Employer-based coverage is often unavailable or unaffordable. Most people under age 65 who have health insurance are covered by insurance from their employer or that of a family member. Uninsured people who have jobs may face one or more of the following barriers:

• Smaller employers are less likely to offer health insurance to their employees because premiums are prohibitively expensive. In 2000, about 17 percent of Texas workers worked for small employers (defined as firms with fewer than 20 employees). Nationally, about 30 percent of workers in firms with fewer than 25 employees are uninsured.
  
  
• Service and labor jobs are less likely to provide workers with health insurance. About 63 percent of uninsured workers hold service and labor jobs, although these jobs only make up about 40 percent of the workforce.
  
  
• Part-time workers are often not eligible for insurance.
  
  
• Even when employers offer health insurance to low-wage workers, the premiums tend to be higher than for higher-paid workers. Low-wage workers have a harder time affording these premiums and are more likely to remain uninsured.

People who lose their jobs often lose their health insurance.

• Nationwide, for every 100 people who become unemployed, 85 people, including family members, lose their health insurance. Increases in unemployment since 2001 have contributed to growth in the number of uninsured. The unemployment rate in Texas has increased from an average of 4.2 percent in 2000 to 6.5 percent in September 2003.
  
  
• Some workers who lose their jobs may be eligible to keep their health insurance through COBRA, but in 1999, nationwide, only about one in fourteen of unemployed workers (7 percent) were eligible for and used COBRA insurance.

Buying coverage in the private individual market is often prohibitively expensive.

• In 2002, a typical standard individual health insurance policy in Texas cost $3,408 per year for a healthy 25-year old woman and $6,768 per year for a health 55-year old woman. A healthy single woman with earnings equal to the poverty level of $8,980 per year would have to spend about 40 to 80 percent of her entire income on health insurance to buy such a policy.
  
  
• People with any sort of health problem or risk factor, from hay fever to HIV, have to pay significantly more for private insurance, or may not be able to obtain insurance at all. In one study, hypothetical consumers with various health problems were rejected entirely by private insurers 37 percent of the time, regardless of their ability to pay.

The healthcare safety net leaves many people uncovered, especially adults. Contrary to public perception, many low-income people, especially adults, cannot qualify for health insurance through safety net programs like Medicaid. More than 80 percent of all uninsured adults nationwide with incomes below 200 percent of the federal poverty level are ineligible for Medicaid and other public health insurance programs.