Health insurance coverage and self‐employment

BACKGROUND: Self‐employed workers are 10% of the US labor force, with growth projected over the next decade. Whether existing policy mechanisms are sufficient to ensure health insurance coverage for self‐employed workers, who do not have access to employer‐sponsored coverage, is unclear. OBJECTIVE: To determine whether self‐employment is associated with lack of health insurance coverage. DATA SOURCES: Secondary analysis of Medical Expenditure Panel Survey (MEPS) data collected 2014‐2017. STUDY DESIGN: Participants were working age (18‐64 years), employed, civilian noninstitutionalized US adults with two years of Medical Expenditure Panel Survey (MEPS) participation in 2014‐2017. We compared those who were employees vs those who were self‐employed. Key outcomes were self‐report of health insurance coverage, and of delaying needed medical care. DATA EXTRACTION METHODS: Longitudinal design among individuals who were employees during study year 1, comparing health insurance coverage among those who did vs did not transition to self‐employment in year 2. PRINCIPAL FINDINGS: 16 335 individuals, representing 121 473 345 working‐age adults, met inclusion criteria; of these, 147, representing 1 097 582 individuals, transitioned to self‐employment. In unadjusted analyses, 25.7% of those who became self‐employed were uninsured in year 2, vs 8.1% of those who remained employees (P