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What we can learn from health insurance coverage in the construction industry

April 3, 2020

Topics: Quote of the Day

By Samantha Brown, M.P.H., Raina D. Brooks, M.P.H., and Xiuwen Sue Dong, Dr.P.H.
The Center for Construction Research and Training, Data Bulletin, April 2020

This Data Bulletin examines the latest trends in health insurance coverage among construction workers, using data from the Annual Social and Economic Supplement (ASEC) of the Current Population Survey (CPS), a nationally representative survey administered by the U.S. Census Bureau to American households each March. The ASEC collects health insurance information on the prior calendar year, as well as current coverage at the time of the interview.

Key Findings

  • Nearly 24% of construction workers did not have any health insurance in 2018, more than double the uninsured rate among all U.S. workers (11%).
  • Nearly half (48%) of Hispanic construction workers were uninsured, more than triple that of their white, non-Hispanic counterparts (13%).
  • Less than 30% of Hispanic construction workers had employment-based insurance coverage in 2018.
  • In 2018, 28% of construction workers in small establishments had employment-based insurance, 60% less than their counterparts in large establishments (69%).
  • Unionized construction workers were nearly 50% more likely than their non-unionized counterparts to have employment-based coverage (71% vs 47%), and twice as likely to have their premiums fully paid by their employer (47% vs 22%).

Many construction workers continue to lack basic insurance coverage. This is particularly concerning given that serious occupational health hazards are common at construction worksites. Hispanic construction workers experienced the lowest rates of health insurance coverage, and the gap in insurance coverage between Hispanic and non-Hispanic white workers enlarged in recent years. Workers in small establishments and certain occupations were also less likely to be insured. In contrast, unionization greatly increased coverage and improved the quality of insurance plans. It is essential to expand insurance coverage among construction workers to better their overall health.



By Don McCanne, M.D.

Many in the policy and political communities, reinforced by the corporate media, keep telling us that we do not want single payer Medicare for All (guaranteed coverage for life) because that would cause us to lose our choice of private plans, especially employer-sponsored plans that supposedly are working so well for us. Well, let’s see how well employer-based insurance really is meeting the health care needs of our construction workforce.

  • One-fourth of construction workers have no health insurance
  • Half of Hispanic construction workers are uninsured
  • Only one-fourth of construction workers in small establishments had employment-based insurance
  • Over one-fourth of unionized construction workers did not have employment-based coverage, and over one-half of non-union workers did not either (some, but not enough, had other private insurance)

Although these are recent numbers, they do not include the impact of policies put in place during the Covid-19 pandemic. This past month unemployment skyrocketed, and with that the risk of losing employer-sponsored coverage greatly increased. COBRA? How many who lost their jobs can afford the high premiums? Union insurance? It’s difficult to extend union-negotiated insurance if you didn’t have it in the first place. ACA plans? During closed enrollment? Medicaid? Negotiating hoops with built-in barriers.

When they tell us that we don’t want single payer Medicare for All, this is the system they are trying to protect? They aren’t listening. It’s time to end the niceties; it’s time for us to respond with delicately phrased belligerence (to communicate more effectively, but not to engage in nonproductive hostilities). They have to hear us. Perhaps the construction workers could help us with our rhetoric.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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