A Profile of Missouri’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. Missouri is eligible for this funding because voters approved expansion in a referendum last year but it has not yet been implemented. The Kaiser Family Foundation estimates that Missouri’s budget would see a net gain of $1.15 The Georgetown University Center for Children and Families (CCF) is an billion over a two-year period when the state begins covering adults in Medicaid.2 independent, nonpartisan policy and Approximately 247,500 uninsured non-elderly adults will gain health insurance.3 research center founded in 2005 with a This fact sheet examines which workers and industries will benefit from the expansion mission to expand and improve high- of Medicaid coverage.4 Industry sectors in Missouri with the largest percentage quality, affordable health coverage for America’s children and families. CCF is of low-wage uninsured workers are hospitality, retail, and health care and social based in the McCourt School of Public assistance, accounting for 49 percent of low-wage workers without insurance (see Policy’s Health Policy Institute. Table 1). The most common jobs for low-wage, uninsured workers are cashiers, cooks, laborers and movers, and maids and housekeeping staff (see Table 2). Table 1. Top Industry Sectors in Missouri For Low-Wage Workers For Low-Wage, Uninsured Workers Health care and social assistance 16.2% Accommodation and food service 19.3% Retail 15.8% Retail 17.1% Accommodation and food service 15.3% Health care and social assistance 12.9% Manufacturing 7.8% Construction 9.5% Administrative, support, and waste management services 7.2% Administrative, support, and waste management services 8.9% Construction 6.9% Manufacturing 7.8% Educational services 6.7% Other services (except public administration) 4.7% Other services (except public administration) 4.9% Educational services 3.4% Transportation and warehousing 3.3% Transportation and warehousing 3.2% Arts, entertainment, and recreation 2.9% Wholesale trade 2.1% Table 2. Top Occupations in Missouri For Low-Wage Workers For Low-Wage, Uninsured Workers Cashiers 5.8% Cashiers 6.9% Cooks 4.3% Cooks 4.6% Waiters and waitresses 3.6% Laborers and freight, stock, and material movers, hand 4.5% Laborers and freight, stock, and material movers, hand 3.5% Construction laborers 4.2% Janitors and building cleaners 3.1% Maids and housekeepers 3.9% Customer service representatives 3.0% Janitors and building cleaners 3.9% Maids and housekeepers 2.9% Waiters and waitresses 3.3% Note: Workers with no occupation are not listed. Source: Georgetown University Center for Children and Families analysis of US Census Bureau American Community Survey (ACS) 2019 Public Use Microdata Sample (PUMS). Demographics of uninsured low-income residents In Missouri, 78 percent of uninsured low-income non-elderly citizens are White, 17 percent are Black, and the remainder describe themselves in other categories including American Indian, Asian/Pacific Islander, or multi-racial.5 As Figure 1 illustrates, different areas of the economy have somewhat different racial compositions for low-wage uninsured workers. Figure 2 shows the gender breakdown for low-wage uninsured workers which varies considerably by industry. 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 Accommodation 78.9% 37.0% 63.0% and food services and food services 17.5% Retail 38.3% 61.7% Health care and 71.4% social assistance Administrative, 21.5% support, and waste 63.4% 36.6% management services Administrative, 69.0% Manufacturing support, and waste 66.4% 33.6% management services 28.7% Other services (except public 48.2% 51.8% WhiteBlack administration) MenWomen Source: Georgetown University Center for Children and Families analysis of US Census Bureau American Community Survey (ACS) Source: Georgetown University Center for Children and Families analysis of US Census 2019 Public Use Microdata Sample (PUMS). 6 Bureau American Community Survey (ACS) 2019 Public Use Microdata Sample (PUMS). 7 Which parts of the state have higher proportions of uninsured workers? Table 3 lists the twenty-one counties with the highest Uninsured Rate for Non-Elderly Workers proportion of uninsured workers, each with more than Above 20% one in five non-elderly employed adults of all incomes Between 10-20% lacking insurance. All of these counties except for Lower than 10% McDonald County are classified as rural counties underscoring other research findings that Medicaid Note: Includes all workers ages 19-64 regardless of income or citizenship expansion substantially benefits rural areas.8 The status. uninsured rate for all non-elderly adult workers varies Source: Georgetown University Center considerably across the state of Missouri, ranging from for Children and Families analysis of U.S. Census Bureau American 32.5 percent in Scotland County to 5.2 percent in St. Community Survey (ACS) 2015-2019 Table DP03. Grey counties indicate Charles County. that estimate is suppressed due to high margin of error and low-reliability Table 3. Missouri Counties Where County Uninsured Rate County Uninsured Rate More than 20 Percent of Non- United States 11.0% Dunklin 22.4% Missouri 11.2% Douglas 22.2% Elderly Workers are Uninsured Scotland 32.5% New Madrid 22.0% Oregon 27.8% Wayne 21.9% Note: Includes all workers ages 19-64 regardless Shannon 27.6% Mississippi 21.6% of income or citizenship status. Knox 27.4% Crawford 20.8% Source: Georgetown University Center for Ripley 26.0% Carter 20.7% Children and Families analysis of U.S. Census McDonald 24.8% Wright 20.6% Bureau American Community Survey (ACS) 2015- Morgan 24.5% Grundy 20.5% 2019 Table DP03. Ozark 24.3% Texas 20.4% Cedar 23.5% Pemiscot 20.3% Taney 23.2% April 2021 CCF.GEORGETOWN.EDU mISSOURI’S low-wage, uninsured workers 2 Endnotes 1 For more information on the provisions of the law, see E. Park and 6 Figure 1: Estimates for the share of low-wage workers in each industry S. Corlette, “American Rescue Plan Act: Health Coverage Provisions sector 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. Estimates of available at https://ccf.georgetown.edu/2021/03/11/american-rescue- race in retail industry and construction industry suppressed due to small plan-act-health-coverage-provisions-explained/. sample sizes and low-reliability of all but one category. Contact authors 2 R. Rudowitz, B. Corallo, and R. Garfield, “New Incentive for States to for more information on the methodology. Adopt the ACA Medicaid Expansion: Implications for State Spending” 7 Figure 2: Estimates of gender in health care and social assistance (Washington DC: Kaiser Family Foundation, March 2021), available at industry and construction industry are suppressed due to small sample https://www.kff.org/medicaid/issue-brief/new-incentive-for-states-to- sizes and low-reliability of one category. Contact authors for more adopt-the-aca-medicaid-expansion-implications-for-state-spending/. information on the methodology. 3 “Medicaid Expansion Enrollment and Eligibility Update: Geographic 8 J. Hoadley, J. Alker, and M. Holmes, “Health Insurance Coverage Distribution of Medicaid Enrollees” (Saint Louis University Center in Small Towns and Rural America: The Role of Medicaid Expansion” for Health Law Studies & Washington University Center for Health (Washington DC: Georgetown University Center for Children and Economics and Policy, March 2021), available at https://publichealth. Families, September 2018), available at https://ccf.georgetown. wustl.edu/wp-content/uploads/2021/03/County_Enrollees_factsheet_ edu/2018/09/25/health-insurance-coverage-in-small-towns-and-rural- final_v.2.pdf. Earlier estimates from the Office of the Governor project america-the-role-of-medicaid-expansion/. enrollment of 274,500 in the first year. 4 All data are from the American Community Survey. Most data are from the 2019 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. Just 3.5 percent of low-income uninsured non- elderly adults identify as Hispanic/Latino. April 2021 CCF.GEORGETOWN.EDU Missouri’s low-wage, uninsured workers 3