Declining Health Insurance in Low-Income Working Families and Small Businesses

A report funded by the Robert Wood Johnson Foundation, as part of its "Affordable Care Act (ACA) Implementation-Monitoring and Tracking Series," examines the trends in employer-sponsored insurance (ESI) for low-income working families and small businesses over the last decade.

Authored by researchers at the Urban Institute, the report finds that declines in ESI have been greater for low-income than high-income families, and greater for small firms than large ones. Additionally, low-income people working in large firms experienced large declines in ESI, whereas high-income people in large firms experienced relatively small declines. The authors note that these trends are important because the rate of ESI is closely tied to the rate of uninsurance.

As the ACA works to address the coverage problems of both low-income families and small businesses, the authors conclude that the employer and income-focused provisions of the ACA are well-targeted, and that monitoring health coverage changes for low-income individuals and small business will continue to be important moving forward.

This report is one in a series of briefs examining coverage trends among different groups targeted by ACA coverage expansions.