As states and the federal government struggle to come up with enough money for Medicaid and other public health insurance programs, legislators around the country are wondering if big firms like Wal-Mart, which has thousands of uninsured employees relying on the government for health care, are pulling their weight.

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Two separate bills have been introduced in the state Legislature that would direct the Department of Public Welfare to develop a list of companies of a certain size -- 20 workers in one version, 50 in another -- whose workers, spouses and dependants get coverage under the state's version of Medicaid. A similar bill applying to all states was introduced in Congress in June.

But if the ultimate goal is to shift health insurance costs to big employers, the effort is bound to run up against a stubborn economic truth: The Wal-Mart way of handling health insurance is the approach that many retail and service companies are taking. And retail -- with tight profit margins that limit employee benefits -- is where the employment growth is. Stick the industry with additional costs, and job growth could suffer.

"When we looked at where the uninsured were working, the highest percentages were in retail and service," said Ann Torregrossa, senior policy manager in Gov. Ed Rendell's Office of Health Care Reform, describing a recent study of the uninsured in Pennsylvania. "That gave us pause because that's the fastest growing segment of our economy."

The Pennsylvania bills are modeled on legislation in Massachusetts, where a February report found nearly 140 employers with 50 or more workers on their payrolls who also were using public assistance.

Almost all were retail or service establishments, including Dunkin' Donuts, the Stop & Shop grocery chain, Wal-Mart, McDonald's, CVS Pharmacy, Home Depot, Target and Sears. Also on the list were the city of Boston, several hospitals and the U.S. Postal Service.

Pennsylvania hasn't done its own count of workers on the state's version of Medicaid, but the state Department of Insurance did perform a limited analysis in November of membership in adultBasic, a state-funded health insurance program for a slightly higher-income group of people.

The study of 15,630 applications to the program showed 6,549 people worked for employers that had at least two workers in adultBasic, with the largest group of workers -- 976 -- in the "other" category, which included maid services, dry cleaners and hair salons. Retailers such as Kmart, Wal-Mart and Target were next, employing 946 of the enrollees, followed by restaurants and food service companies at 706.

There are various reasons why the retail industry has a lot of employees without coverage, said K. Conwell Smith, senior director of government relations for the National Retail Federation, an industry lobbying organization.

For example, 43 percent of retail workers are part-time and many do not stay at one place for extended periods of time. While critics might argue that is because many sales positions do not hold promise for great careers, the flip side is many workers do not want a major commitment or are simply entering their first -- but not final -- job, she said. More than half of retail employees are under 34, and a third are under 24, she said.

Providing health insurance benefits immediately for such part-time workers who may stay just a few months would dramatically bump up administrative costs, Smith said. That's a big burden for an industry in which profit margins already average a slim 2 to 3 percent.

Moreover, it's not as if retailers don't provide coverage, she said. Wal-Mart representatives point out the company covers more than 568,000 of its 1.2 million workers, many of whom lacked health insurance or relied on the government before coming to work there.

Union officials like to cite warehouse club Costco Wholesale Club as a firm that provides more extensive benefits and still competes effectively.

Both retailers and non-retailers in the Fortune 500 tend to offer coverage to almost all full-time workers, according to a 2002 study published by the journal Health Affairs.

But because retailers hire many more part-time and seasonal employees who are less likely to receive such benefits, only 62 percent of their workers were offered health insurance, compared with 92 percent for non-retail companies in the Fortune 500, the study said.

Similar forces could explain why so many uninsured Pennsylvanians work for large companies, a finding that raised eyebrows in Harrisburg in May when the state released its survey on health insurance. Lawmakers traditionally have thought it is the smaller mom-and-pop shops that push health coverage by the wayside.

But the report found 70 percent of the 800,000 uninsured people in Pennsylvania worked full- or part-time jobs, 83 percent of those jobs were in retail or service and 20 percent of those workers without coverage said they worked for firms with over 1,000 employees.

The fact that so many uninsured people work for large companies explains why providing tax credits for small employers to provide coverage is an incomplete answer to lowering the uninsured rate, said James Maxwell, director of health policy and management research at John Snow Inc. Research and Training Institute, a consulting firm in Boston.

Solutions such as mandating that employers provide coverage, as critics have demanded of Wal-Mart, don't seem viable in the current political and economic landscape, either, said Alwyn Cassil of the Center for Studying Health System Change, a health policy group in Washington, D.C.

Some say the discussion of whether the Wal-Marts of the world shoulder more health costs does little more than distract from the more important issue of rising costs.

General Motors is confronting questions about its survival in part because it has been so generous in offering health care to existing and retired workers, saddling it with costs that many of its foreign competitors don't confront because of government-sponsored care in those countries.

GM is seeking to slash its health-care coverage, and other domestic automakers as well as steelmakers have been cracking down, too, in a bid to survive and compete in the global economy.

"The fact that the largest employers in the economy are going to great lengths to avoid offering what's been considered traditional, generous health insurance benefits to employees -- is that a precursor of our economy not being able to sustain that level of benefit going forward?" asked Cliff Shannon of the SMC Business Councils, which helps small companies in Pittsburgh purchase health insurance.

"Can we be competitive globally and still provide benefits that cost what they do and are increasing at the pace they're increasing? More than anecdotal evidence says we can't."