One of the central features of health reform since the 1970s–including the Affordable Care Act–has been its reliance on a foundation of job-based coverage. But that foundation is crumbling, undermined by both the growing costs of health care (to workers and their employers) and by the slipping share of the workforce that can rely on career employment in large (actuarially-diverse, and often unionized) employer groups. This graph plots the decline of job-based health insurance in Iowa over the last decade. This decline has been driven by both declining rates of coverage in key sectors, and by declining employment in sectors with higher rates of coverage  .
Manufacturing, for example, had a job base in Iowa of 244,000 workers in 2002, about 73 percent of whom had job-based health coverage. By 2012, manufacturing had shed 38,000 jobs. If the rate of job-based coverage had held over that decade, this would have meant a loss of about 28,000 jobs with health coverage (73 percent of 38,000). But because the rate of of job-based insurance in manufacturing also slipped over this decade (to under 69 percent) the net loss of “covered jobs” of was much higher–over 36,000.
-  Employment by sector is calculated from the Current Employment Statistics series; job-based coverage by sector is from Elise Gould, A Decade of Decline in Employer-Sponsored Health Coverage (EPI, February 2012) ↩