Understanding the Health and Health Insurance Enrollment of Gig Workers

Abstract
“Gig work” is a critical component of the current United States labor market and has become increasingly
prevalent in recent years. Despite this rise in gig work and the precarious position many of these individuals
face not having access to traditional employer-sponsored health insurance, the health impacts of these jobs and
health insurance coverage rates for this population are generally unknown. According to a recent non-
representative survey, about 1 in 4 gig workers do not have health insurance and there are especially high
uninsurance rates among Hispanic and Black gig workers, suggesting that the rise of nonstandard work
arrangements may exacerbate health disparities by socioeconomic status.
This project will fill this surprising gap in knowledge by leveraging administrative tax records and collecting
novel survey data to characterize the health and health insurance status of gig workers with special emphasis
on disparities based on income, education, race and ethnicity, marital status, urbanicity, and sex. We will use
the universe of tax records to characterize gig workers and examine health insurance rates by source. We will
also study the trajectory of mortality, disability receipt, and earnings for gig workers relative to non-gig
workers. In addition, we will develop, test, and field surveys to understand the health of gig workers and the
unique factors associated with gig work which impact health. The surveys will be fielded on two distinct and
complementary panels. We will construct a gig-focused sample using Upwork, a leading platform connecting
gig workers with clients, as well as a nationally representative sample of workers with an embedded gig worker
subsample from a survey platform. The surveys will also include an experimental treatment whereby half of
respondents will receive a low-cost nudge to purchase health insurance, enabling us to examine how a low-cost
intervention impacts health insurance rates among gig workers and how this varies by socioeconomic status.
We will compare the impacts of this nudge by analyzing a prior executed nudge by the IRS in 2016 and its
effects on health insurance take-up for the gig worker population relative to non-gig workers.
Finally, we will examine whether higher health insurance rates impact mortality for the gig worker population
as well as disability receipt, earnings, and a large set of self-reported health measures. We will examine self-
reported health via a follow-up survey and study disparities. With the tax data, we will directly assess mortality
and whether there are differential impacts based on income and assets. This research represents an important
step in understanding the challenges of an extremely vulnerable group of workers who are becoming an
increasingly important part of the labor market. Documenting the health status and health insurance coverage
of these workers is crucial for identifying effective support mechanisms. By collecting and linking these data to
information on health outcomes and mortality, the study will contribute to the development of well-informed
policies during a time when addressing the needs of gig workers is a prominent focus in the policy landscape.

Grant Number: 1R56AG086462-01A1
NIH Institute/Center: NIH
Principal Investigator: Lisa Abraham