Employment, Marriage, and Inequality in Health Insurance for Mexican-Origin Women

Abstract

In the United States, a woman's health insurance coverage is largely determined by her employment and marital roles. This research evaluates competing hypotheses regarding how the combination of employment and marital roles shapes insurance coverage among Mexican-origin, non-Hispanic white, and African-American women. We use data from the 2004 and 2006 March Supplements to the Current Population Surveys. Results show these roles largely substitute for each other among non-Hispanic white and African-American women, although marriage generally increases the odds of coverage slightly more than employment among non-Hispanic white women. In contrast, these roles cumulatively increase the odds among Mexican-origin women. Yet, neither employment, nor marriage, nor their combination assures their coverage. Married Mexican-origin women are particularly disadvantaged. As women increasingly spend a smaller fraction of their lives married, and as benefit-rich occupations are the purview of few women, stable and equitable coverage may require a universal health insurance system.In the United States, a woman's health insurance coverage is largely determined by her employment and marital roles. During the second half of the twentieth century, women increasingly entered the workforce and many now assume full responsibility for their health insurance coverage. Yet for women, as for men, employment is no guarantee of health insurance. While highly educated professional women tend to have health insurance, poorly educated women who work in the low-wage service sector often do not. Despite the growing number of women who obtain health insurance through their own employment, marriage continues to represent a significant source of insurance for a large fraction of women (Harrington Meyer and Pavalko, 1996;Moen and Roehling, 2005). As is the case with employment, marriage is no guarantee of health insurance. The smaller economic gains from marriage for some women, coupled with the current climate of marital instability, means that marriage is neither a likely nor a long-term source of insurance for many. Furthermore, historically institutionalized gender roles, occupational segregation, and wage gaps place many women at a disadvantage relative to men in terms of their own employment-based health insurance, which can increase their reliance on men as the primary economic provider in marriage (Orloff, 1993;Pascall and Lewis, 2004).In addition to gender, minority group status constitutes a significant structural barrier to health insurance in the United States. Compared to non-Hispanic whites, African-American and Mexican-origin adults are more likely to be employed in low-wage jobs that do not offer coverage. Among the working age population, 45% of Mexican-origin adults lack coverage, compared to 24% of non-Hispanic Blacks, and 13% of non-Hispanic whites (Angel, Angel, and Lein, 2007b). Given the long history of minority exclusion from full employment in the *Address correspondence to Jennifer Karas Montez, University of Texas...

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