The Business of Health Care

Changes In Work Hours and Employer Insurance Not Borne Out

Today, two AHRQ-sponsored studies were released that conclude that the Affordable Care Act (ACA) has not reduced the availability of full-time work or the work incentive for low-wage workers.

In the first study, researchers examined the effects of the requirement in the ACA for employers to provide health coverage to employees working at least 30 hours a week or pay a penalty. Using data from the Census Bureau’s Current Population Survey, an interview of approximately 60,000 households monthly, researchers did not find increases in the frequency of working either 25-29 hours weekly or fewer than 25 hours weekly in 2013, 2014 or the first half of 2015. Researchers also did not find a reduction in 2014 or 2015 in the frequency of working 30-34 hours, further demonstrating that employers have not reduced employee work hours below the 30-hour threshold to avoid the requirement to provide coverage.

In the second study, researchers assessed the impact of the expansion of Medicaid coverage on low-wage workers by analyzing job loss, job switching, and full- versus part-time status. Based also on data from the Census Bureau’s Current Population Survey, researchers compared states that had not expanded the program to states that have done so. The researchers found no statistically significant changes in labor market behavior as a result of Medicaid expansion, contrary to claims that the law would substantially reduce labor supply.

Since the ACA and its provisions have been put in place, roughly 17.6 million Americans have obtained health coverage. With this increase, the country has now reached the lowest levels of uninsured on record. In addition, not only are there fewer people without insurance, but everyone is benefiting from new protections, like preventive health care services at no cost and no lifetime limits.

And, further, as these studies make clear, dire predictions about what would happen to people working part time and how employers might respond have proven to be unfounded. As these papers underscore, the ACA is working.


3 replies »

  1. “As these papers underscore, the ACA is working.”

    That’s funny, many of the patients I see in my Occ Med practice are middle to lower income factory workers. Many still don’t have insurance because they can’t afford it. Some are fortunate enough to have it provided through work, but not that many. There are also quite a few on Medicaid.
    Then, when I talk to friends and colleagues who are higher wage earners, most have insurance but the rates and costs for medical care have increased significantly.
    By the way, you can’t say that people are getting preventive care at no cost. It’s being taken out in premiums if not being paid out by the patient. Do you think providers are dong things for free? Do you think insurance companies are that benevolent?
    17.6 million have insurance. Are these all new? Does this include marketplace and Medicaid? Are these estimates of those signed up only or those that are still paying premiums? Are these people all getting or able to afford the care they need?

  2. There’s no question the ACA has expanded the insurance pool, and some of the dire predictions from conservatives about destruction of the US economy proved to be false. Yippee. The bigger question, though, is at what cost? I was/am a supporter of pooling risk among the uninsured, mandatory payments to make it work…but it has to be within a cost framework that makes sense. Maybe the ship will right itself but…the ACA has been almost singlehandedly responsible for bending up the health care cost curve (, and the revenue in the form of various taxes (Cadillac tax, health insurance company tax, medical device company tax, reducing overpayment to medicare advantage plans – that was supposed to help fund the ~1 trillion dollar over 10 year cost of the ACA have (as of now) vanished. (

    So we have covered more people and there are fewer uninsured hospital stays, etc. by spending a lot of money. Great. Who is going to pay for all this?

  3. The ACA is an abysmal failure and all those associated with the ACA should be ashamed. The ACA’s reduction in the uninsured relies mostly upon Medicaid and high subsidies, but didn’t do much good for most of the middle class that now pay more. Even some in the lower income groups can applaud the ACA for making them lose otherwise good insurance only to find themselves on Medicaid.