"Research on employer provided health insurance has shown that worker characteristics, wages and unionization influence the prevalence of health insurance. Using the SIPP, this research confirms that these factors are also important in the construction industry. However, in this volatile industry populated by small firms, the institution of collectively bargained multiemployer health trust funds provides an additional impetus for the delivery of health insurance by exploiting cross-firm economies of scale in the purchase of health insurance services and reducing the barriers to health insurance created by firm-labor turnover through the creation of cross-employer portable health benefits that do not require multiple probation periods and tolerate spells of unemployment. Additionally, while there is a countercyclical pattern of health coverage in the nonunion sector associated with the shedding of marginal workers and contractors in the downturn, this countercyclical pattern is not present in unionized construction. The greater insurance coverage of marginal unionized workers facilitated by multiemployer trust-fund efficiencies means that the shedding of marginal workers in the downturn does not disproportionately shed workers who are not covered by insurance."

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