The current state of employment-based health coverage

Journal of Law, Medicine and Ethics

Volumn 32, Issue 3, 2004, Pages 404-409

  Glied, Sherry A ^a   Borzi, Phyllis C ^b  

^a NewYork Presbyterian Hospital   (United States)

^b GEORGE WASHINGTON UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CONFERENCE PAPER; EMPLOYER; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH INSURANCE;

EID: 5044220680     PISSN: 10731105     EISSN: None     Source Type: Journal    
DOI: 10.1111/j.1748-720X.2004.tb00150.x     Document Type: Conference Paper

References (63)

1. A.C. Enthoven, "Employment-Based Health Insurance Is Failing: Now What?" Health Affairs Web Exclusive (May 28, 2003) 〈http://content. healthaffairs.org/cgi/content/full/hlthaff.w3.237v1/DC1〉 (last visited July 1, 2004); J.R. Gabel, "Job-Based Health Insurance, 1977-1998: The Accidental System Under Scrutiny," Health Affairs 18, no. 6 (1999): 62-74; M. Pauly, A. Percy and B. Herring, "Individual Versus Job-Based Health Insurance: Weighing the Pros and Cons," Health Affairs 18, no. 6 (1999): 28-44; U.E. Reinhardt, "Employer-Based Health Insurance: A Balance Sheet," Health Affairs 18, no. 6 (1999): 124-132; D.A. Hyman and M. Hall, "Two Cheers for Employment-Based Health Insurance," Yale Journal of Health Policy, Law, and Ethics 2, no. 1 (2001): 23-57.
2. A.C. Enthoven, "Employment-Based Health Insurance Is Failing: Now What?" Health Affairs Web Exclusive (May 28, 2003) 〈http://content. healthaffairs.org/cgi/content/full/hlthaff.w3.237v1/DC1〉 (last visited July 1, 2004); J.R. Gabel, "Job-Based Health Insurance, 1977-1998: The Accidental System Under Scrutiny," Health Affairs 18, no. 6 (1999): 62-74; M. Pauly, A. Percy and B. Herring, "Individual Versus Job-Based Health Insurance: Weighing the Pros and Cons," Health Affairs 18, no. 6 (1999): 28-44; U.E. Reinhardt, "Employer-Based Health Insurance: A Balance Sheet," Health Affairs 18, no. 6 (1999): 124-132; D.A. Hyman and M. Hall, "Two Cheers for Employment-Based Health Insurance," Yale Journal of Health Policy, Law, and Ethics 2, no. 1 (2001): 23-57.
3. A.C. Enthoven, "Employment-Based Health Insurance Is Failing: Now What?" Health Affairs Web Exclusive (May 28, 2003) 〈http://content. healthaffairs.org/cgi/content/full/hlthaff.w3.237v1/DC1〉 (last visited July 1, 2004); J.R. Gabel, "Job-Based Health Insurance, 1977-1998: The Accidental System Under Scrutiny," Health Affairs 18, no. 6 (1999): 62-74; M. Pauly, A. Percy and B. Herring, "Individual Versus Job-Based Health Insurance: Weighing the Pros and Cons," Health Affairs 18, no. 6 (1999): 28-44; U.E. Reinhardt, "Employer-Based Health Insurance: A Balance Sheet," Health Affairs 18, no. 6 (1999): 124-132; D.A. Hyman and M. Hall, "Two Cheers for Employment-Based Health Insurance," Yale Journal of Health Policy, Law, and Ethics 2, no. 1 (2001): 23-57.
4. A.C. Enthoven, "Employment-Based Health Insurance Is Failing: Now What?" Health Affairs Web Exclusive (May 28, 2003) 〈http://content. healthaffairs.org/cgi/content/full/hlthaff.w3.237v1/DC1〉 (last visited July 1, 2004); J.R. Gabel, "Job-Based Health Insurance, 1977-1998: The Accidental System Under Scrutiny," Health Affairs 18, no. 6 (1999): 62-74; M. Pauly, A. Percy and B. Herring, "Individual Versus Job-Based Health Insurance: Weighing the Pros and Cons," Health Affairs 18, no. 6 (1999): 28-44; U.E. Reinhardt, "Employer-Based Health Insurance: A Balance Sheet," Health Affairs 18, no. 6 (1999): 124-132; D.A. Hyman and M. Hall, "Two Cheers for Employment-Based Health Insurance," Yale Journal of Health Policy, Law, and Ethics 2, no. 1 (2001): 23-57.
5. A.C. Enthoven, "Employment-Based Health Insurance Is Failing: Now What?" Health Affairs Web Exclusive (May 28, 2003) 〈http://content. healthaffairs.org/cgi/content/full/hlthaff.w3.237v1/DC1〉 (last visited July 1, 2004); J.R. Gabel, "Job-Based Health Insurance, 1977-1998: The Accidental System Under Scrutiny," Health Affairs 18, no. 6 (1999): 62-74; M. Pauly, A. Percy and B. Herring, "Individual Versus Job-Based Health Insurance: Weighing the Pros and Cons," Health Affairs 18, no. 6 (1999): 28-44; U.E. Reinhardt, "Employer-Based Health Insurance: A Balance Sheet," Health Affairs 18, no. 6 (1999): 124-132; D.A. Hyman and M. Hall, "Two Cheers for Employment-Based Health Insurance," Yale Journal of Health Policy, Law, and Ethics 2, no. 1 (2001): 23-57.
6. T. Francis, "Medicare Law Helps Business: A Few Major Corporations Expect Combined Savings in Excess of $2.5 Billion," Wall Street Journal, March 2, 2004.
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8. "EBRI Research Highlights: Health Benefits," EBRI Special Report SR-41, Issue Brief, no. 247 (Washington, D.C.: Employee Benefit Research Institute, 2003): 21 at Figure 18; "Employer Health Benefits 2003 Annual Survey: Summary of Findings," (Washington, D.C.: Kaiser Family Foundation/Health Research and Educational Trust, 2003) [hereinafter cited as Kaiser/HRET 2003 Summary]: 5, available at 〈http://www.kff.org/insurance/ loader.cfm?url=/commonspot/security/getfile.cfm&PageID=20 688〉 (last visited June 23, 2004).
9. S. Glied, "The Employer-Based Health Insurance System: Mistake or Cornerstone?" in D. Mechanic, L. Rogut, D. Colby and J. Knickman, eds., Policy Challenges in Modern Health Care (New Jersey: Rutgers University Press, 2005).
10. J. Sheils and R. Haught, "The Cost of Tax-Exempt Health Benefits in 2004," Health Affairs Web Exclusive (February 25, 2004): W4-106-112 〈http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.106v1/ DC1〉 (last visited July 1, 2004): This number includes expenditures for the following types of favorable tax treatment for health plans: (1) deductibility of employer contributions to an employment-based health plan, (2) non-inclusion in employee income of the amount their employer pays on their behalf for health insurance, (3) tax-exempt treatment for any investment income that was generated if the employer's health plan was fanded, and (4) deductibility of health insurance premiums for the self-employed.
11. Id., at W4-110.
12. EBRI Special Report, supra note 3, at 35, table 32.
13. E. O'Brien, "Employers' Benefits from Workers' Health Insurance," Milbank Quarterly 81, no. 1 (2003): 5-43; T.C. Buchmueller, The Business Case for Employer-Provided Health Benefits: A Review of the Relevant Literature (Irvine, CA: California HealthCare Foundation, 2000).
14. E. O'Brien, "Employers' Benefits from Workers' Health Insurance," Milbank Quarterly 81, no. 1 (2003): 5-43; T.C. Buchmueller, The Business Case for Employer-Provided Health Benefits: A Review of the Relevant Literature (Irvine, CA: California HealthCare Foundation, 2000).
15. O'Brien, id.
16. J. Newhouse, Free for All: Lessons from the RAND Health Insurance Experiment (Cambridge: Harvard University Press, 1993).
17. Buchmueller, supra, note 8; O'Brien, supra note 8.; R.C. Kessler, et. al., "The Effects of Chronic Medical Conditions on Work Loss and Work Cutback," Journal of Occupational and Environmental Medicine 43, no. 3 (2001a): 218-225.
18. Buchmueller, supra, note 8; O'Brien, supra note 8.; R.C. Kessler, et. al., "The Effects of Chronic Medical Conditions on Work Loss and Work Cutback," Journal of Occupational and Environmental Medicine 43, no. 3 (2001a): 218-225.
19. Buchmueller, supra, note 8; O'Brien, supra note 8.; R.C. Kessler, et. al., "The Effects of Chronic Medical Conditions on Work Loss and Work Cutback," Journal of Occupational and Environmental Medicine 43, no. 3 (2001a): 218-225.
20. P. Fronstin, "Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2003 Current Population Survey." EBRI Issue Brief, no. 264 (Washington, D.C.: Employee Benefit Research Institute, 2003): 4 (citing P. Fronstin and S. Snider, "An Examination of the Decline in Employment-Based Health Insurance Between 1988 and 1993," Inquiry (Winter 1996/97):317-325).
21. P. Fronstin, "Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2003 Current Population Survey." EBRI Issue Brief, no. 264 (Washington, D.C.: Employee Benefit Research Institute, 2003): 4 (citing P. Fronstin and S. Snider, "An Examination of the Decline in Employment-Based Health Insurance Between 1988 and 1993," Inquiry (Winter 1996/97):317-325).
22. I b i d.
23. J. Holahan and M. Wang, "Changes in Health Insurance Coverage During the Economic Downturn: 2000-2002." Health Affairs Web Exclusive (January 28, 2004): W4-31-42, at W4-32 〈http://content.healthaffairs.org/cgi/ content/full/hlthaff.w4.31v1/DC1〉 (last visited July 1, 2004).
24. Kaiser/HRET 2003 Summary, supra note 3, at 5; 91 percent of firms that employ union workers offer health insurance compared with 60 percent of firms that do not have union employees, "Employer Health Benefits 2003 Annual Survey," (Washington, D.C.: Kaiser Family Foundation/Health Research and Educational Trust) [hereinafter cited as Kaiser/HRET 2003 Survey]: 38, available at 〈http://www.kff.org/insurance/ehbs2003-abstract.cfm〉 (last visited June 23, 2004).
25. Kaiser/HRET 2003 Summary, supra note 3, at 5; 91 percent of firms that employ union workers offer health insurance compared with 60 percent of firms that do not have union employees, "Employer Health Benefits 2003 Annual Survey," (Washington, D.C.: Kaiser Family Foundation/Health Research and Educational Trust) [hereinafter cited as Kaiser/HRET 2003 Survey]: 38, available at 〈http://www.kff.org/insurance/ehbs2003-abstract.cfm〉 (last visited June 23, 2004).
26. Holahan and Wang, supra note 14, at W4-39-40; 82.6 percent of employees in large firms had health insurance coverage, while only 53.6 percent of workers in small firms had coverage.
27. Fronstin, supra note 12, at Figure 10.
28. Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, "Table I.A.2(2001) Percent of private-sector establishments that offer health insurance by firm size and selected characteristics: United States, 2001," (Medical Expenditure Panel Survey-Insurance Component, 2001) at
29. J.L. Medoff, H. B. Shapiro, M. Calabrese, and A.D. Harless, "How the New Labor Market is Squeezing Workforce Health Benefits," The Commonwealth Fund 449 (2001).
30. S. Glied and M. Stabile, "Explaining the Decline in Health Insurance Coverage Among Young Men," Inquiry 37, no. 3 (2000): 295-303; G. Acs, "Explaining Trends in Health Insurance Coverage Between 1988 and 1991," Inquiry 32, no. 1 (1995): 102-110.
31. S. Glied and M. Stabile, "Explaining the Decline in Health Insurance Coverage Among Young Men," Inquiry 37, no. 3 (2000): 295-303; G. Acs, "Explaining Trends in Health Insurance Coverage Between 1988 and 1991," Inquiry 32, no. 1 (1995): 102-110.
32. S. Glied, J.M. Lambrew and S. Little, "The Growing Share of Uninsured Workers Employed by Large Firms," Commonwealth Fund. 672 (2003); Medoff et. al., supra, note 19.
33. R. Kronick and T. Gilmer, "Explaining the Decline in Health Insurance Coverage, 1979-1995," Health Affairs 18, no. 2 (1999): 30-47.
34. S. Glied and K. Jack, "Macroeconomic Conditions, Health Care Costs, and the Distribution of Health Insurance," National Bureau of Economic Research (NBER), working paper no. w10029, (October 2003).
35. Fronstin, supra note 12, at 13 and 17, Figure 15.
36. Kaiser/HRET 2003 Summary, supra note 3, at 5.
37. Fronstin, supra note 12, at Figure 16.
38. Glied, supra note 4; tabulations of the March 2003 Current Population Survey; S. Hippie, "Contingent Work in the Late 1990s," Monthly Labor Review 124, no. 3 (2001): 3-27.
39. Glied, supra note 4; tabulations of the March 2003 Current Population Survey; S. Hippie, "Contingent Work in the Late 1990s," Monthly Labor Review 124, no. 3 (2001): 3-27.
40. U. Reinhardt, "Health Care Spending and American Competitiveness," Health Affairs 8, no. 4 (1989): 5-21.
41. The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), P.L. 99-272 (April 7, 1986), requires employment-based health plans to offer "qualified beneficiaries" who would otherwise lose coverage under the plan because of the occurrence of a "qualifying event," the right to continue their health coverage for a specified period of time by paying 102% of the cost of coverage. Employees who terminate employment (either voluntarily or involuntary) may generally continue coverage for up to 18 months, unless they become covered under another group health plan or first become eligible for Medicare during that period. Continuation coverage can also be terminated for certain other reasons, such as non-payment of premiums.
42. J. Gruber and B.C. Madrian, "Health Insurance, Labor Supply, and Job Mobility: A Critical Review of the Literature," NBER working paper no. w8817 (February 2002).
43. The Health Insurance Portability and Accountability Act of 1996 (HIPAA), P.L. 104-191 (August 21, 1996), provides protections for employees in group health plans from the imposition of waiting periods or additional preexisting condition restrictions. In addition, it protects employees from discrimination in their health plans based on health-related factors. Much more limited protections apply to products sold in the individual marketplace so that employees with existing health problems who lose their jobs and then need to purchase individual coverage may find it difficult to secure that coverage. For a discussion of coverage portability, see J. Meyer and L. Stepnick, "Portability of Coverage: HIPAA and COBRA," Commonwealth Fund Issue Brief 569 (November 2002).
44. The Health Insurance Portability and Accountability Act of 1996 (HIPAA), P.L. 104-191 (August 21, 1996), provides protections for employees in group health plans from the imposition of waiting periods or additional preexisting condition restrictions. In addition, it protects employees from discrimination in their health plans based on health-related factors. Much more limited protections apply to products sold in the individual marketplace so that employees with existing health problems who lose their jobs and then need to purchase individual coverage may find it difficult to secure that coverage. For a discussion of coverage portability, see J. Meyer and L. Stepnick, "Portability of Coverage: HIPAA and COBRA," Commonwealth Fund Issue Brief 569 (November 2002).
45. Kaiser/HRET 2003 Survey, supra note 15, at 62-64 and Exhibits 4.2, 4.3, 4.4.
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47. Reinhardt, supra note: 28, at 1.
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54. The percentage of employers offering retiree medical benefits; has fallen from 66 percent of large firms (5000 employees or more) in 1998 to only 38 percent in 2003; Kaiser/HRET 2003 Survey, supra note 15, at 132 and Exhibit 11.1.
55. U.S. Bipartisan Commission on Comprehensive Health Care, A Call for Action: Final Report (Washington, U.S. Government Printing Office, 1990).
56. G.R. Wilensky, "Viable Strategies for Dealing with the Uninsured," Health Affairs 6, no. 1 (1987): 33-46.
57. M. Merlis, "Public Subsidies for Employees' Contributions to Employer-Sponsored Insurance," Inquiry 38, no. 2 (2001): 121-32.
58. S. Silow-Carroll, E.K. Waldman and J.A. Meyer, "Expanding Employment-Based Health Coverage: Lessons from Six State and Local Programs," Commonwealth Fund 445 (2001).
59. J.A. Meyer and E.K. Wicks, "A Federal Tax Credit to Encourage Employers to Offer Health Coverage," Inquiry 38, no. 2 (2001): 202-213.
60. S. Rosenbaum, P.C. Borzi and V. Smith. "Allowing Businesses and the Self-Employed to Buy Health Care Coverage Through Public Programs," Inquiry 38, no. 2 (2001): 193-201.
61. R. Helman and R. Chrisensen, "Findings From the 2003 Health Confidence Survey: Americans Increasingly Worried About Health Care Costs," EBRI Notes (Employee Benefits Research Institute, October 2003): 5.
62. I b i d.
63. I b i d.