Job-based health insurance, 1977-1998: The accidental system under scrutiny

Health Affairs

Volumn 18, Issue 6, 1999, Pages 62-74

  Gabel, Jon R ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; AGE; AGED; ARTICLE; DEMOGRAPHY; ECONOMICS; EDUCATIONAL STATUS; GOVERNMENT; HEALTH CARE POLICY; HEALTH INSURANCE; HUMAN; INCOME; INSURANCE; LEGAL ASPECT; MIDDLE AGED; ORGANIZATION; QUESTIONNAIRE; RACE; STATISTICS; UNITED STATES;

ADULT; AGE FACTORS; AGED; CONTINENTAL POPULATION GROUPS; EDUCATIONAL STATUS; HEALTH BENEFIT PLANS, EMPLOYEE; HEALTH POLICY; HUMANS; INCOME; INSURANCE COVERAGE; MIDDLE AGED; ORGANIZATIONAL INNOVATION; QUESTIONNAIRES; RESIDENCE CHARACTERISTICS; UNITED STATES; UNITED STATES AGENCY FOR HEALTHCARE RESEARCH AND QUALITY;

EID: 0033219475     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.18.6.62     Document Type: Article

References (31)

1. Fundamentals of Employee Benefit Programs, 5th ed. (Washington: Employee Benefit Research Institute, 1997), 5-9.
2. S. Law, Blue Cross: What Went Wrong? (New Haven, Conn.: Yale University Press, 1974), 11-13.
3. The denominator for this figure is "major medical" insurance. Medicare supplemental, hospital indemnity, and dread-disease policies are not included.
4. In 1977 the Agency for Health Care Policy and Research (AHCPR) was known as the National Center for Health Services Research (NCHSR). The 1977 survey was the National Medical Care Expenditure Survey (NMCES); the 1987 survey was the National Medical Expenditure Survey (NMES); and the 1996 survey was the Medical Expenditure Panel Survey (MEPS).
5. Because I was the project director for both the HIAA and KPMG/KFF surveys, the two survey questionnaires and sample designs are highly similar.
6. For 1977 NMCES methods, see S. Cohen and P. Parley, Estimation and Sampling Procedures in the NMCES Insurance Surveys, DHHS Pub. no. (PHS)84-3369 (Rockville, Md.: NCHSR, 1984); and S. Cohen and W. Kalsbeck, NMCES Estimation and Sampling Variances in the Household Survey, Instruments and Procedures 2, DHHS Pub. no. (PHS)81-3281 (Rockville, Md.: NCHSR, 1981). For 1987 NMES methods, see S. Cohen, R. DiGaetano, and J. Waksburg, Sample Design of the 1987 Household Survey, NMES Methods 3, AHCPR Pub. no. 91-0037 (Rockville, Md.: AHCPR, 1991). For the 1996 MEPS methods, see A. Monheit and J. Vistnes, Health Insurance Status of Workers and Their Families: 1996, MEPS Research Findings 2, AHCPR Pub. no. 97-0065 (Rockville, Md.: AHCPR, 1997).
7. For 1977 NMCES methods, see S. Cohen and P. Parley, Estimation and Sampling Procedures in the NMCES Insurance Surveys, DHHS Pub. no. (PHS)84-3369 (Rockville, Md.: NCHSR, 1984); and S. Cohen and W. Kalsbeck, NMCES Estimation and Sampling Variances in the Household Survey, Instruments and Procedures 2, DHHS Pub. no. (PHS)81-3281 (Rockville, Md.: NCHSR, 1981). For 1987 NMES methods, see S. Cohen, R. DiGaetano, and J. Waksburg, Sample Design of the 1987 Household Survey, NMES Methods 3, AHCPR Pub. no. 91-0037 (Rockville, Md.: AHCPR, 1991). For the 1996 MEPS methods, see A. Monheit and J. Vistnes, Health Insurance Status of Workers and Their Families: 1996, MEPS Research Findings 2, AHCPR Pub. no. 97-0065 (Rockville, Md.: AHCPR, 1997).
8. For 1977 NMCES methods, see S. Cohen and P. Parley, Estimation and Sampling Procedures in the NMCES Insurance Surveys, DHHS Pub. no. (PHS)84-3369 (Rockville, Md.: NCHSR, 1984); and S. Cohen and W. Kalsbeck, NMCES Estimation and Sampling Variances in the Household Survey, Instruments and Procedures 2, DHHS Pub. no. (PHS)81-3281 (Rockville, Md.: NCHSR, 1981). For 1987 NMES methods, see S. Cohen, R. DiGaetano, and J. Waksburg, Sample Design of the 1987 Household Survey, NMES Methods 3, AHCPR Pub. no. 91-0037 (Rockville, Md.: AHCPR, 1991). For the 1996 MEPS methods, see A. Monheit and J. Vistnes, Health Insurance Status of Workers and Their Families: 1996, MEPS Research Findings 2, AHCPR Pub. no. 97-0065 (Rockville, Md.: AHCPR, 1997).
9. For 1977 NMCES methods, see S. Cohen and P. Parley, Estimation and Sampling Procedures in the NMCES Insurance Surveys, DHHS Pub. no. (PHS)84-3369 (Rockville, Md.: NCHSR, 1984); and S. Cohen and W. Kalsbeck, NMCES Estimation and Sampling Variances in the Household Survey, Instruments and Procedures 2, DHHS Pub. no. (PHS)81-3281 (Rockville, Md.: NCHSR, 1981). For 1987 NMES methods, see S. Cohen, R. DiGaetano, and J. Waksburg, Sample Design of the 1987 Household Survey, NMES Methods 3, AHCPR Pub. no. 91-0037 (Rockville, Md.: AHCPR, 1991). For the 1996 MEPS methods, see A. Monheit and J. Vistnes, Health Insurance Status of Workers and Their Families: 1996, MEPS Research Findings 2, AHCPR Pub. no. 97-0065 (Rockville, Md.: AHCPR, 1997).
10. Using the Consumer Price Index (CPI), I have expressed all prices in constant 1998 dollars. A dollar in 1977 would purchase $2.62 in 1998.
11. P. Farley, Private Health Insurance in the United States, Data Preview 23, DHHS Pub. no. 86-3406 (Rockville, Md.: NCHSR, September 1986).
12. These figures are from the Current Population Surveys (CPS) of 1979,1989, and 1996. We were unable to obtain data from the 1977 NMCES and 1996 MEPS on the education level attained by the head of the family. The CPS altered its definition of uninsured in 1987. This change may affect the absolute number and percentage of uninsured persons, but not the relative number of uninsured persons by educational attainment.
13. Note that Exhibit 2 examines coverage from one's employer. Exhibit 1 examines coverage of workers from their employer or coverage from another employer for which a household member works.
14. "Take-up rate" refers to the percentage of eligible employees who accept their firm's coverage offer. See P.F. Cooper and B.S. Schone, "More Offers, Fewer Takers for Employment-Based Health Insurance: 1987 and 1996," Health Affairs (November/December 1997): 142-149.
15. These data are from the HIAA and KPMG/KFF surveys of employers. For the 1988 and 1998 data, statistics are calculated at the firm rather than the establishment level. In some cases, the firm may not offer a plan at all establishments. In addition, in a hypothetical situation in which Aetna offers a POS and a PPO plan, the survey instrument would record this as two plans. Some household-survey respondents may regard this as one plan. Hence, the reader should regard the figures in Exhibit 3 as maximum amounts.
16. KPMG Peat Marwick 1996 Health Benefits Survey and 1998 KPMG/KFF Health Benefits Survey.
17. Data for these calculations are from Parley, Private Health Insurance in the United States; 1988 HIAA Health Benefits Survey; and 1998 KPMG/KFF Health Benefits Survey.
18. 1988, 1989, and 1990 HIAA Health Benefits Surveys; 1991-1997 KPMG Health Benefits Surveys; and 1998 KPMG/KFF Health Benefits Survey.
19. Bureau of Labor Statistics Web site, 146.142.4.24/cgi-bin/surveymost?ee.
20. I have included HMOs as having a $0 network deductible.
21. 1998 KPMG/KFF Health Benefits Survey.
22. These estimates are derived from the 1988 HIAA survey.
23. Fundamentals of Employee Benefit Programs, 35.
24. M. Carroll and R. Arnett III, "Private Health Insurance Coverage in 1977: Coverage, Enrollment, and Financial Experience," Health Care Financing Review (Fall 1979): 3-23.
25. R. Kronick and T. Gilmer, "Explaining the Decline in Health Insurance Coverage, 1979-1995," Health Affairs (March/April 1999): 30-47.
26. B. Bluestone, "The Inequality Express," American Prospect (Winter 1995): 81-83.
27. U.S. Census Bureau, Historic Income Tables-Households (1 June 1999).
28. J. Gabel et al., "Class and Benefits at the Workplace," Health Affairs (May/June 1999): 144-150.
29. For a discussion of studies on the subject, see D. Shactman and S. Altman, "A Study of the Decline in Employment Based Health Insurance" (Prepared for the Council on the Economic Impact of Health Care Reform, Washington, D.C., May 1995).
30. www.bls.gov/news.release/ecopro.table2.htm.
31. www.hcfa.gov/stats/nhe-oact/tables/nhe97.txt.