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Mothers’ Nonstandard Employment, Family Structure, and Children’s Health Insurance Coverage

Abstract

Using data from two longitudinal studies on mothers and children (NLSY79 and NLSY79 Children), this study first examined the relationship between mothers’ nonstandard employment and children’s health insurance coverage while adjusting for various compositional characteristics of mothers, children, and families. This study also evaluated whether this relationship differed across family structures. Results from multinomial logistic regression models showed that mothers’ nonstandard work was associated with a higher likelihood of children being uninsured or relying on public programs. In addition, in single-mother families, children’s uninsurance rate was highest if the mother held a nonstandard job, even compared to children of non-employed mothers. These study findings contribute to the literature on access to health insurance for children in the United States.

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Fig. 1

Notes

  1. 1.

    It is worth noting that most OECD countries provide universal health care to all of their citizens (Pearson et al. 2016). There would be some variability in terms of health care systems across countries; however, a person’s health insurance status is generally not tied to their employment status in these countries.

  2. 2.

    Children’s public insurance coverage mainly comes from Medicaid and Children’s Health Insurance Program (CHIP). The eligibility for Medicaid programs is largely determined by household income. Some states take into account other factors such as household size, family status (e.g., pregnancy or caring for young children). If the mother (or household)’s income is above the threshold for Medicaid eligibility, then the child could obtain insurance through CHIP, which is now offered in all states.

  3. 3.

    It is worth noting that legal marriage in the period of examination (1994–2008) meant heterosexual marriage in most states. In addition, NLSY79 did not collect information on same-sex partners prior to 2000. Therefore, “spouse” or “partner” in this study refers to heterosexual relationships.

  4. 4.

    It is possible that some of these single-mother families included cohabiting partners. But this family type was not differentiated in this study since the child may not be considered as the cohabiting partner’s dependent and may not be placed on his employer-sponsored health insurance. Also, information on cohabitation in the NLSY79 was not complete (e.g., lack of data on cohabitation in earlier surveys and the loss of a substantial proportion of short-term cohabitations) (Casper and Bianchi 2002). In a supplementary analysis, I estimated models with two-parent families that included either a biological (resident) father or a non-biological, live-in partner. The results were almost identical regardless of the definition of two-parent families.

  5. 5.

    The NSLY79 Children survey assigned the mother’s race to the child (as recorded in NLSY79 survey).

  6. 6.

    Family income and nonstandard employment might be jointly determined. In ancillary analyses, I estimated models that excluded family income. The results were very similar to those estimated from models that included family income.

References

  1. Abraham, J. M., & Royalty, A. B. (2005). Does having two earners in the household matter for understanding how well employer-based health insurance works? Medical Care Research and Review, 62, 167–186. https://doi.org/10.1177/1077558704273803.

    Article  Google Scholar 

  2. Acock, A. C. (2005). Working with missing values. Journal of Marriage and Family, 67, 1012–1028. https://doi.org/10.1111/j.1741-3737.2005.00191.x.

    Article  Google Scholar 

  3. Altman, D. (2014). A perilous gap in health insurance literacy. Retrieved from https://blogs.wsj.com/washwire/2014/09/04/a-perilous-gap-in-health-insurance-literacy/.

  4. America’s Health Insurance Plans (AHIC). (2013). Health literacy and America’s health insurance plans: Laying the foundation and beyond. Retrieved from https://www.ahip.org/wp-content/uploads/2013/11/HealthLiteracyBook2013_Third_Edition.pdf.

  5. Autor, D. H., Katz, L. F., & Kearney, M. S. (2006). The polarization of the US labor market. American Economic Review, 96, 189–194. https://doi.org/10.1257/000282806777212620.

    Article  Google Scholar 

  6. Barker, K. (1993). Changing assumptions and contingent solutions: The costs and benefits of women working full-and part-time. Sex Roles, 28, 47–71. https://doi.org/10.1007/BF00289747.

    Article  Google Scholar 

  7. Bass, L. E., & Warehime, N. M. (2011). Family structure and child health outcomes in the United States. Sociological Inquiry, 81, 527–548. https://doi.org/10.1111/j.1475-682X.2011.00391.x.

    Article  Google Scholar 

  8. Bauer, J. W., & Dolan, E. M. (2011). Rural families and work overview. In J. W. Bauer & E. M. Dolan (Eds.), Rural families and work: Contexts and problems (pp. 1–15). New York: Springer.

    Chapter  Google Scholar 

  9. Berk, M. L., & Taylor, A. K. (1984). Women and divorce: Health insurance coverage, utilization, and health care expenditures. American Journal of Public Health, 74, 1276–1278. https://doi.org/10.2105/AJPH.74.11.1276.

    Article  Google Scholar 

  10. Blank, R. M. (1998). Contingent work in a changing labor market. In R. B. Freeman & P. Gottschalk (Eds.), Generating jobs: How to increase demand for less-skilled workers (pp. 258–294). New York: Russell Sage Foundation.

    Google Scholar 

  11. Blossfeld, H. P., & Rohwer, G. (1997). Part-time work in West-Germany. In H.-P. Blossfeld & C. Hakim (Eds.), Between equalization and marginalization: Women working part-time in Europe and the United States of America (pp. 164–190). New York: Oxford University Press.

    Google Scholar 

  12. Brooks, T. (2013). Assister types abound: But will navigators and assisters be plentiful enough? Retrieved from https://ccf.georgetown.edu/2013/05/17/assister-types-abound-but-will-navigators-and-assisters-be-plentiful-enough/.

  13. Casper, L. M., & Bianchi, S. M. (2002). Continuity and change in the American family. Thousand Oaks: SAGE.

    Google Scholar 

  14. Cassier, N. (2003). Work arrangements among women in the United States. In S. Houseman & M. Osawa (Eds.), Nonstandard work in developed economies: Causes and consequences (pp. 307–349). Kalamazoo: WE Upjohn Institute for Employment Research.

    Google Scholar 

  15. Clemans-Cope, L., & Garrett, B. (2006). Changes in employer-sponsored health insurance sponsorship, eligibility, and participation: 2001 to 2005. Washington, DC: Kaiser Commission on Medicaid and the Uninsured.

    Google Scholar 

  16. Clemans-Cope, L., Kenney, G., & Lucas, A. (2010). Health Insurance in nonstandard jobs and small firms: Differences for parents by race and ethnicity. Washington, DC: Urban Institute.

    Google Scholar 

  17. Cochran, C., Skillman, G. D., Rathge, R. W., Moore, K., Johnston, J., & Lochner, A. (2002). A rural road: Exploring opportunities, networks, services, and supports that affect rural families. Child Welfare, 81, 837–848.

    Google Scholar 

  18. Dillender, M., Heinrich, C., & Houseman, S. N. (2016). Effects of the affordable care act on part-time employment: Early evidence. Labour Economics, 43, 151–158. https://doi.org/10.17848/wp16-258.

    Article  Google Scholar 

  19. Ditsler, E., Fisher, P., & Gordon, C. (2005). On the fringe: The substandard benefits of workers in part-time, temporary, and contract jobs. New York: The Commonwealth Fund.

    Google Scholar 

  20. Dolan, E. M., Bauer, J. W., & Braun, B. (2011). Policy issues and applications: Rural concerns. In J. W. Bauer & E. M. Dolan (Eds.), Rural families and work: Contexts and problems (pp. 217–230). New York: Springer.

    Chapter  Google Scholar 

  21. Even, W. E., & Macpherson, D. A. (2016). The Affordable Care Act and the growth of involuntary part-time employment. IZA Discussion Papers. https://doi.org/10.2139/ssrn.2653995.

    Google Scholar 

  22. Farber, H. S. (1997). Job creation in the United States: Good jobs or bad? (No. 385). Industrial relations section. Princeton: Princeton University.

    Google Scholar 

  23. Ferber, M. A., & Waldfogel, J. (1998). The long-term consequences of nontraditional employment. Monthly Labor Review, 121, 3–12. https://doi.org/10.7916/D8794FDK.

    Google Scholar 

  24. Filer, R. K. (1985). Male-female wage differences: The importance of compensating differentials. Industrial and Labor Relations Review, 38, 426–437. https://doi.org/10.1177/001979398503800309.

    Article  Google Scholar 

  25. Finkelstein, J. A., Lozano, P., Farber, H. J., Miroshnik, I., & Lieu, T. A. (2002). Underuse of controller medications among Medicaid-insured children with asthma. Archives of Pediatrics & Adolescent Medicine, 156, 562–567. https://doi.org/10.1001/archpedi.156.6.562.

    Article  Google Scholar 

  26. Golden, L. (2016). Still falling short on hours and pay: Part-time work becoming new normal. Washington, DC: Economic Policy Institute.

    Google Scholar 

  27. Hakim, C. (1997). A sociological perspective on part-time work. In H.-P. Blossfeld & C. Hakim (Eds.), Between equalization and marginalization: Women working part-time in Europe and the United States of America (pp. 22–70). New York: Oxford University Press.

    Google Scholar 

  28. Hakim, C. (2002). Lifestyle preferences as determinants of women’s differentiated labor market careers. Work and Occupations, 29, 428–459. https://doi.org/10.1177/0730888402029004003.

    Article  Google Scholar 

  29. Hamel, L., Firth, J., & Brodie, M. (2014). Kaiser health policy news index: February 2014. Henry J. Kaiser Family Foundation. Retrieved from https://www.kff.org/health-reform/poll-finding/kaiser-health-policy-news-index-february-2014/.

  30. Heck, K. E., & Parker, J. D. (2002). Family structure, socioeconomic status, and access to health care for children. Health Services Research, 37, 173–186. https://doi.org/10.1111/1475-6773.99190.

    Google Scholar 

  31. Hill, H. D., & Shaefer, H. L. (2011). Covered today, sick tomorrow? Trends and correlates of children’s health insurance instability. Medical Care Research and Review, 68, 523–536. https://doi.org/10.1177/1077558711398877.

    Article  Google Scholar 

  32. Hofferth, S. L., & Anderson, K. G. (2003). Are all dads equal? Biology versus marriage as a basis for paternal investment. Journal of Marriage and Family, 65, 213–232. https://doi.org/10.1111/j.1741-3737.2003.00213.x.

    Article  Google Scholar 

  33. Hornstein, A., & Price, D. A. (2016). Assessing the effect of the Affordable Care Act on part-time employment. Richmond Fed Economic Brief, (October), 1–6.

  34. Houseman, S., & Osawa, M. (2003). The growth of nonstandard employment in Japan and the United States. In S. Houseman, & M. Osawa (Eds.) Nonstandard work in developed economies: Causes and consequences (pp. 175–214). Kalamazoo: WE Upjohn Institute for Employment Research.

    Google Scholar 

  35. Janicki, H. (2013). Employment-based health insurance: 2010. Washington, DC: United States Census Bureau.

    Google Scholar 

  36. Kalil, A., & Ziol-Guest, K. M. (2005). Single mothers’ employment dynamics and adolescent Well-being. Child Development, 76, 196–211. https://doi.org/10.1111/j.1467-8624.2005.00839.x.

    Article  Google Scholar 

  37. Kalleberg, A. L. (2000). Nonstandard employment relations: Part-time, temporary and contract work. Annual Review of Sociology, 26, 341–365. https://doi.org/10.1146/annurev.soc.26.1.341.

    Article  Google Scholar 

  38. Kalleberg, A. L. (2009). Precarious work, insecure workers: Employment relations in transition. American Sociological Review, 74, 1–22. https://doi.org/10.1177/000312240907400101.

    Article  Google Scholar 

  39. Kalleberg, A. L. (2011). Good jobs, bad jobs: The rise of polarized and precarious employment systems in the United States, 1970s to 2000s. New York: Russell Sage Foundation.

    Google Scholar 

  40. Kalleberg, A. L., Reskin, B. F., & Hudson, K. (2000). Bad jobs in America: Standard and nonstandard employment relations and job quality in the United States. American Sociological Review, 65, 256–278. https://doi.org/10.2307/2657440.

    Article  Google Scholar 

  41. Katras, M. J., Sharp, E. H., Dolan, E. M., & Baron, L. A. (2015). Non-standard work and rural low-income mothers: Making it work. Journal of Family and Economic Issues, 36, 84–96. https://doi.org/10.1007/s10834-014-9410-7.

    Article  Google Scholar 

  42. Katz, L. F., & Krueger, A. B. (2016). The rise and nature of alternative work arrangements in the United States, 1995–2015 (No. w22667). Cambridge: National Bureau of Economic Research.

    Book  Google Scholar 

  43. Kenney, G. M., Haley, J. M., Anderson, N., & Lynch, V. (2015). Children eligible for Medicaid or CHIP: Who remains uninsured, and why? Academic Pediatrics, 15, S36–S43. https://doi.org/10.1016/j.acap.2015.01.009.

    Article  Google Scholar 

  44. Kogan, M. D., Alexander, G. R., Teitelbaum, M. A., Jack, B. W., Kotelchuck, M., & Pappas, G. (1995). The effect of gaps in health insurance on continuity of a regular source of care among preschool-aged children in the United States. JAMA, 274, 1429–1435. https://doi.org/10.1001/jama.1995.03530180023025.

    Article  Google Scholar 

  45. Lawson, D. W., & Mace, R. (2008). Sibling configuration and childhood growth in contemporary British families. International Journal of Epidemiology, 37, 1408–1421. https://doi.org/10.1093/ije/dyn116.

    Article  Google Scholar 

  46. Levitt, L. (2014). JAMA forum: Why health insurance literacy matters. Retrieved from https://newsatjama.jama.com/2014/11/26/jama-forum-why-health-insurance-literacy-matters/.

  47. Lo Sasso, A. T., & Buchmueller, T. C. (2004). The effect of the state children’s health insurance program on health insurance coverage. Journal of Health Economics, 23, 1059–1082. https://doi.org/10.1016/j.jhealeco.2004.03.006.

    Article  Google Scholar 

  48. Long, S., & Goin, D. (2014). Large racial and ethnic differences in health insurance literacy signal need for targeted education and outreach. Washington, DC: Urban Institute Health Policy Center and the Robert Wood Johnson Foundation.

    Google Scholar 

  49. Lovejoy, M. C., Graczyk, P. A., O’Hare, E., & Neuman, G. (2000). Maternal depression and parenting behavior: A meta-analytic review. Clinical psychology review, 20, 561–592. https://doi.org/10.1016/S0272-7358(98)00100-7.

    Article  Google Scholar 

  50. Malhortra, M., Starrs, L., Tatko, J., & Henson, T. (2017). Outreach and enrollment issue brief: Expanding the role of the enrollment assister at community health centers. Retrieved from http://www.nachc.org/wp-content/uploads/2017/03/2017EnrollmentAssister-IssueBrief_FINAL_PUBLIC.pdf.

  51. McWilliams, J., Afendulis, M., McGuire, C. C. T. G., & Landon, B. E. (2011). Complex Medicare advantage choices may overwhelm seniors: Especially those with impaired decision making. Health Affairs, 30, 1786–1794. https://doi.org/10.1377/hlthaff.2011.0132.

    Article  Google Scholar 

  52. Medicaid. (2017). Waiting periods in CHIP. Retrieved from https://www.medicaid.gov/chip/eligibility-standards/waiting-periods/index.html.

  53. Mishel, L. R., Bernstein, J. & and Shierholz, H. (2009). The state of working America, 2008/2009. Ithaca: ILR Press/Cornell University Press.

    Google Scholar 

  54. Mofidi, M., Rozier, R. G., & King, R. S. (2002). Problems with access to dental care for Medicaid-insured children: What caregivers think. American Journal of Public Health, 92, 53–58. https://doi.org/10.2105/AJPH.92.1.53.

    Article  Google Scholar 

  55. Murasko, J. E. (2008). Married women’s labor supply and spousal health insurance coverage in the United States: Results from panel data. Journal of Family and Economic Issues, 29, 391–406. https://doi.org/10.1007/s10834-008-9119-6.

    Article  Google Scholar 

  56. Palloni, A. (2006). Reproducing inequalities: Luck, wallets, and the enduring effects of childhood health. Demography, 43, 587–615. https://doi.org/10.1353/dem.2006.0036.

    Article  Google Scholar 

  57. Pearson, M., Colomo, F., Murakami, Y., & James C. (2016). Universal Health Coverage and Health Outcomes, OECD, July. Retrieved from https://www.oecd.org/els/health-systems/Universal-Health-Coverage-and-Health-Outcomes-OECD-G7-Health-Ministerial-2016.pdf.

  58. Peter, R. F., Newacheck, P. W., & Halfon, N. (1992). Access to care for poor children: Separate and unequal? JAMA, 267, 2760–2764. https://doi.org/10.1001/jama.1992.03480200068026.

    Article  Google Scholar 

  59. Peters, H. E., Simon, K., & Taber, J. R. (2014). Marital disruption and health insurance. Demography, 51, 1397–1421. https://doi.org/10.1007/s13524-014-0317-6.

    Article  Google Scholar 

  60. Royston, P. (2007). Multiple imputation of missing values: Further update of ICE, with an emphasis on interval censoring. Stata Journal, 7, 445–464.

    Article  Google Scholar 

  61. Rudowitz, R., Artiga, S., & Arguello, R. (2014). Children’s health coverage: Medicaid, CHIP and the ACA. Washington, DC: Kaiser Family Foundation.

    Google Scholar 

  62. Sano, Y., & Richards, L. N. (2011). Physical health, food security, and economic well-being: The rural perspective. In J. W. Bauer & E. M. Dolan (Eds.), Rural families and work: Contexts and problems (pp. 77–98). New York: Springer.

    Chapter  Google Scholar 

  63. Shaefer, H. L. (2009). Part-time workers: Some key differences between primary and secondary earners. Monthly Labor Review, 132, 3–15.

    Google Scholar 

  64. Smith, V. (1993). Flexibility in work and employment: The impact on women. Research in the Sociology of Organizations, 195–216.

  65. Spalter-Roth, R., & Hartmann, H. (1998). Gauging the consequences for gender relations, pay equity, and the public purse. In K. Barker & K. Christensen (Eds.), Contingent work: American employment relations in transition (pp. 69–100). Ithaca: Cornell University Press.

    Google Scholar 

  66. Stone, P. (2007). Opting out?: Why women really quit careers and head home. Berkeley: University of California Press.

    Google Scholar 

  67. The Catalyst Center. (2015). Medicaid and children with special health care needs/disabilities: An overview. Retrieved from http://cahpp.org/wp-content/uploads/2015/04/medicaid-fact-sheet-1.pdf.

  68. Thompson, J. W., Ryan, K. W., Pinidiya, S. D., & Bost, J. E. (2003). Quality of care for children in commercial and Medicaid managed care. JAMA, 290, 1486–1493. https://doi.org/10.1001/jama.290.11.1486.

    Article  Google Scholar 

  69. Thorpe, K. E., & Florence, C. S. (1999). Why are workers uninsured? Employer-sponsored health insurance in 1997. Health Affairs, 18, 213–218. https://doi.org/10.1377/hlthaff.18.2.213.

    Article  Google Scholar 

  70. Valletta, R., & van der List, C. (2015). Involuntary part-time work: Here to stay? Economic research. San Francisco: Federal Reserve Board.

    Google Scholar 

  71. Vernon, J. A., Trujillo, A., Rosenbaum, S., & DeBuono, B. (2007) Low health literacy: Implications for national health policy. Washington, DC: The George Washington University.

    Google Scholar 

  72. Webber, G., & Williams, C. (2008). Mothers in “good” and “bad” part-time jobs: Different problems, same results. Gender & Society, 22, 752–777. https://doi.org/10.1177/0891243208325698.

    Article  Google Scholar 

  73. Weinick, R. M., & Monheit, A. C. (1999). Children’s health insurance coverage and family structure, 1977–1996. Medical Care Research and Review, 56, 55–73. https://doi.org/10.1177/107755879905600104.

    Article  Google Scholar 

  74. Williams, J. (2000). Unbending gender: Why family and work conflict and what to do about it. Oxford: Oxford University Press.

    Google Scholar 

  75. Yoshikawa, H., Weisner, T. S., & Lowe, E. D. (Eds.). (2006). Making it work: Low-wage employment, family life, and child development. New York: Russell Sage Foundation.

    Google Scholar 

  76. Ziol-Guest, K. M., & Dunifon, R. E. (2014). Complex living arrangements and child health: Examining family structure linkages with children’s health outcomes. Family Relations, 63, 424–437. https://doi.org/10.1111/fare.12071.

    Article  Google Scholar 

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Lim, S. Mothers’ Nonstandard Employment, Family Structure, and Children’s Health Insurance Coverage. J Fam Econ Iss 40, 148–164 (2019). https://doi.org/10.1007/s10834-018-9596-1

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Keywords

  • Children
  • Health insurance
  • Family structure
  • Maternal employment
  • Nonstandard employment
  • Single-mother families