A Profile of Tennessee’s Low-Wage Uninsured Workers by Joan Alker and Alexandra Corcoran May 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 Tennessee’s budget would see a net gain of $900 million over a two-year period if the state expanded Medicaid.2 The Georgetown University Center Approximately 226,200 thousand uninsured nonelderly adults, or 38 percent of the for Children and Families (CCF) is an state’s uninsured adult population, would gain health insurance.3 independent, nonpartisan policy and research center founded in 2005 with a This fact sheet examines which workers and industries would benefit from expansion mission to expand and improve high- of Medicaid coverage.4 The top three industry sectors employing low-wage uninsured quality, affordable health coverage for workers are hospitality, retail, and construction, accounting for 43.3 percent of those America’s children and families. CCF is working without insurance (see Table 1). Restaurants alone employ 15 percent of low- based in the McCourt School of Public wage uninsured workers. The most common jobs for low-wage uninsured workers in Policy’s Health Policy Institute. Tennessee are cooks, cashiers, laborers/movers, and janitors (see Table 2). Table 1. Top Industry Sectors in Tennessee For Low-Wage Workers For Low-Wage, Uninsured Workers Accommodation and food services 16.3% Accommodation and food services 17.1% Retail 15.4% Retail 14.8% Health care and social assistance 13.0% Construction 11.4% Manufacturing 9.3% Manufacturing 11.2% Administrative, support, and waste management services 9.0% Administrative, support, and waste management services 10.0% Construction 6.3% Health care and social assistance 8.9% Other services (except public administration) 5.4% Other services (except public administration) 6.0% Transportation and warehousing 5.1% Transportation and warehousing 3.9% Educational services 4.5% Educational services 2.5% Professional, scientific, and technical services 2.3% Professional, scientific, and technical services 1.4% Table 2. Top Occupations in Tennessee For Low-Wage Workers For Low-Wage, Uninsured Workers Cashiers 5.5% Cooks 6.6% Cooks 3.9% Cashiers 4.8% Waiters and waitresses 3.3% Laborers and freight, stock, and material movers, hand 3.9% Laborers and freight, stock, and material movers, hand 3.1% Janitors and building cleaners 3.4% Janitors and building cleaners 3.0% Construction laborers 3.3% Maids and housekeeping cleaners 2.9% Waiters and waitresses 2.9% Retail salespersons 2.6% Other assemblers and fabricators 2.6% Miscellaneous production workers, including equipment Retail salespersons 2.3% 2.6% operators and tenders Personal care aides 2.4% Miscellaneous production workers, including equipment 2.3% operators and tenders Other assemblers and fabricators 2.3% Driver/sales workers and truck drivers 2.2% Note: Workers with no occupation are not listed. Source: Georgetown University Center for Children and Families analysis of U.S. Census Bureau American Community Survey (ACS) 2019 Public Use Microdata Sample (PUMS). Contact authors for more information on the methodology. Demographics of uninsured low-income adults Overall, White people comprise 72 percent of low-income uninsured citizen adults and Black people comprise 25 percent. This is similar to their proportion of low-income citizen adults overall. Figure 1 shows the top industry sectors with low-wage uninsured workers by race and Figure 2 shows the top industry sectors by gender. 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 70.0% Accommodation and food services and food services 41.3% 58.7% 27.2% Retail 81.5% Retail 44.4% 55.6% 17.0% Manufacturing 73.3% Manufacturing 23.8% 75.8% 24.2% Administrative, 59.1% Administrative, support, and waste support, and waste 47.5% 52.5% management services 29.5% management services Health care and 77.4% Health care and social assistance 15.8% 22.0% 78.0% social assistance WhiteBlack MenWomen Source: Georgetown University Center for Children and Families analysis Source: Georgetown University Center for Children and Families analysis of U.S. Census Bureau American Community Survey (ACS) 2019 Public of U.S. Census Bureau American Community Survey (ACS) 2019 Public Use Microdata Sample (PUMS).5 Use Microdata Sample (PUMS).6 Which parts of the state have higher proportions of uninsured workers? The map on the right shows the range of uninsured rates for all nonelderly adult workers across the state of Tennessee by county. Sevier County has the highest rate Uninsured Rate for of uninsured workers at 24 percent. Table 3 Nonelderly Workers shows the 17 counties where 15 percent or Above 20% Note: Includes all workers ages 19-64 regardless of more of workers are uninsured regardless income or citizenship status. Between 10-20% of income or citizenship. Source: Georgetown University Center for Children Lower than 10% and Families analysis of U.S. Census Bureau American Community Survey (ACS) 2015-2019 Table Estimate suppressed DP03. Contact authors for more information on the due to unreliable data methodology. Table 3. Tennessee Counties with County Uninsured Rate County Uninsured Rate 15 Percent or More of All Working United States 11.0% Cumberland 15.8% Adults Uninsured Tennessee 12.1% Bedford 15.7% Sevier 24.1% Crockett 15.4% Note: Includes all workers ages 19-64 regardless of Van Buren 19.3% Lewis 15.4% income or citizenship status. Chester 18.4% Loudon 15.4% Source: Georgetown University Center for Children Grundy 18.2% Lake 15.3% and Families analysis of U.S. Census Bureau American Wayne 16.6% Johnson 15.2% Community Survey (ACS) 2015-2019 Table DP03. Out of Tennessee’s 95 counties, two county estimates were Warren 16.4% Trousdale 15.1% suppressed due to high margins of error and low- Macon 16.3% Meigs 15.0% reliability; this did not affect the counties presented in Hancock 15.9% Table 3. Contact authors for more information on the methodology. May 2021 CCF.GEORGETOWN.EDU Tennessee’S low-wage, uninsured workers 2 Endnotes 1 For more information on the provisions of the law, see E. Park and 5 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. Estimates for available at https://ccf.georgetown.edu/2021/03/11/american-rescue- construction industry suppressed due to small sample sizes and low- plan-act-health-coverage-provisions-explained/. reliability in all but one category. Contact authors for more information on the methodology. 2 R. Rudowitz, B. Corallo, and R. Garfield, “New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending” 6 Estimates for construction industry suppressed due to small sample (Washington DC: Kaiser Family Foundation, March 2021), available at sizes and low-reliability in one category. Contact authors for more https://www.kff.org/medicaid/issue-brief/new-incentive-for-states-to- information on the methodology. adopt-the-aca-medicaid-expansion-implications-for-state-spending/. 3 Kaiser Family Foundation, “Who Could Medicaid Reach with Expansion in Tennessee?” (Washington DC: Kaiser Family Foundation, February 2021), available at https://files.kff.org/attachment/fact-sheet- medicaid-expansion-TN. 4 All data are derived from the American Community Survey (2019). Most data come from the Public Use Microdata Sample; county data calculated from American Community Survey five-year (2015-2019) prepared tables. Contact authors for more information on sources of data and methods. May 2021 CCF.GEORGETOWN.EDU Tennessee’s low-wage, uninsured workers 3