Workers and their dependents are increasingly at risk of being uninsured, inadequately insured, or lacking in choices among health plans. Although employer-sponsored health insurance remains the foundation for coverage of working families, it has eroded steadily during much of the past decade, and all indicators point to further decline in the next century. Reduced employer commitment to health benefits for workers reflects economic pressures to cut labor costs and compete in an international market, as well as the impact of international competition on the composition of U.S. jobs. The resulting economic pressures on workers—especially unskilled and low-wage workers—are severe. If employers do not offer health insurance coverage or pay a significant share of the premium, low-wage workers often cannot afford insurance and risk going without coverage.