When the government starts helping low-wage workers pay for health insurance next year, 6,704 Oklahoma cooks will be left empty-handed.
So will 6,154 cashiers, 4,572 waiters, 4,207 housekeepers and 3,870 retail salespeople, an Oklahoma Watch data analysis shows.
They are among 109,227 uninsured Oklahoma workers whose annual incomes fall below the federal poverty level, making them ineligible for health-insurance tax credits that take effect in January.
Most of them also are ineligible to participate in SoonerCare, Oklahoma's version of Medicaid, because it doesn't cover most working adults unless they have dependent children, and then only if they make less than $4,368 a year for a two-person family.
The Oklahoma Watch analysis uses Census Bureau survey data to determine which occupations and employers have the largest number of uninsured working people who will remain stuck in the health care “coverage crater” — a gap created by the state's decision not to expand Medicaid under the Affordable Care Act.
The working poor comprise a little more than a third of the total coverage crater population. According to census data, 283,329 uninsured adults fell below the federal poverty line. But many of those people were not employed during the 12 months before the Census Bureau survey.
Of those who were employed, the analysis shows that many held low-wage jobs in fields such as construction, food service, retail establishments, janitorial firms and landscaping services — sectors responsible for some of the highest rates of job growth in recent years.
Some of those industry groups pay among the lowest wages and have among the lowest rates of insurance coverage, the data shows. In the landscaping business, for example, average annual wages are $11,361, and 61 percent of all workers are uninsured.
Among restaurants and food service firms, average annual wages are $13,326, and 48 percent of workers are uninsured. In hotels and motels, workers are paid $15,456 on average, and 59 percent are uninsured.
Cassie Clark, who works part-time as an administrative assistant at an Oklahoma City dance and fitness studio, falls into the coverage crater. Clark, 25, plans to return to college this fall and expects her annual income will fall below $11,000. Her employer doesn't offer health insurance, and she doesn't think she can afford a policy on her own.
“It would be a third or a quarter of my monthly income just to have insurance,” Clark said. “It's almost like a luxury item.”
The analysis casts new light on an important segment of the population at the center of the ongoing debate over the Affordable Care Act, also known as Obamacare.
When the act was signed into law, it divided lower-income Americans into two overlapping groups.
Uninsured people making below 138 percent of the poverty level would receive coverage through an expansion of Medicaid. Uninsured people making between 100 percent and 400 percent of the poverty level could buy insurance on new online federal or state exchanges and receive tax credits to offset part of the cost.
The exchanges will begin accepting applications in October. The tax credits will take effect in January. But the U.S. Supreme Court ruled that the federal government could not force states to expand Medicaid if they didn't want to. Oklahoma is among more than 20 states that have either rejected Medicaid expansion or appear headed in that direction.
State leaders are studying a proposal by an independent consulting firm to develop an “Oklahoma Plan” that would help uninsured adults obtain coverage. But if officials stick with the status quo, Oklahomans in the coverage crater will remain there, ineligible for SoonerCare and too poor to receive tax credits.
“It's the working poor,” said Kris King, lead organizer for Voice, an Oklahoma City advocacy group. “In Oklahoma we have almost this two-tiered society. There are groups of people that are making absolutely low-wage jobs and not getting any benefits.”
The Oklahoma Watch study is based on findings from a 2011 Census Bureau survey, the most recent data available. It is limited to those Oklahomans between the ages of 18 and 64 who reported having no health insurance, either public or private, and who had been employed at some point during the previous 12 months.
Those populations were then analyzed to determine which industry groups and occupations had the highest numbers and rates of uninsured workers.
Of the 424,173 Oklahoma workers who have no insurance, 109,227 had family incomes below the poverty level, placing them in the coverage crater. The federal poverty level is $11,490 for a single person and $15,510 for a two-person family. Each additional dependent increases the level by $4,020.
Some types of employment account for a disproportionately large number of uninsured workers with incomes below the poverty line: 20,220 people in food preparation and serving jobs, 12,869 in construction trades, 12,758 office workers, 11,980 retail salespeople and 11,739 janitors and housekeepers.
Chris Lewis, president of First Maintenance Co., does not offer health insurance to the more than 300 janitors who work for him, mainly at night, cleaning more than 6 million square feet of office space in and around Oklahoma City.
Lewis said most of his employees work about four hours per night, often as a second job. He pays them the equivalent of about $10 an hour on a per-job basis. Janitorial services contracting is a highly competitive, labor-intensive industry, he said, and his gross profits run about $200 to $300 per month per employee.
“Sure, I'd like to be able to do that,” Lewis said. “But if you're grossing $200 per person per month, can you buy each person a $250 health care plan? No, you can't.”
In some categories of employment, more than half of below-poverty-line workers have no insurance: 89 percent of roofers, 87 percent of stock clerks, 85 percent of carpenters, 84 percent of construction laborers and 81 percent of landscapers.
Restaurants and other food establishments account for many of the uninsured. Among all cooks, waiters, kitchen help and other food-service employees, for example, 67 percent of those below the poverty line have no insurance.
Some of those may be by choice.
Chris Lower, part owner of four Oklahoma City restaurants, said he offered nearly 100 employees the opportunity to participate in Insure Oklahoma, a program that subsidizes health insurance coverage for workers with state tax funds and employer contributions. His workers were asked to pay only 15 percent of the total monthly premium.
Fewer than 10 employees wanted to take part, Lower said.
“We passed that out to almost 40 people at Big Truck (Tacos) and had one person sign up. I was shocked,” he said.
“Unless an employer is going to fund 100 percent of the employee's benefits, it's hard to get somebody who's making $24,000 a year to pay for even a small part of their benefits,” Lower said. “A lot of these are young people who think they're bulletproof.”
Under the Affordable Care Act, employers with more than 50 full-time-equivalent employees will be required to offer affordable health care workers beginning in 2015. Uninsured people will be required to obtain insurance policies or pay a penalty, starting at $95 per adult in 2014 and rising to $625 per adult in 2016. In states that refuse to expand Medicaid, those earning less than the poverty level will not have to pay the penalty.
Christy Johnson, 38, is a single mother who earns about $9 an hour for a small telecommunications firm. Her employer doesn't provide health insurance. Even if it did, she doesn't think she could afford her share of the monthly premiums.
“I wouldn't have a couple of hundred per month for that,” she said. “I could squeeze out, maybe, $75 a month.”
Johnson's 13-year-old daughter is covered by SoonerCare because she's a minor, but Johnson doesn't qualify. So she's come up with her own alternative health care plan to deal with occasional illness.
“I take NyQuil,” she said.