How Have Workers Fared Under the ACA?

A supermarket employee refills produce.

The Affordable Care Act had no adverse impact on employer health coverage. Concerns about lower hours worked and lower wages earned did not materialize.


The Issue

Concerns regarding negative effects on employment and employer-sponsored insurance (ESI) did not come to fruition according to an Urban Institute analysis of federal data from the American Community Survey. In fact, between 2010 and 2016, employment increased, as did health insurance coverage offered to these workers. (The term “worker” refers to people who are currently employed and excludes those who are not currently employed but are seeking employment.) Specifically, workers in historically low-insurance rate jobs experienced an increase—e.g., restaurant and retail workers. The findings indicate that coverage gains were well-targeted to workers and their dependents who most needed the assistance.

Key Findings

  • Overall, employment increased by 8.2 percent as coverage rose by 9.6 percent.

  • Among employees earning less than $15 per hour (jobs in food preparation and service; farming, forestry, and fisheries; building and grounds maintenance; personal care; health care support; and transportation and material moving), ESI coverage increased by 6.8 percent, alongside non-ESI coverage that increased by 71.1 percent (e.g., Medicaid, marketplace coverage).


The ACA increased coverage substantially for workers, without creating an appreciable negative impact on ESI or employment.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.

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Health Reform: By The Numbers

Timely data and analysis on key issues related to Affordable Care Act (ACA) coverage expansion and ACA implementation and impact.

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