Fragmented Futures: Occupational Stratification and Health Insurance Inequality in the U.S. Labor Market

This study examines how occupational stratification structures access to health insurance in the post-Affordable Care Act U.S. labor market. Drawing on nationally representative public-use data from the American Community Survey, the Current Population Survey, and the National Health Interview Survey, the analysis compares employer-sponsored insurance, public coverage, uninsurance, and access-to-care outcomes across occupational groups, employment arrangements, and intersecting race, gender, and nativity categories. Guided by Weberian stratification, occupational closure, labor market segmentation, intersectionality, and cumulative disadvantage perspectives, the study shows that coverage remains unevenly organized through the labor market. Professional, managerial, educational, and licensed healthcare occupations exhibit high rates of employer-sponsored coverage, while service, manual labor, healthcare support, part-time, contract, and self-employed workers face greater exposure to uninsurance and reliance on public coverage. These gaps are especially salient for women, workers of color, foreign-born workers, and workers concentrated in low-wage care and service occupations. Results are associative rather than causal, but they indicate that employer-linked insurance continues to transmit occupational inequality into health access inequality even after the ACA expanded non-employer coverage pathways. The article contributes to public sociology by connecting work, benefits, and health inequality while identifying policy-relevant reform pathways around coverage portability, Medicaid access, and benefit transparency.