A Profile of Alabama’s Low-Wage Uninsured Workers by Joan Alker and Alexandra Corcoran April 2021 The recently enacted American Rescue Plan Act of 2021 (ARP) includes new large financial incentives for states to extend health insurance coverage to low-wage workers and other adults earning less than $17,775 a year.1 These incentives apply to regular spending in a state’s Medicaid program and offer a five-percentage point across the board increase in the federal share for a 24-month period after the state extends coverage. The Kaiser Family Foundation estimates that Alabama’s budget would see a net gain of $540 million over a two-year period if the state expanded Medicaid.2 Approximately 204,100 uninsured non-elderly adults, or 49 percent of the The Georgetown University Center for Children and Families (CCF) is an state’s uninsured adult population, would gain health insurance.3 independent, nonpartisan policy and This fact sheet examines which workers and industries would benefit from research center founded in 2005 with a expansion of Medicaid coverage.4 The top three industry sectors employing low- mission to expand and improve high- wage uninsured workers are hospitality, retail, and health care and social assistance, quality, affordable health coverage for America’s children and families. CCF is accounting for approximately 47 percent of those working without insurance; these based in the McCourt School of Public industry sectors include businesses such as restaurants, general merchandise stores Policy’s Health Policy Institute. (such as warehouse clubs and supercenters), and nursing care facilities (see Table 1). The most common jobs for low-wage, uninsured workers are cashiers, cooks, freight and stock laborers, and maids and housekeeping staff (see Table 2). Table 1. Top Industry Sectors in Alabama For Low-Wage Workers For Low-Wage, Uninsured Workers Retail trade 16.9% Accommodation and food services 19.0% Accommodation and food services 15.5% Retail trade 16.2% Health care and social assistance 12.8% Health care and social assistance 11.4% Manufacturing 10.2% Manufacturing 11.0% Construction 7.1% Construction 10.1% Administrative, support, and waste management 7.0% Administrative, support, and waste management 9.3% Education services 6.5% Other services (except public administration) 5.6% Other services (except public administration) 5.5% Transportation and warehousing 3.0% Table 2. Top Occupations in Alabama For Low-Wage Workers For Low-Wage, Uninsured Workers Cashiers 7.4% Cashiers 9.4% Cooks 3.7% Cooks 4.9% Stockers and order fillers 3.2% Laborers and freight, stock, and material movers 3.5% Retail salespersons 2.9% Maids and housekeeping cleaners 3.3% Waiters and waitresses 2.8% Janitors and building cleaners 2.6% Note: Workers with no occupation are not listed. Laborers and freight, stock, and material movers 2.6% Source: Georgetown University Center for Children and Families analysis of US Census Bureau American Community Survey (ACS) 2019 Public Use Microdata First-line supervisors of retail sales workers 2.6% Sample (PUMS). Nursing assistants 2.5% Maids and housekeeping cleaners 2.3% Demographics of uninsured low-income adults Our analysis finds that women make up a disproportionate share of low-income, non-elderly adult citizens in Alabama (60 percent) and account for 55 percent of those who are uninsured. In Alabama, 58 percent of uninsured low-income citizens are White, 39 percent are Black, and the remainder describe themselves in other categories including American Indian, Asian/Pacific Islander, or multi-racial. Approximately two percent of low-income citizen non-elderly adults identify as Hispanic/Latino.5 As Figure 1 illustrates, all of the top industry sectors with the greatest number of low-wage uninsured workers have a majority of White workers except for manufacturing. Figure 2 shows that the hospitality, retail, and service industries employ more uninsured, low-wage women, while manufacturing, and administrative, support, and waste management services employ more uninsured, low-wage men. Figure 1. Race of Low-Wage, Figure 2. Gender of Low-Wage, Uninsured Workers in Top Industry Sectors Uninsured Workers in Top Industry Sectors Accommodation 51.3% Accommodation and food services 25.6% 74.4% 47.8% and food services Retail 63.8% Retail 33.5% 66.5% 33.7% Health care and 50.5% Manufacturing 68.3% 31.7% social assistance 48.7% Administrative, Manufacturing 46.2% support, and waste 60.8% 39.2% 51.4% management services Administrative, 50.1% Other services (except support, and waste public administration) 38.2% 61.8% management services 46.1% WhiteBlack MenWomen Source: Georgetown University Center for Children and Families analysis of Source: Georgetown University Center for Children and Families analysis of U.S. Census Bureau American Community Survey (ACS) 2019 Public Use U.S. Census Bureau American Community Survey (ACS) 2019 Public Use Microdata Sample (PUMS). 6 Microdata Sample (PUMS). 7 Which parts of the state have higher proportions of uninsured workers? The map on the right shows the range of uninsured Uninsured Rate for rates for all non-elderly adult workers across the Non-Elderly Workers Between 10-20% state of Alabama, ranging from 7.4 percent in Lower than 10% Shelby County to 19.2 percent in DeKalb County. Table 3 lists eleven counties with high proportions of uninsured workers, each with more than 15 Note: Includes all workers ages 19-64 regardless of income or citizenship status. percent of non-elderly employed adults lacking Source: Georgetown University Center for insurance. The counties are a mix of rural counties Children and Families analysis of US Census Bureau American Community Survey (ACS) and those with small cities and towns. 2015-2019 Table DP03. Grey counties indicate that estimate is suppressed due to high margin of error and low-reliability. Contact authors for more information on the methodology. Table 3. Counties with High Uninsured County Uninsured Rate County Uninsured Rate Rates for Non-Elderly Adults United States 11.0% Chilton 17.7% Alabama 12.1% Russell 17.1% Note: Includes all workers ages 19-64 regardless of income or DeKalb 19.2% Conecuh 16.9% citizenship status. Source: Georgetown University Center for Children and Families Dale 18.2% Henry 15.7% analysis of US Census Bureau American Community Survey (ACS) Clay 18.1% Winston 15.5% 2015-2019 Table DP03.8 Geneva 18.1% Cullman 15.3% Marshall 18.0% April 2021 CCF.GEORGETOWN.EDU alabama’S low-wage, uninsured workers 2 Endnotes 1 For more information on the provisions of the law, see E. Park and 6 Estimates for the share of low-wage workers in each industry sector S. Corlette, “American Rescue Plan Act: Health Coverage Provisions who are American Indian/Alaska Native, Asian/Native Hawaiian Explained” (Washington DC: Georgetown University Center for Children or Pacific Islander, and Two or More Races/Some Other Race are and Families and Center on Health Insurance Reform, March 2021), suppressed due to small sample sizes and low-reliability. Contact available at https://ccf.georgetown.edu/2021/03/11/american-rescue- authors for more information on the methodology. plan-act-health-coverage-provisions-explained/. 7 Estimates for health care and social assistance industry as well as 2 R. Rudowitz, B. Corallo, and R. Garfield, “New Incentive for States to construction industry suppressed due to small sample size and low- Adopt the ACA Medicaid Expansion: Implications for State Spending” reliability in one category. Contact authors for more information on the (Washington DC: Kaiser Family Foundation, March 2021), available at methodology. https://www.kff.org/medicaid/issue-brief/new-incentive-for-states-to- 8 Out of Alabama’s 67 counties, three county estimates were suppressed adopt-the-aca-medicaid-expansion-implications-for-state-spending/. due to high margins of error and low-reliability. Suppression rules did result 3 Kaiser Family Foundation, “Who Could Medicaid Reach with in the exclusion of Bullock County, which may have an uninsured rate for Expansion in Alabama?” (Washington DC: Kaiser Family Foundation, non-elderly workers higher than 15 percent. Contact authors for more February 2021), available at https://files.kff.org/attachment/fact-sheet- information on the methodology. medicaid-expansion-AL. 4 Contact authors for more information on sources of data and methods. All data are derived from the American Community Survey (2019) most from the Public Use Microdata Sample; county data calculated from American Community Survey five-year (2015-2019) prepared tables. 5 The American Community Survey measures race and ethnicity as two separate facets of an individual’s identity. Hispanic/Latino individuals can be of any race. April 2021 CCF.GEORGETOWN.EDU alabama’s low-wage, uninsured workers 3