The Health Status of Workers Who Decline Employer-Sponsored Insurance:

Why do so Many Workers in Less-Than-Perfect Health Turn Down Their Employer's Offer of Health Coverage?

November 2001
Health Affairs , Vol. 20, No. 6
Linda J. Blumberg, Len M. Nichols

his paper uses data from the 1997 National Health Interview Survey to compare workers who decline employers' offers of health insurance (decliners) with comparison groups of workers who take up offers of employer coverage and those who do not have such offers. Uninsured decliners fare much worse than coverage takers on every mental health measure. While the evidence on physical health measures is somewhat mixed, decliners who are not healthy appear to have greater difficulty obtaining needed services than do workers who take up employer coverage, although decliners tend to have somewhat better access than do the uninsured who are not offered such coverage.

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