure how it would impact the overall gap between full-time and part-time workers," Berdahl told FierceHealthcare. "[It's] really important to study because we don’t really expect those things to be getting better over time, and in fact, they kind of did after the ACA.”

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While the ACA narrowed the gap, the study found that full-time employees are still roughly twice as likely to have insurance as part-time workers.

"[The ACA] targets people without employer-sponsored insurance offers, and it’s very well known that part-time workers are less likely to get such offers,” said co-author Asako Moriya, an economist in the Division of Research and Modeling Center for Financing, Access and Cost Trends at AHRQ.

Part-time workers in Medicaid expansion states also appeared to take advantage of the program's new coverage opportunities. The study found that the majority of care gains among part-time employees came from Marketplace plans in states that did not opt to expand the Medicaid program.

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In Medicaid expansion states, there was a marked decrease in the number of part-time employees taking employer-sponsored insurance where it was offered. That change suggests insurers did not move to limit part-time employees’ eligibility for coverage but rather that part-time employees opted for Medicaid coverage instead.

Seeing the magnitude of the impact on part-time workers can form the basis of future policymaking, says Berdahl. She pointed out that the ACA implementation has provided a huge amount of data for researchers to slice and dice to tease out trends and identify effective interventions.

For example, the study points to the controversial employer mandate, implemented outside the study period, as a logical place to see what effect, if any, it may have had on the trends identified in the current study.

“We’re certainly planning on continuing our work in this area, because we do think that work hours was one of these dimensions of work and employment status that hadn’t had as much attention, even though it seems sort of obvious,” she said.