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With job opportunities in middle-skilled occupations declining, it is important to understand differences in outcomes of middle- and higher-skilled adults in the labor force and other areas of well-being. This paper uses data from Program for the International Assessment of Adult Competencies (PIAAC), to compare middle-skilled and higher-skilled U.S. adults - in literacy and numeracy – by employment and health-related indicators. Middle-skilled adults showed less positive outcomes than high-skilled adults along various measures, including showing lower rates of being employment, less employment in skilled occupations, lower incomes, lower self-reported health status, and less use of preventative health screenings. The findings highlight the importance of continuing skills development for middle-skilled adults, with benefits for employment and areas beyond the labor market.