P. Fronstin, Workers' Health Insurance: Trends, Issues, and Options to Expand Coverage, The Commonwealth Fund, March 2006
Since World War II, employment-based health benefits have been the foundation of health insurance for the under-65 population, providing the primary source of coverage for the vast majority of workers and their dependents. In 2004, more than 100 million workers, or 71 percent of the adult working population, were covered by employment-based health benefits. Taking into account all adults under age 65, the employment-based health benefits system covered 159.1 million individuals, or 62 percent of the nonelderly population (Figure 1).
In recent years, this foundation has been eroding, resulting in an increasing number of working adults without health insurance coverage and forecasts of continuing declines in coverage. The growing share of the workforce without health insurance has negative implications for individuals and the larger economy. The Institute of Medicine (IOM) conducted a series of studies on the consequences of uninsurance and found the following:
To reverse these trends and expand coverage for workers and their families, a range of public and private policies are under discussion. The approaches vary in the extent to which they would build on the employment-based system, adapt the non-group or individual market, or expand public programs. This report highlights recent trends in employment-based health benefits and compares an array of policy approaches that seek to expand coverage.