The Prevalence and Correlates of Pre-ACA Health Insurance “Job Lock” Among a National Sample of the U.S. Workforce
Despite declining rates of employer-sponsored health insurance (ESI), the workplace remains the primary provider of coverage in the U.S. Prior to the passage of the Affordable Care Act (ACA), the non-portability of ESI created a risk of “job lock.” The term refers to an employee’s inability to leave a dissatisfying work environment for fear of losing employer-provided health insurance. Job lock constrains individual job choices such as decisions to switch jobs or retire, and contributes to decreased job mobility. This paper examines the prevalence and correlates of job lock in the American workforce. I examine whether demographic and job characteristics differ among those who are and are not “locked in” their current job, and identify job lock predictors. Finally, I examine the effects of job lock on employees’ overall life satisfaction and mental and physical well-being.
Methods:
The study analyzes data from the nationally representative 2008 National Study of the Changing Workforce, drawing a sample of 2,857 organizationally-employed workers who did not face job lock and 167 workers who were “locked in” their current job, operationalized as those receiving health insurance from their main employer, having no intention to leave the job in the next year, and “not looking forward” to going to work. I conducted t-tests and Chi squared analyses to evaluate demographic and job characteristic differences between groups. Between-group differences in job lock were tested using logistic regression, and ordinary least squares regression (OLS) models assessed job lock’s association with employee depression, mental health, overall health and overall self-reported life satisfaction. Regression controls included marital and parenting status, race, sex, education, union membership, industry, difference in desired and actual number of work hours, and value placed on health insurance.
Results:
Contrary to past findings, descriptive analyses found no significant differences between locked-in and unlocked workers across demographic and family characteristics. Locked-in workers were more likely to be employed full-time, however, and place high value on insurance, and be in a union. Further, a lower proportion of locked-in workers felt that their work schedules met their personal needs and that they could develop skills in their jobs; they were also less likely to be able to choose their own starting and quitting times.
Regression analyses found that locked-in employees also had higher rates of depression and stress, lower self-reported life satisfaction and poorer mental health, with marital status moderating the relationship between job lock and mental health. Being in the service or production industry, having union membership and valuing insurance were correlated with job lock.
Conclusions/Implications:
Social work practitioners are involved in securing the health, and health care access, of vulnerable populations, and will play a central role in the implementation of ACA. They also help promote clients’ labor force entry and retention. While ACA’s effects on job lock remain to be determined, these findings provide evidence that job lock is associated with ESI dependence pre-ACA, and represents an issue of serious social welfare concern given its negative link to employee well-being.