Until recently, health insurance eligibility was determined by the various state governments. Although the U.S. government administered various healthcare-related programs like Medicare and Medicaid, it permitted the states to make their own rules with regards to the provision of health insurance and need-based healthcare programs. While most states constructed robust social safety nets that included significant contributions into the national Medicaid fund, there were few state-sponsored health insurance programs for middle-income workers.
Likewise, the means by which employers provided their employees with access to group health insurance benefits were also determined at the state level. In order to compel major employers to provide these benefits for their core employees, most states maintained mandatory eligibility requirements for group health insurance coverage. These typically consisted of an "hours-worked" mandate that enabled employers to provide health insurance benefits to certain "full time" workers. In most cases, "full time" workers were defined as employees who worked more than 30 hours in a given workweek. In some states, the threshold might have been slightly higher.
However, few states actually compelled employers to offer these benefits. Only Massachusetts codified a so-called "individual mandate" that required most of its residents to purchase health insurance. As in other parts of the country, most of the state's residents obtained health insurance benefits through their employers.
Today, this arrangement is largely obsolete. The federal Affordable Care Act now compels most medium-sized and large-scale employers to provide health insurance coverage for all of their full-time workers. Certain significant exceptions exist for smaller employers. For instance, businesses that employ fewer than 50 workers or operate small, widely dispersed facilities across a vast geographical area are exempt from the law.
Enacted in 2009, the Affordable Care Act was politically contentious. During the drafting and debate phases of the law's development, some politicians argued that the proposed bill should be more inclusive. These individuals proposed amending the bill to require employers to provide health insurance for part-time as well as full-time employees. Others argued that this would represent an undue burden for many low-margin businesses like restaurants and grocery stores. Ultimately, the current compromise was reached and passed into law.
Under the new health insurance law, part-time or unemployed workers who can't procure health insurance through their employers may still be able to find affordable coverage. The law mandates the creation of so-called "healthcare exchanges" that operate within specific states and permit individuals to purchase single-coverage plans at reduced rates.