ACA Has Helped Cut Independent Worker Uninsured Rate Nearly in Half, Yet Many Remain Without Health Coverage Due to Perceived Unaffordability

"We've done a great job year over year getting more self-employed and independent workers the healthcare coverage they need at a price they can afford. Alongside our partners, policymakers, and other business leaders, in the last year, we've brought this population's uninsured rate down from 24 percent in 2022 to 19 percent in 2023," said Noah Lang, CEO & Cofounder of Stride. "However, there is an issue with perceived affordability versus actual affordability so there is still more work to be done to educate and inform this critical part of the American workforce."

In fact, independent workers pay less on their monthly premiums than full time employees. Over half (53%) of independents report paying $0 for health insurance premiums, compared to 10% of full-time employees. Meanwhile, 55% of uninsured independent workers simply assume it's unaffordable, as Stride's 2022 survey revealed that 80% assumed coverage would cost them more than $100 per month, while 72% of those who were insured paid less than $100 per family member.

The findings also shed light on independent workers' lack of "shopping" their health insurance to look for new plans each year that might better fit their healthcare or financial needs year-to-year. New prescriptions, changes in family medical conditions or changes in doctors should be considered every Open Enrollment when there's opportunity to update plans.

Additionally, the plans themselves change every year: for 2024, plan rates are up 5% on average nationally—due to both inflationary pressures and increased health care use post-COVID—but some states like California have launched new state-funded subsidies to lower copays for certain plans and, in some cases, eliminate deductibles. At the same time, new plans enter and leave markets every year. There's good news on that front for independent workers: in most states, there are more health plans entering the market in 2024 than leaving so, on average, they are now able to choose from 7 insurance carriers, each with a variety of plans.

And yet, two-in-five insured independent workers say they are simply enrolling in the same plan as last year or plan to let their insurance company or the marketplace auto-enroll them in the same plan as opposed to shopping around for plans that might better suit their needs. This is possibly the reason they are also more likely than full time employees to report feeling like their healthcare coverage does not cover their needs (21%).

For more insights from the report including a data breakdown of independent workers compared to full time employees, male versus female workers as well as age and location, see below.

Independent Workers vs. Full Time Employees

Independents are far more likely to pay less on their monthly premiums than full time employees.

• Over half (53%) of independents report paying $0 for health insurance monthly. Only 4% say they pay $500 or more per month.
• That compares to 10% of full-time employees who report paying $0 per month on their healthcare premiums.

In most instances, independent workers appear to have more healthcare challenges than their full-time counterparts.

• When looking at workers who do not have healthcare coverage, almost three in five independent workers cite affordability issues as being the reason for their lack of coverage.
• Another 17% report "not needing it."

Regardless of how people choose to work, having access to healthcare is among the topmost important benefits. It is the #2 most important benefit to all workers - both independent workers and full-time employees - coming in right behind access to affordable childcare. The top five most important benefits for independent workers and full-time employees is as follows:

Location

Among survey respondents, the top five cities for insured workers are Indianapolis (95%), Philadelphia (93%), Boston (92%), New York (90%) and San Francisco (90%). On the flip side, workers across cities in Texas report not having health insurance at higher rates than other cities across the country.

• 27% of workers in San Antonio, 26% of workers in Austin and 22% of workers in Dallas and Houston report not having health insurance.

Workers in Boston (53%) are the least likely to say they do not have medical debt and have never had it in the past whereas workers in Indianapolis are the most likely to report having or having had medical debt in the past (32%).

Age

Older people pay more for health insurance because they typically need more medical care. While federal rules limit how much individuals pay for Affordable Care Act (ACA) plans based on age, workers aged 55-64 are most likely to report not having health insurance due to affordability issues.

• More than three in four uninsured workers in this age group said they don't have it because it's not affordable.
• It appears, based on the data, that there is a gap in the worker population where workers aged 55-64 are going uninsured for a period of time before qualifying for Medicare at 65.
• The younger the workers, the less likely they are to cite not having healthcare due to affordability reasons.

That said, younger workers find it more difficult to enroll in health coverage than older people.

• 56% of workers ages 18-24 said they find enrolling in healthcare difficult as compared to
• 31% of workers ages 55-64.

Gender

Of uninsured workers, over 2x as many men as women report not having coverage because they "feel like they don't need it" even though women, on average, have just 10% more in total health expenditures relative to men.

Men (68%) are more likely than women (55%) to believe the quality in US healthcare coverage is good. Men (14%) are also slightly less likely than women (19%) to report that their healthcare coverage lacks in covering their needs i.e., doctors, prescriptions, procedures, etc.

For more on Stride's Independent Worker Wellness report, click here.

ABOUT STRIDE: 
Stride enables independent workers to reap the benefits of their independence. Stride simplifies the challenges of being self-employed by helping workers handle the complexities of insurance and taxes — in one convenient platform. Stride has helped over 3.7 million workers save over $6 billion on their taxes and monthly health insurance premiums.

Stride also supports over 100 leading enterprises including contract workforces, employers, health plans, and agents in delivering access to health benefits and financial planning tools to their workers and customers. Companies like Uber, Amazon, DoorDash, and Instacart partner with Stride to provide their gig economy workforces access to Stride's benefits platform. The company is backed by $96 million in capital from Venrock, New Enterprise Associates, Fidelity's F-Prime Capital Partners, Mastercard, Allstate and King River.

Visit us at www.stridehealth.com for more information. Read our blog and follow us on Instagram, TikTok and LinkedIn. To become a partner, click here.

SOURCE Stride Health