56. Impact of Health Insurance on Healthcare and Medical Expenditures among Construction Workers

Healthcare services are necessary for managing and preventing disease, disability, and premature death.¹ Unfortunately, many construction workers fail to receive the care they need because they lack health insurance coverage from any source (see page 26).

Health insurance coverage has a particularly large impact on use of healthcare.² In 2015, about 55% of uninsured (see page 26) construction workers did not have a usual source of care when sick, compared to 12% among their counterparts with health insurance (chart 56a). About 60% of Hispanic workers that had no health insurance lacked a usual source of care when sick, while the percentage reduced to less than 15% among Hispanic workers that had insurance. A similar pattern was found among white, non-Hispanic workers.

Lack of health insurance significantly increases the likelihood of using emergency room services. On average over a three-year period, over 9% of uninsured construction workers usually visited the hospital emergency room for healthcare when sick, compared to less than 1% of their insured counterparts (chart 56b). Although ethnic disparities remain, the gap in healthcare access and utilization is narrower among insured workers. These findings are consistent with research on the impact of the Affordable Care Act.^3-6

Having health insurance also affects frequency of care. Construction workers without health insurance have fewer visits to healthcare providers. In 2015, 58% of uninsured Hispanic construction workers had not seen a doctor or health professional in more than 12 months, compared to just 24% of insured Hispanics and 17% of insured white, non-Hispanics (chart 56c). As a result, close to half (45%) of uninsured Hispanic workers did not receive any preventive care, such as a regular physical exam or check-up, flu shot etc., within the past year, compared to only 13% of insured Hispanic workers (chart 56d).

Health insurance status plays an important role in the payments made to healthcare providers and institutions, also known as medical expenditures (see Glossary). Among uninsured construction workers, the average medical expenditures for both Hispanics and white, non-Hispanics were much lower than those of their insured counterparts. Insured Hispanics had more than five times, and white, non-Hispanics more than four times the medical expenditures of their uninsured counterparts (chart 56e).

In addition to ethnicity and insurance coverage, medical expenditures are also affected by age. Medical expenditures among insured workers increased steadily with age and soared after age 65 (chart 56f). Older workers are more likely to have medical conditions (see page 54), which can significantly increase overall medical costs in a worker’s later years.⁷ Another explanation could be that uninsured older workers may delay health services until they are eligible for Medicare.⁸ Given that retirement is a time when many workers experience a loss of employment-based health insurance, workers retiring or losing jobs prior to age 65 are at a higher risk for lack of healthcare access.

The data used for this page were obtained from the National Health Interview Survey (NHIS) and the Medical Expenditure Panel Survey (MEPS). The NHIS provides more detailed information on health behaviors, while the MEPS data cover healthcare use, expenditures, and sources of payment.

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