Employer-sponsored health insurance is the leading source of health insurance for non-elderly Americans, reflecting a historical tendency in the United States for health coverage to be accessed through employment. Over the past 65 years, General Motors autoworkers have had access to increasingly comprehensive health insurance plans, which have set the standard for employer-based health coverage in the United States. However, as part of GM’s 2009 bankruptcy and restructuring measures, GM and the United Auto Workers (UAW) union agreed to cuts to coverage, illustrating not only the strain of the financial crisis on auto industry employees, but also hinting at larger shifts within the American economy, whereby millions of newly unemployed were loosing their health insurance altogether. The financial crisis also coincided with the passing of the Affordable Care Act (ACA). This dissertation explores GM workers’ ideas about health insurance within the context of these economic and political circumstances. Specifically, it examines the ways in which GM employees were constructing ideas of merit and responsibility for health insurance at a time in which popular assumptions about the responsibilities of the individual, the employer, and the state, in the provision of health insurance, were being challenged by the material realities of economic instability, and debate surrounding health reform and the ACA. This study is set at two General Motors manufacturing plants in mid-Michigan, from 2009 to 2011, following the company’s restructuring, and the passage of health reform. Using qualitative methods of semi-structured interviewing and participant observation, as well as discourse analysis of the ACA, this dissertation examines emerging health policy, and the opinions of production workers and managers to understand: 1) notions of deservedness, or moral worthiness, for health insurance; 2) how conflicting ideas about responsibility and merit for health insurance are expressed; and 3) the ways that ideas regarding responsibility for health insurance are manifested in emerging health care policy. I found that for those interviewed, there was an insistence that deservedness for, and morally legitimate claims to, health insurance, are predicated on one’s ability, or willingness, to work. I argue that this reflects not only the structure of employer-sponsored benefits at GM, but also neoliberal understandings of the self and of the state. I further illustrate that participants viewed the individual as responsible for the provision of health insurance, with employers and the state acting as facilitators or regulators of this access. I argue that the ACA reinforces this configuration of responsibilities, reaffirming the role of the individual and the employer in the provision of insurance coverage, while simultaneously divesting the state of the bulk of the responsibility for health insurance. Ultimately, this dissertation shows that, combined, an insistence on the importance of work as a prerequisite to morally legitimate claims to health insurance, the perception that health insurance is an individual responsibility, and the ACA’s reinforcement of the individual and the employer as the primary bearers of responsibility for health insurance, further strengthen and normalize the link between health insurance and employment in the United States.
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