加州低薪工人基于工作的医疗保险不平等

Inequities in job-based health coveragefor California low-wage workers By Alexis Manzanilla, Savannah Hunter, and Miranda Dietz Most Californians under age 65 receive health coverage through their or afamily member’s employer. Workers earning low wages, however, are farless likely to have job-based coverage, and more likely to be on Medi-Cal oruninsured. This creates a real public cost: California spends tens of billionsin state and federal dollars covering low-wage workers through Medi-Cal. Inthe face offederal Medicaid cutsin H.R. 1, California must revisit the questionof who bears responsibility for the health coverage of low-wage workers in a The job-based health coverage systems leaves gapsfor low-wage workers For decades, the health insurance system in California, as throughout thenation, has been dominated by job-based coverage. Health insurance throughan individual’s job or through the job of a family member is themain coveragesource for California adults 65 and below. Among California’s non-self-employed workers age 16 and older, there is a notable difference in rates ofjob-based coverage between those paidlow wages(less than about $20 anhour in 2022) and non-low-wage workers. As seen in Figure 1, in 2022 69% of There are three main reasons that workers might not have job-based coverage throughtheir own job: their employers do not offer it, they are ineligible, or the associated costs(premiums, copayments, deductibles, etc.) are unaffordable. While the Affordable CareAct(ACA) requires employers with 50 or more full-time employees to offer job-basedhealth coverageto their full-time employees or pay a penalty, smaller employers are notrequired to do so. As a result, many smaller businesses (65% of California private-sector Even when workers are offered health insurance, it may be unaffordable. In 2025, theaverage annual worker premium contribution in Californiawas $1,300 for single coverage, and $7,300 for family coverage. At most firms, the premium contribution is the same forall workers, regardless of their wages: the CEO and the administrative assistant pay thesame amount. Nationally only 14% of large firms (those with 200 or more employees)reported offering areduced premium contribution for lower-wage employees. The costof health insurance premiums can be prohibitive for workers paid low wages: for instance, job-based coverage, not including alikely deductibleand other out-of-pocket expenses.A single person at the poverty line would need to pay about 8% of their income for the average single premium contribution, and up to 19% of their income if they hit theaverage full deductible. Affordability is a growing concern, aspremiums have increasedsubstantially over time: Over the past two decades, family health care premiums for Latino and non-citizen workers have especially low ratesof job-based coverage Among California’s workers, rates of health coverage through one’s own job vary notjust by wages but also by race and immigration status. Figure 2 shows that workers whoidentify as Latino and those who are not citizens (including but not limited to those Structural factors drive these disparities. Latino and non-citizen workers aredisproportionately concentrated in low-wage occupations and in smaller firms that are Disparities in job-based coverage for low-wage workershave a real public cost Employers’ limited offers of affordable job-based coverage for low-wage workers resultinsignificantMedi-Calcosts for the state and federal government and therefore thepublic. Approximately 3.6 million California workers—excluding those who are self-employed—receive health benefits through Medi-Cal. Using projected per-enrollee costsfrom the California Department of Health Care Services, the state will spend 36 billion in Asanalyses across a range of industrieshas shown,low-wage, low-road businessstrategies come with real public costs. Policies to raise wages and labor standards,whether inhealth care,fast foodor inthe workforce generallyis one way to reduce thesepublic costs, including Medicaid related costs. Some states are monitoring and attempting to address thepublic cost of gaps in job-based coverage California is not the only state facing significant public costs due to gaps in job-based healthcoverage, and several states have implemented or are considering implementing laws to One approach is to collect data and monitor the problem. For a number of years,New Jersey,Nevada, andWashingtonhave produced publicly available annual reports on which firms employ people who are enrolled in Medicaid, the number of employees’ dependents onMedicaid, and the estimated cost to the state. In the wake of federal Medicaid funding cuts, some states have considered employer feesbased on Medicaid enrollment. In March 2026, New Jersey Governor Mikie Sherrill unveiled astate budget plan that includeda proposal to fine large employerswith workers on Medicaid,charging fees of up to $725 annually for every perso