CounterPunch Exclusives

CounterPunch Exclusives

Precarious Work, Precarious Care: Income Instability and Interruptions in Health Care Access

Photograph by Nathaniel St. Clair

Access to health care is one of the key indicators of workers’ well-being, but monthly volatile income may undermine the continuity and affordability of care access. With the rise of precarious employment over the past few decades, it is not uncommon for employers to be reluctant to offer health insurance or other benefits. Further, workers bear the risk of losing jobs or experiencing hour variability, both of which are likely to intertwine with intermittent health insurance coverage.

Changes to the Medicaid eligibility rules under the One Big Beautiful Bill Act will exacerbate health care challenges for workers, especially those with irregular employment patterns and unpredictable income fluctuations. Previous research focusing on Canadian men aged 30 to 55 indicates that workers with less volatility in annual income have better self-rated health. Analyses of US samples with more frequent panel data show that increased monthly volatility is also associated with poorer self-rated health. Affordability and continuity of medical care may be key mechanisms linking income instability to health outcomes.

Using nationally representative monthly panel data, this article documents whether a worker’s earnings instability within a year links to their health insurance coverage gap during the year, net of other socio-economic characteristics. The sample includes........

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