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Employment Status of Medical Assistance Clients

Substitute House Bill 1486 (Per Governor's Veto) 59th Legislature, 2005 Regular Session

Introduction

Nationally, a growing number of employers faced with growing employee health care premium costs either have chosen to drop health care benefits for their employees or to pass on to their employees a greater share of coverage costs. As a consequence, more employees and their dependents either go without health insurance, apply for state purchased health care programs supported with public funds, or seek uncompensated care at hospitals and community clinics.

In response to these trends, the 2005 State Legislature enacted SHB 1486. This legislation directed the Department of Social and Health Services (DSHS) and the Health Care Authority (HCA) in coordination the Employment Security Department (ESD) to report on the employment status of Medical Assistance clients and Basic Health Program (BHP) enrollees. Due to funding limitations and privacy and state public disclosure restrictions non the release of employer-specific information, Governor Gregoire directed the agencies to submit a report that would include information on:

• The number of Medical Assistance and BHP employees by industry type and size;
• The employee size of the employer by industry type; and,
• The number of hours worked by employees with Medical Assistance and BHP medical coverage.

The following public report provides aggregate data within the constraints of confidentially laws.

Findings

OVERALL EMPLOYMENT LEVELS
1. In the average quarter in calendar year 2004, there were 107,643 persons (28 percent of all DSHS medical clients aged 16-64) with DSHS medical coverage and ESD-reported earnings in the quarter (see Table 1A “All Firms”). The number of employed DSHS medical assistance clients ranged from a low of 96,075 clients in 2004Q1 to a peak of 115,638 clients in 2004Q3.

2. Most employed DSHS Medical Assistance clients worked part time.

• The median hours worked among employed DSHS Medical Assistance clients was 17 hours per week (for their primary employer).
• On average, 57 percent of employees with DSHS coverage worked 20 hours per week or less for their primary employer in the quarter.
• Another 26 percent worked 21 to 34 hours per week for their primary employer, while only 17 percent worked 35 hours per week or more for
  their primary employer.

3. The vast majority of employed clients or parents of dependents with DSHS medical coverage had a single employer (per quarter with employment). In cases where the client had more than one employer in the quarter, the primary employer was defined to be the employer for whom the client worked the greatest number of hours in the quarter.

4. Adding employed (non-client) parents of dependents with DSHS medical coverage to the count of employed clients with DSHS medical coverage pushed employment counts significantly higher. In the average quarter in 2004, there were 232,481 employed clients or parents of dependents with DSHS medical coverage (see Table 2A “All Firms”). By “parents of dependents with DSHS medical coverage” we mean the head of household, spouse, or unmarried co-parent associated with a DSHS medical assistance client.

5. Employed (non-client) parents with dependents enrolled in DSHS medical coverage are more likely to be working full-time than employed DSHS clients with medical coverage. Fifty percent of employed parents of dependents with DSHS medical coverage worked 35 or more hours per week for their primary employer, compared to only 17 percent of employed clients with DSHS medical coverage.

EMPLOYMENT BY INDUSTRY AND FIRM SIZE
1. Clients with DSHS medical assistance were most frequently employed in the following industries:

• Accommodation and food services (21,960 employed clients per quarter)
• Retail trade (17,683 per quarter)
• Health and social assistance (15,408 per quarter)
• Administrative and waste services (11,898 per quarter)

2. Half of employed clients with DSHS medical coverage worked for firms with more than 100 employees; 17 percent of clients worked for firms with less than 10 employees.

3. Adding employed parents of dependents with DSHS medical assistance significantly increased the count of persons employed in the following industries:

• Health and social assistance (17,062 additional employed parents of dependents with DSHS coverage per quarter)
• Retail trade (14,819 per quarter)
• Manufacturing (14,293 per quarter)
• Agriculture (13,815 per quarter)
• Accommodation and food services (12,588 per quarter)
• Construction (9,323 per quarter)

4. There was significant variation in average hours worked by industry.

• Among employed clients or parents of dependents with DSHS medical coverage, median hours worked per week were lowest (less than 20 hours per week) in the educational services and administrative services industries.
• Hours per week were highest in manufacturing and wholesale trade (36.9 hours per week), among those industries employing a significant number of clients or parents of dependents with DSHS medical coverage.

5. We found significant variation by industry in the likelihood that an employed client or parent of a dependent with DSHS medical coverage was in a household with other insurance. For each employed client or parent, we identified whether any member of their household was covered through other insurance (such as employer-provided medical coverage) in the quarters in which they were employed. We did not have information on the specific source of the other insurance, and could not identify whether the employee’s primary employer was the source of the coverage. Nevertheless, this provides a rough estimate of the percentage of clients or parents who have health insurance for themselves and/or their dependents through their primary employer.

• A relatively high proportion of clients or parents of dependents with DSHS medical coverage employed in the public administration (21
  percent) or educational services (19 percent) industries were in households with other insurance.
• A relatively low proportion of clients or parents of dependents with DSHS medical coverage employed in the agricultural

Modified: Friday December 08 2006

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