Lack of Health Care for the Working Class - Research Paper Example

However, despite dramatic increases in expenditures, inequities exist within the Medicaid system that limit distribution of health care resources and affect health outcomes. Employer-sponsored, private health insurance coverage has declined gradually since the late 1970s (Jacobson and Buchmueller, 2007). In 2010, the number of uninsured Americans approached 49.9 million (U.S. Census Bureau, 2010a). Two major trends are driving the decline: First, changes in the labor market, including the decline in manufacturing jobs, the increase in service-jobs, and the growth in temporary and part-time employment have produced more "benefit-poor" occupations.

Second, declining real wages, combined with employer moves to shift rising health care costs onto employees via increased premiums, deductibles and copayments, has reduced the numbers of employees who can afford health care coverage and the extent of that coverage (Swartz, 2009). Working class and women are especially vulnerable to lack of access to employer-sponsored coverage, given the structure of private health care insurance. In the United States, individuals generally qualify for employer-sponsored health insurance plans in one of two ways; as workers in occupations where health insurance benefits are offered to employees, or as dependents or spouses of covered workers (Kim & Muntaner, 2011; Buchmeuller and Valletta 1999).

Direct coverage, as workers, is now and has been limited for working class and women due to their historic and continuing concentration in the secondary sector of the labor market. That is, lower working class and women are more likely than others to be employed in the kinds of occupations that are becoming more prevalent and that are less likely to offer coverage; i.e. service jobs, non-unionized jobs, and part-time and temporary work. Indirect, or spousal coverage, though limited to women legally wed to men whose employers offer the benefit, provides