'Choice of Health Plan: Findings from the 2009 EBRI/MGA Consumer Engagement in Health Care Survey,' and 'Labor Force Participation Rates: The Population Age 55 and Older, 2008'

The labor-force participation rate is increasing for older Americans (those age 55 and older) as older workers are faced with higher health costs and economic losses, according to a new study published by EBRI. <A href="http://www.ebri.org/pdf/PR.865_18Feb10.JobPart.pdf">Press release </A>

Choice of Health Plan: Findings from the 2009 EBRI/MGA Consumer Engagement in Health Care Survey

LIMITED CHOICE: Most employers do not offer a choice of health plan, but when they do, large firms are much more likely than small firms to offer a choice. Because a disproportionate share of those with employment-based health benefits are employed by a large firm, between 50 percent and 60 percent of the covered population has a choice of health plan.

SURVEY RESULTS: The 2009 EBRI/MGA Consumer Engagement in Health Care Survey finds that individuals with a choice of health plan are not only those who tend to work for a large firm, but also individuals with higher incomes and higher education. Individuals with a choice of health plan are more likely than those without a choice to be satisfied with their health plan and health care along a number of dimensions. However, controlling for choice of plan did not change the difference in satisfaction rates between individuals with traditional coverage and those enrolled in consumer-driven health plans and high-deductible health plans, when differences in satisfaction existed.

Labor Force Participation Rates: The Population Age 55 and Older, 2008

THE NEAR ELDERLY AND ELDERLY ARE STAYING IN THE WORK FORCE LONGER: The labor-force participation rate is increasing for those age 55 and older. The percentage of civilian noninstitutionalized Americans age 55 or older who were in the labor force declined from 34.6 percent 1975 to 29.4 percent in 1993. However, since 1993, the labor-force participation rate has steadily increased, reaching 39.4 percent in 2008—the highest level over the 1975–2008 period.

WOMEN ARE THE DRIVING FORCE FOR LONGER PARTICIPATION IN THE WORK FORCE: For those ages 55–64 (the near elderly), this is being driven almost exclusively by the increase of women in the work force; the male participation rate is flat to declining. However, among those age 65 and older (the elderly), labor-force participation is increasing for both males and females.

EDUCATION A MAJOR FACTOR: Education is a strong factor in an individual’s participation in the labor force at older ages: Individuals with higher levels of education are significantly more likely to be in the labor force than those with lower levels of education.

TREND WILL CONTINUE UPWARD: This upward trend among the working near elderly and elderly is not surprising and is likely to continue because of workers’ need for access to employment-based health insurance and for more earning years to accumulate assets in defined contribution (401(k)-type) plans—especially after the 2008 downturn in the stock market and economy. Many Americans also want to work longer, especially among those with more education.

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(1) do not of ACS er- fer /C BNY a cho hoic Mello e He ice o alth n H f hS Plan (F eA Solutio alth plan. irst of n: E H To m w we o P ployer ver, arts).” large Surve The New firms are muc y & A Engla CS/BNY nd h Mellon H Journa more likely l of Medicin SA So th lution: Acco an small e, Vol. 29 firm un 8, no. 12 s to t Educational Level, March 1987–2008 1 Civilian Labor Demogr -Force aphi Parcs and Job ticipation Rate Char fo acteristics Among r Americans Age 55 or Over, Consumer Engagement in Health Care Survey For the trend in the percentage of workers by age group from 1987–2004, see Jack VanDerhei, Craig Copeland, and Dallas Salisbury, Figure 1 Figure 4 The Population Age 55 and Older, 2008 for Americans Age 55 and Older, by Gender, 1975–2008 they w self-rep eorte re in d 1 health 975 (F status igure 3 of e C ) of . 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In 1987, 28.5 percent of workers Centers for Disease Control and Prevention: “Worksite Health Promotion: Principles, Resources, and Challenges” 90% Percen Heal tag th Statu e of Adul s and Health ts Ages 21– y Beh 64 Wi avi th Employment-Ba or Among Adults Ages 21–64 With sed Health Coverage With to be the exception o in goo 50% 55% d to poor f th healt e l A a hg bor-for (Figure e 55 co e 4 rparti ) . O ver cipation , by E rate o duc f th atiose on 55 al –5 Lev 9, whi el, M ch is ar esse ch 1 ntially 987–2 flat 00 exc 8 ept for the 1 per- Civilian Labor-Force Participation R Cov atee frag or e, by Choice of Heal No H th Plan, 2009 igh Graduate a Health Promotion large firm, between 50 and Workplace Wel percent and lness Strategi 60 percent of t es: he c Suo rvey vered Report popula . $tion has 325. Buck a choi Cons ce of ultants, An A health plC an. I S Compa ndivin dual y, Attn: s by Craig Copeland, Employee Benefit Research Institute February 2010 • Vol. 31, No. 2 ________ 70% _. “Consumer-Choice Health Plan (Second of Two Parts).” The New England Journal of Medicine. Vol. were age 45 or older, compared with 39.8 percent in 2004. In 2008, this number had All grown to 42.5 percent. www.cdc.gov/PCD/issues/2010/jan/pdf/09_0048.pdf With Choice Employment-Based Heal of Health Plan, by Demog th Coverage, raphics an by Choic Choice of d Job Ch e of Health Plan, aracNo teristics, 20 2009 09 By Paul Fronstin, Employee Benefit Research Institute centage American point s A jump in ge 55 o 2 r0 Over, b 08, the tre y An gd amo e andn g each age group has been School upward since High School 199Som 3. e Bachelor's Professional Globa with a choice l Survey of health Resources, 5 plan0 are not 0 Plaza only t Dr., Sh eose who tend caucus, NJ 0709 to work for a 6-1533, (800) large firm, but 887-0509, ww also w.b inu divi cksur duals veys.com with h igher 50.5% 50.3% 298, no. 13 (March 30, 19 80% 78b): 709–720. Plan Choice of Choice No Men Race/Ethnicity, March 1987–2008 Year Diploma Diploma College 49.4%Degree Degree 2 Choice of Plan No Choice Don't Know incomes an 50% d higher education. 63.2% 63.2% 63.3% Plan Choice See Ruth 65% Helman, Craig CopelaTotal 100% nd, and Jack VanDerhei, “The 2009 Retirement Confidence Surve y: Ec100% onom y Drives Confidence to Record 48.7% CIGNA: “CIGNA Choice Fund® Ex 62.3% perience Study: Summary of Key Findings” 62.2% 45% 47.8% 61.7% 47.5% 61.8% In contrast to males, fema 61le .5%labor-force participation rates for those ages 55–59 and 60–64 increased sharply from 61Total 59% .4% 61.2% 47.1%36% 61.2% 4% Center for Healthcare Supply Chain Research. 2009-2010 HDMA Fact61 book: Th .0% e Facts, Figures and Trends in 49.8% Healthcare 46.8% Ages 55–59 1987 58.8% Women 70.3% 60.6% 75.5% 80.2% 89.4% Introduction 70% 60Total 100% .5% 60.5%100% Gender 46.4% 46.4% 49.4% _________. Theory a 46.3%nd Practice of Managed Competition in Health Care Finance. Amsterdam, The Netherlands: Lows; Many Looking to Work Longer,” EBRI Issue Brief, no. 328 (Emplo 59 y .ee Benefit 8% 60.0% Research Institute, April 2009). 46.0% 59.7% 45.7% 45.7% http://newsroom.cigna.com/images/56/1209_CIGNA%2Figure 2 0ChoiceF und_Study.pdf 48.4% 59.0% Gender 45.1% 197Year 5–2008 W(Fihite gure 4Blac ). k Th H e 197ispani 5 ratc e for f Otheremales ages 1990 55–59 was 457.0% 7.9 percent, com 70.7% pare78.2% d with 67.7 p82.3% ercent in 289.5% 008. Self-reported Health Status 44.8% [Hardco Indivi duals py & C with D a c ]. HhD oice of MA mehealth mbers Male pla , $3n2 ar 5; e more likely nonmembers, t 58h .2 $52 an % those without a 5. Center for Healthcar 50 choice e to be sa Supply Ch 49 tisfied with their hea 47.6% ain Research, 901 lth plan North 60% 57.9% 57.6% 44.3% 44.1% 44.1% The American Elsevier Sci work forc ence Publi e is agins g, he with rs, B.V., 1988. 43.9% a larger percentage of workers nearing the ages that 46.9% are associated with 45% Male 43.6% 43.7% 60 35 5 Introduction 46.1% 56.2% 56.2% 1987 71.9% 61.4% 63.4% 64.1% 1992 54.3% 71.8% 77.1% 85.1% 92.8% 60% Excelllent 17 13 3 PercentageFemal of Adul e ts Ages 21–64 With Employment-Ba 50 sed He51 alth Coverage Choice of Health Plan: Findings from the 2009 EBRI/MGA The olde r female age groups also had an upward trend, but not as sharply as th 45.4% ose for the females ages 55–64. Gle and bhealt e Rd., h Sui cartee 1 alon 000, g a Arli nu 1n mber o gton, VA 2 f dime 22nsions. How 03, (703) 78e 7ver -0000, , cont farolli x: (7 ng 03 fo ) r choice 812-528 of 2, pl wa ww.hcsu n did not ch pplycan hainresearc ge t 55 h.e 0%diffh. erorg ence i n The data in this study go through the end of year 2008—when the stock market sharply declined and the upward trend in unemployment 40% Female 58 36 5 retirement Colonial Life: (55 and ol “Reinvent der the ). However, Enrollment wor Exk perie ers increasi nce: How ng to ly ar Driv e fa e cin Valu g more e for Your respo Be nsibility nefits Packa in payin geg” for t [Whit heir e Pa retir pere ]ment 1990 73.2% 60.3% 66.6% 70.6% 1997 57.9% 73.6% 77.3% 82.9% 89.9% Very Good 48 53 45 .6% Age 44.0% 53.4% Most employers do not With Choice offer a cho of He ice ofalth Pla health plan. n, by Heal In 2009, th Statu 86 perc s and Healthy ent of employers offe Behavior, 2009 ring health bene 43.6% fits offered 55% 52.9% 43.3% 43.3% 43.3% Fron satisfaction ra stin, Pautes bet l. “Finding ween i s from the 2009 ndividuals withEBRI/MGA traditional cConsume overage an r Eng d those enro agemenlled i t in Health Ca n CDHPs and re Su HDHPs, wh rvey.” EBen RI Issue emerged that continued throu Age gh 2009. The full impact of the recession from 2009 on these trends in labor-force participation w ill not be fully Consumer Engagement in Health Care Survey, 1992 74.2% 60.6% 63.6% 74.0% 2000 54.4% 70.4% 51.7% 76.5% p. 2 84.1% 87.0% expenses: Priv 50% ate-sector Good workers who have access to an employment-based ret51 irement .3% 28 plan most commonly hav 34 42.2% e a www.colonial life.com/About/~/me21–29 dia/A 25 5FB8EAE34F349D2823AA04881538AD6.ashx 26 1 41.9% 50.5% 50.7% 40% 41.6% 50.1% 50.2% 41.4% only one Institute o he f M alteh dici plan; ne o13 f th pe e rNational cent offer Aca ed t demies. wo choic Am es; a eric na’s Uninsur d 1 percent o ed Crisis: Conse ffered three or que more c nces for hoices. Health a Large nd Heal firms a th Care re . 21–29 57 41.0% 49.7%36 6 49.5% 40.8% 1997 Brief, 76.2% no. 337 68.2% 40.7% (Employee B 40.7% 66.8% enefit Re 71.8% 40.6% sea 40.6% rch Institute, Decem 200249.4% 54.2%ber 200 72.6% 9). 78.8% 83.5% 88.5% d documented until ne ifferences in 49.1%sati 49.w 1% sfaction existed. data a 49.3Fai %re r r eleased later this 40.5% 49.0% year. The recession may have reduced the labor-f 6 orce participation of these 7 older 40.3%30–44 24 23 40.1% 40.2% No Don't defined contribution plan (typically a 4 39.7% 01(k) plan, 39.8% financed at least partially with the worker’s own contributions), and 50% 39.5% 47.5% 30–44 62 35 3 mo Labor-Force Participation Rates: 2000 re likely t 75.1% 35% o offer h 66.2% ealth47 insu .1% 66.2% rance an 68.8% d to offe March Supplement to the CPS r a choice 2006 of health 54.7% plan than small 70.3%firms. Forty-fiv 77.3% e percent 82.8% of la 89.8% rge Paperback + PDF, $51.50; Paperback alone (ordered by mail), $44; Paperback alone (if ordered online), $39.60. Labor Force Partici 40% Poor pation Rates: The Populati 46.5% Choice of Plan 1 Choice on Age 55 1 Know EBRI Employee Benefit Resear45–54 ch Institute Not 31 es (ISSN 1085 -4452) is published monthly b 38.3% y27 the Employee Benefit Research Americans due to increased unemployment, job layoffs, etc., but it may have instead increased labor force participation among these workers, Deloitte: “2009 Survey of Health Care Consumers: Key Findings, Strategic Implications” 50.0% 37.7% 37.5% 37.9% retiree health insurance th is becoming increasingly scarce. Even for those who do have retiree health insurance, ca49 ps on .4% 45–54 62 37.4%32 6 2002 77.3% 68.0% 67.7% 75.0% 2008 53.2% 71.9% 77.4% 83.9% 89.1% Chronic Conditions 48 . 6% 48.6% 48.5% FronInstitute, 1 stin, PauTotal 59% 100 1 l, and Murray N. Ro 3 St. NW, Suit55–64 e 878, Wa ss. 20 “Adshingt dressi on, DC ng Heal 20005 th Care M -4051, at $ arket Reform T 300 per year or i hsroug incl24 uded a h an Insu36% s pa 36.2% rt of ran4% c a membership e Exch ange: firms offered t National Academies Pr wo or mor ess, 5 e ch00 oices, wherea Fifth St., NW, Lockbo s 13 percent o x 285, f sm Washi all 36.6% firms ngtodid so. n, DC 2 As a r 0055, e (88 sult, about 8)48 6 .22 %4-7 on 654 e-hal , fax: f o (2 f cover 02) 334- ed This sectio35% n examines labor-force participation rates using the March Supplement to the Current Population Survey, in 33.2% as they felt they would not be abl 35.9% e to afford to retire due to the negative stock market retur 36.0% ns and the condition of the economy. 35.8% 35.8% 35.4% www.delo and Older, 2008, 45% itte.com/assets/Dcom- 35.6% p. 10 47.1% 55–64 54 40 6 2006 77.2% 67.7% 35.3% 66.6% 74.4% 35.4% Ages 60–64 what t sub hs e cription. Periodic employer will apay a ls posnnually tage rate paid in 35.1% for the 35.2% coverage ar Washington, DC Figure 5 e bein , and additional mailing offic g r eached and/or surpas es sed. . PO 34.9% STMASTER : Send address None 46 2 34.9% 52 30% 30%Self-reported Health Status Marital Status 31.8% 34.1% 31 8% 34 1% Essential Policy Components, the Public Pl 34 34.4% 4% an Option, and Other Issues to Consider.” EBRI Issue Brief, workers had a choice of health plan, th and according to the 2009 EBRI45 /MGA Consum .3% er Engagement in Health Care 2451, www.nap.edu order to show greater 44.9% detail about demographic trends. a The civilian noninstitutional 44.9% ized population is analyzed, along Marital Status 44.7% 2008 change77.8% s to: 44.5% EBR 65.7% I Notes, 1100 13 71.0% St. NW, Suite 878, Washi 74.6% ngton, DC 20 No Hig30.7%h Gr 005-4051. Copyright 2010 by Employee Benefitaduate UnitedStates/Local%20Assets/Documents/us_chs_2009SurveyHealthCo 30.6% nsumers_March2009.pdf At least one chronic health condition 54 43.9% 48 30% Excelllent Not married 43.7% 18 67 19 31 1 30.0% 4 43.4% 43.0% 42.9% 42.9% 29.6% no. 330 (Employee Benefit Research Institute, June 2009). See U.S. Department of Labor, Bureau of Labor Statistics, "Labor Force Statistics f 29.1% rom the Current Population Survey—Civilian Labor Force Survey, 5 Resea9 rch Institut percent of Not marri e. All rights re adults Satisfaction ed ages 42 served, Vol. 31, no .2%21–64 With Various with em . 2. ploymen 42.2% Aspe t-bas cts ed h of Heal ealth 57 th Ca coverage h re and Views of a36 d a choice of 7 health plan (Figure New Publications and Internet Sites, with t40 he %portion of this population t42 hat is .0% employed, looking for a job, or on p. 17 a layoff (i. e., the labor force). Since these 30% Ages 60–64 School High School Some Bachelor's Professional At least one chronic health co 28.5% ndition & fair or po 41.6%or health 55 51 Consequently, 20% workers to Very good day have Married great er incentives to 28.3% stay in the work force, 82 62 such as the a 81 35 bility (and 3 in some cases 28.0% 27.8% 27.8% Married 27.3% 60 36 5 27.1% Job Satisfaction Participation Rates," available at Year White Black H Heal www.bls.gov/dat ith Plan Among Adults Ag spanic 27.0%Other a/home.htm SeYear e also Craig Cop es 21–64 With Employment-Based Diplom eland, “Labo a Diplom r-Foa rce Participation: The Population CollegeDegree D Age 55 egree 1). 26.8% Smokes Cigarettes Good Presence of Children 53 39 8 rates are only Hewitt Associafor the month tes: “Hewitt R of March, esearch Co they ntinues to are differ Show ent Hi from the gh Rate annu of Cal num OBRA Enrollm ber preents Among S sented in the previous sect ubsidy-Eligible io n. the need) to continue to accumulate assets in defined contribution plans and to have access to employment-based 37.9% 37.8% 37.6% Presence of Children 37.7% 37.7% 1987 52.7% 47.3% 37.0% 46.4% 47.3% 1987 44.3% 49.1% 59.5% 66.0% 72.1% 35% Yes Health Coverage, by Choice of Health Plan, 2009 18 16 36.9% and Older,” EBRI 10% Notes, Fair no. 6 (Emplo No children yee Benefit Research Institute, June 2007): 2–8, for an 54 51 earlier 36 anal .7% 54 ysis of these data. 36 13 36.5% 36.3% 25% 36.3% However, t Society for Employees” [Press Release] Hu he same tren man Resourc ds feo Management. und in t 36.1% he fir 36.s 1 % t section also 2009 Emp 35.9% loyee Jo are prese b Sat nt i isfn a the ction: Un 35 March .9% ders nutmbers andin 36g t .1(Fi %hg e ur Fa e 5 ctors ). The That M 36.6% over aall ke 35.8% The Em 35.7% ployee Benefit Research Institut 35.7% 35e .4 %(EBRI) was founded in 1978. Its mission is to health insuran 25% ce covera No children ge, i nstead of having to tap into their savings t59 o pay for their ex 36 penses. 5 1990 54.6% 51.8% 46.9% 52.0% 35.1% 1990 43.9% 52.6% 60.6% 64.8% 73.0% No 82 83 Poor Has children 46 47 46 53 0 EXEC UTIV E SUMMAR Y While the percentage of individuals with traditional employment-based health benefits who have a choice of health plan Choice of Plan No Choice contribute to, to encourage, and to enhance the development of sound employee benefit Work Gratifying. SHRM members, $79.95; nonmembers, $99.95. Society for Human Resource Management, 1800 Duke partici www.he pation wittassociates.com/Intl/NA/e rate reac Has children hes a low pointn-US in 1994, /AboutHe and th witt/N en increases ewsroom/ thr PressReleaseDetail.asp ough 59 2008. The mal 36 e x rat ?cide =7916 fo5 llows th e same U- 1992 56.3% 48.1% 43.4% 44.2% 1992 40.8% 55.4% 61.3% 64.1% 73.7% 5 Exercise Endnotes 30% 0%Chronic Conditions Race/Ethnicity The U.S. Census Bureau conducts the Current Population Survey (CPS) for the Bureau of Labor Statistics by interviewing about 57,000 Who we are was in large part unchanged s Satisfaction With ince 20 programs and so Quality of 05 (rangin Care gund public policy from 5 Received 4 p ercent through objective to 62 percent)resear , the percenta ch and educati ge of in on. EBR diviI is the only duals with a 2 Race/Ethnicity 1997 55.8% 48.8% 47.5% 54.9% 1997 39.9% 53.4% 61.3% 61.5% 75.8% Furthe shape tr St., Alexa rmore, t en nd, driwhile a, he VA 22 200 the f 9 314Neve Retir em -3ar 20 4 e le tre 99, (8 ment Co nd is u 00) 44 nfip dward across t 4- en500 ce S 6, urvey option #1, (R he e CS) ntire found t htt time p://shr h per atmstore.shrm.org workers a iod. nticipate r etiring 19 at later ages. While None 57 White, non-Hispanic 78 82 39 5 1 Extremely or very satisfied 77% 69% *** households and 20% 20% 24.8%asking numerous questions about private, nonprof individuals’ w it, nonpar ork tisan status, emplo , Washington, DC-b yers, income, and ased organi basic demographic characteristi zation committed exclusivel cs. y to Choice of Health Plan: Findi See Exhibit 4.1 in http://ehbs.kff.org/pdf/2009/7936.pdf ngs from the 2009 EBRI/MGA Consumer Engagement 24.2White, non-Hispa % nic a 59 37 4 consumer-driv 2000 56.9% en he 51.2% alth plan50.7% (CDHP) an 61.2% d a choice of hea 2000 lth plan ros 43.3% e steadily b 52.5% etween 2005 62.2% and 2009, i 61.2% ncreasin76.0% g from Investment Company Institute: “Enduring Confidence in the 401(k) System: Investor Attitudes and Actions” 1 day pe 23.7% r week, on average 21 21 22.7% At least one chronic health co Minority ndition 61 22 18 33 6 not all of those who expect to work until older ages will be able to do so for health reasons or due to a lack o 23.3% f job 25% 1987 1988 1989 1990 22.9 1991 % 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 22.6%Somewhat satisfi public ed policy research and education on econ 20 omic securit24 y and em ** ployee benefit issues. Minority Year 60 31 9 Therefo 2002 re, the 59.3% CPS provides detailed information about 50.5% 49.4% 54.7% workers fro 2002 m a broad sampl 43.0% e of Americans, making it possible to establis 21.9%53.9% 61.1% 65.5% 21 h a .9%75.0% in Health Care Survey 21.8% 21.7% 2–3 days per week, on a 21.4%verage 21.5% 35 21 35 .5% 21.5% 47 perc 2 ent to 70 perc At least one ent (Fr chro Househ o nic health co nstin old Inco 2009). nditi me on & fair or poor health 60 21.3% 2134 .3% 6 21.1% 21.2% 21.0% ww Indivi w.ici.org duals a /p gd e 5 f/pp 5 or r_1 older 0_retwith _saving.p define df d benefit pension income have a lower labor-force participation rate than those Pension Plans/Retirement Year See Exhibit 4.2 in http://ehbs Not too or .kff.org/ not at EBRI’s member pdf/2009/7936.pdf all satisf 20 ied .4%ship includes a cross-section of 3 pension funds; businesses; trade associations; 7 *** availability, many Americans age 55 and older will postpone retireme 20.2% nt—and, in fact, since 1993, there has been a clear Household Income 2006 61.0% 47.1% 51.9% 58.0% 2006 42.0% 53.5% 61.9% 66.4% 76.6% consistent annual and timely 4–5 days pe trend across num r week, on a erous w vero age rker charact eristics and the char Year acteristics of their emplo 17 17 yers. Smokes Cigarettes Less than $30,000 3 13 55–59 60–64 65–69 70–74 75+ 65+ withou 20t th % is income. In Ease of 2008Getting , 24.9 p labor un an Appointment ercen ions; h t of teh alth ose w With a Docto care prov ith peiders and insur nsion i r When Needed ncome w ers; e government org re in the labor anizations; force, compare and service firms. d with Less than $30,000 26 61 13 LIMITED CH upwar 2008 d tren 62.8% d OI for many CE: Most em 52.9% in th ployers is grou 57.0% p to do not 55.5% stay in t offer a he choic work e2008 of forc health e. In a plan 41.1% ddit , but ion to t wh 55.1% h en e th nee ey do, d for61.5% money large fir (m ms are muc entione 70.4% d a hb more 76.8% ove), Organisation 3 for Economic Co-operat All ion a Mal n ed Develo Fem pme alent. Pensions at No Pension Ia Glanc ncome e 2009: Retirem Pension Income ent-Income Systems in More than 5 days per week 7 7 Yes $30,000–$49,999 16 62 17 34 5 Increasin Alain Enthov g cho Source: eince of , “Consum Employee health Benef er- plan is a Cithoic Research e He key Ialth nstitcomponent utPlan (F e, from U.irst of S. Depart of h Tm w e 6 ent alth o P ofa r Labor, rts),” eform Bureau of The New advocates. Labor St Engla atist Th nid cs, e he Journa Labor Force St alth l of Medicin insur atist ance ics from eexcha , Vol. 29 nge is 8, no. 12 built JPMorgan Asset Manageme Extremel nt: “R y or eady very satisfied ! Fire! Aim? 2009: How Some Target 75 Date Fund Designs Co 68 *** ntinue to Miss the 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 $30,000–$49,999 55 35 10 649.8 percent of those without pension income (Figure 5). The rate for those with pension income held steady at SourAges 65–69 ce: Employee Benefit Research Institute, from U.S. Department of Labor, Bureau of Labor StatisAges 65–69 tics, Labor Force Statistics from the likely than small firms to of Body Ma fess r a Inde choice. x Because a disproportionate share of those with employme nt-based health OECD Countr many of today the Current ies ’No s old . $4e 7 (Pri Populat r Amer nt + ion ic Survey–Civil ans$50,000–$99, Free PD appear iaF). n Labor Force Part t OECD 99 o be9 41 motivate Distri icipat bu ion d tion by a Rate, Ce online at desir nter, e c www. t/o o Tur work lo bls.gov pin Distribution Se /59 dat nger, a/home and they .htm43 36 rvic arees, 143 likely to co 5 West St ntinue i ., New n Pension income refers to annuity payments from defined benefit plans. This does not include any lump-sum payments or periodic Source: Em Somewhat satisfi ployee Benefit Research ed Institute estimates from 1987–2009 March Current 21 Population Surve 25 ys. ** on Alain (March 23, 19 Entho 78a): 650 ven’s model o –658. f managed competition, which ent Ye ails ar sponsors acting on behalf of groups of individuals to Current Population $50,000–$99, Surv99 ey–Civ9 60 ilian Labor Force Participation Rate, online at www.bls.gov/data/home.htm 38 3 Mark on Providing Retirement SecuEBRI’s work advances knowledge and unders rity to Those Who Need It Most” tanding of employee benefits and their Year White Black Hispanic Other No High Graduate Underweight 3 2 4 around 23 percDeclined ent from 1 987–2$100,000–$14 005 with a9, slight999 21 uptick in 2007 and 2008, whil 58 e the trend13 for 28 those witho 15 ut pension the benefits ar work forc e employed by e as long as jobs remain a large firm, avail between able to th 50 perc em.ent and 60 percent of the covered population has a choice of Milford, withdraw CT als from 06776, defined benefit (800) 4 Not too or 56 or-6 defined contrib 32not at 3, fax: all satisfied (860 ution plans. ) 350-0039, oecdna@turpin-dis 4 tribution.com 7 ** 3 No High School Diploma High School Diploma $100,000–$149,999 70 importance to the nation’s economy among policymakers, 25 the news media, and 5 the public. It 1987 27.0% 23.5% 24.6% 28.2% School High School Some Bachelor's Professional negotiate with insurers and offer participants a menu of choices among different plans (Fronstin and Ross 2009). To www.jpmorgan.com/cm/Sat Normal e llite/Ready!_Fire!_Aim__2009_How_some_target_date 28 _fund_desi26 gns_continue_to_miss_th Exercise $150,000 or more 13 8 income was upward since its low point in 1994. Satisfaction With Out-of-Pocket Costs for Prescription Drugs health plan. $150,000 or more Some College 69 Bachelor's Degree 27 4 does this by conducting and publishing policy research, analysis, and special reports on 1990 29.3% 27.7% 23.7% 20.9% Year Diploma Diploma CollegeDegree Degree Overweight 33 32 What we do Never 56 Declined to answer 6 6 33 10 obtain the benefits of competition requires that insurance policies be easily comparable to facilitate consumer choice, 7 e_mark_on_providing_retirement_security_to_those_who_need_it_most.pdf?blobcol=urldata&blobheader=application Extremely or very satisfied 56 45 *** This artic U.S. Gover Any chang le es that result from legi nex me amines rec nt Accoune tability Of nt U.S. Ce slation being discussed as this arti fice. nsus (1 Bureau ) 401(k) Pla data o nn s: Policy la cle is being w bor-force Chanpartici rges Coul itten could change pation d R a edu mong America ce the this dy Long-te namic, such as m ns age 55 a rm Effeeasures th cts of nd older, at Declined to answer employ Gr ee benef aduate/P its issues; holding educational br rofessional Degree 59 iefings for EBRI memb 37 ers, congressional and 4 1992 27.0% 21.0% 19.6% 18.4% 1987 20.8% 25.2% 32.6% 36.8% 47.9% Obese 29 32 1 day per week, Education on average 61 36 3 and quality measures be Somewhat satisfi develope d that c ed onsumers can use to make informe 30 d decisions. 34 ** %2Fpdf&blo Race/Ethnicity— bkey=id&blobtaParticipat ble=Mungo ion has Blobs&b increa lobw sed across eac here=1158571 h race 701753 /eth &ssbinary nicity grou =true p ex ami ned since the middle SURVEY RESULTS Education : The 2009 EBRI/M federal agen GA Consumer En cy staff, and th gagement e news media; in Heal and sponsoring public opinion survey th Care Survey finds that in dividuals with s on employa ee 1997 30.0% 21.5% 22.9% 31.7% 1990 22.6% 26.1% 33.8% 37.9% 54.6% which might allow 1997 incl fo u 30 des both r e .0% asier access to h 21 the .5% near ealth insurance fo 22 el .9% derly (a31 ges .7%55– r people this ag 64) and th 1990 e through e elderly other t (64 22.6% a han an emplo nd above 26.1% ). yer T or union. he first sectio 33.8% n uses a 37.9% nnuali54 zed .6% Leakage on Workers’ Ret Declined to an irement Savi swer ngs. (2) Pension Benefit Guaranty Corporation: 8 More Strategi 7 c Approach Needed 2–3 days per week, on a High school grad verage uate or less 29 59 41 37 4 Source: Employee Benefit Research Institute estimates from 1987–2009 March Current Population Surveys. Not too or not at all satisfied 14 21 *** High school graduate or less benefit issues. EBRI’s Education and Re 49 search Fund (EBRI-ERF) performs 42 9 the charitable, 2000 31.8% 28.8% 26.5% 30.3% 1992 17.3% 25.4% 29.5% 39.3% 50.1% 199 choice o 0s (Fi f h gure ealt 6). h pl an ar White e Am notericans a only those who ten nd those falli d to ng in wo trk for a he “other lar” cat ge firm, but egory (inc also i ludin ng Asians dividuals ) h wit ave hi h higher gher inco rate m ses and of Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. 4–5 days per week, on a Some college, trade, or bu verage siness school 31 60 29 36 5 for Proc data on la essing Compl bor-force partici ex Plan pas Prone tion from to D the elCurrent ays and Ov Popul erpayments ation Survey . (3) (availabl Retirement Sa e from the vings: B Bureau o etter I f Labor nformation Statisti an cs We d b Satisfaction With Out-of-Pocket Costs for Other Health Care 8This article explores dif Some college, trade, or bu ferences in choice educationa sine of l, and ss hesch alth pla scientif ool n ic func using tidata ons of the Instit from 62 the 20 ute. EBRI 09 EBRI/M 34 -ERFGA Co is a tax-ex nsumer En 4 empt organization gagement in 2002 35.3% 23.7% 27.4% 34.3% 1997 20.3% 25.3% 31.9% 41.5% 50.8% MassMutual Financiala Group: “A Fiduciary Planning Guide for Plan Sponsors: Helping You Fulfill Your Fiduciary Duties— See Joseph Quinn, “Retirement More than 5 days per Patterns and Bri College graduate week dge Jobs in the 1 or some graduat 990s,” e work EBRI Issue Brief, 27 no. 206 59 (Emplo 21 36 yee Benefit Research Institute, 5 labor-force participation in the most recent years. Hispanic Americans’ rate is just below that of the whites’, while black higher education. Indivi Arthritis; a duals with sthm a cho a, emphysema ice of hea or lung disea lth plan are more lik se; cancer; depre ely than ssion; diabetes; h those with eart attack out a choice to be satisfied site). However, these data Extremel provide only y or very satisfied an overall pictur e, not specific demo 53 graphic deta 39 ils. In*** order to examine Sponsor Guidance Could Improve Oversight and Reduce Fees for Participants. Order from GAO. supported by contributions and grants. 2006 35.7% College graduate 25.5% 29.7% or some grad 30.2% uate work 2000 23.5% 66 28.9% 31 32.7% 3 39.8% 48.4% Figure 4 Health Care Survey. It examines the likelihood of havinFigure 2 g Figure 6 a choice of plan by various demographics and work-related 2010 Calendar Body Ma ” http: ss //ww Index wrs.massmutual.com/retire Graduate degree /pdffolder/rs2468.pdf 14 10 or other heart disease; high cholesterol; or hypertension, high blood pressure or stroke. February 1999), and David Rajnes, “Phased Retirement,” EBRI Notes (Employee Benefit Research Institute, September 2001): 1–8. Americans ha with their head th lth pl e lo an a west l nSomewhat satisfi d he abor-force alth care alo par ed n ticipation g a num rate. ber o f dimensions. However, co 30 ntrolling for 35 choi ** ce of plan did not Graduate degree 69 29 2 demogra 2008 phic 37.0% trends 30.6% of the U29.1% .S. populatio 32.5% n, the second s 2002 ection uses 21.7% data from t 32.4% he March Curr 39.3% ent Population 39.2% Surv 52.0% ey Ann ual Civilian Labor-Force Participation Rate of Underweight Firm Size (base: employed full-time or part-time) 48 48 4 Civilian Annu Labor al Civilian -Force Labor Participation Rate -Force Participation Rate for Americans variables. It also examines choice by health status and health behaviors. The relationship between satisfaction with Not too or not at all satisfied 17 26 *** Firm Size (base: employed full-time or part-time) change the difference in satisfaction rates between individuals with traditional coverage and those enrolled in Reference Ages 70–74 2006 22.4% 31.0% 37.2% 41.2% 50.1% (CPS). EBRI Issue Briefs are periodicals providing expert evaluations of employee benefit issues and Normal American Females Ag Self employed with no employe e 55 es and Older, by Ag 1 61 e, 1975–2008 2 35 4 Ag of Americans e 55 or Over Ag , be 55 y Race/Ethnicity and Older, b,y Mar Agc eh , 1975–2008 1987–2008 Satisfaction With Choice of Doctors health insurance and health care and health plan choice is then explored, as is the role of type of health plan. National Conclusio Aca Educational Level— demy for n Self employed wi State Health The la th no employe Policy: bor-for “O ce e pportu s particnities and Recom ipation rates of those m 33 endatio age 55 an ns for State-Feder d ol 55 der showed relat a12 l Coordi ivel nation y small to Year White Black Hispanic Other 2008 21.3% 31.8% 37.3% 43.3% 54.1% trends, as well as critical analyses of employee benefit policies and proposals. th EBRI Notes is a consumer-drive Overweight n health pl ans and high-de2–9 4 ductible health plans, when differences 60 in satisfaction 8 35 existed 5 . Our 70% International FoundationEx of Employee Ben tremely or very satis efit Plans. fied Benefits and Compensation 79 Glossary 74 . 12 E *** dition. IFEBP 46% 80% 2–9 43 48 8 1987 15.2% 15.8% 8.3% 17.6% Ages 70–74 monthly periodical providing current information on a variety of employee benefit topics. changes from Improve Healt h 198 System 7–200Performance: A 8 across each e Fo duccus on P ational atta atient inment Safety” group (Figure 7). However, individuals with a higher Obese 10–49 7 56 20 37 7 44.8% Somewhat satisfied 17 19 Controlling for choice of plan does not change the differences in satisfaction rates by plan type. Overall, there was no members, $44; nonmem10–49 38 bers, $59. International Foundation of Employee Benefit Plan62 s, Publications0 Department, P.O. The 1990 labor-15.5% force part 15.3% icipation rate 12.5%is incr 16.1% easing for those age 55 an Nd ol o Hider. gh Gr For those ages 55–64, this is being driaduate ven EBRI’s Pension Investment Report provides detailed financial information on the universe of Declined to answer 50–199 9 63 20 32 5 publications 44.1% level o Overall Annual Labor-Fo http://nash f educ p.org/sites/defaul ation had a slightt/f upward tre iles/Patient_ rc nd in Se Partic afety_ their rat 1-12e -1 s ipatio , whil 0.pdf e those n Rat with e lower s levels of education had a flat to slight Not too or not at all satisfied 4 6 *** 43.8% 50–199 43 57 0 dif 1992 ference 70% 15.8% in satisfaction 14.1% betw 10.8% een indivi 15.0% duals with traditional covera Sc ge and those wit hool High School h a CD Som HP ewith respect Bachelor to 's qu Profes ality of sional Labor For 44%ce Participation Rates: defined benefit, defined The Population Age 55 and Older, 2008 contribution, and 401(k) plans. EBRI Fundamentals of Employee Box 68-9953, 60% Milwaukee, WI 53268-9953, (888) 334-3327, option 4; fax: (262) 786-8780, e-mail: Source: EBRI/MGA Con200–499 sume 9 r Engagement in Health Care Survey, 2009. 12 New Publications and Internet Sites almost exclusively by the increase of women in the work force; the male participation rate is flat to declining. However, 43.0% Overall Satisfaction With Health Plan downward trend. Overall, the higher the educational attainment, the higher the labor-force participation 43.0% rate was. For 200–499 55 42.8%43 2 43.7% The U.S. B 1997 16.0% ureau of Labor 13.1% Statistics pr 14.4% ovides annu 12.8% alized Year numbers for t Diplom he civi a lia Dn iplnoninstitutionalized population a oma CollegeDegree D ned gree Benefit Programs offers a straightforward, basic explanation of employee benefit programs in a 500–1,999 12 42.5%13 care rec Characteristics of Individuals Wi eived, ease of getting an appointment th a Choice of Health Plan with a doctor when needed, and satisfaction with choice of doctors bookstore@ifebp.org, www.ifebp.org/bookstore 42.3% Arthritis; asthma, emphysema or lung disease; cancer; depression; diabetes; h42. eart attack or 2% other heart among those age 65 and ol Extremel der, l y or abor very satisfied -force part icipation increased for both mal 69 es and females. 54 *** Transamerica Center for Retirement Studies: “Women 42. a 1% nd Retirement: Facing Challenges in a Recession” 42.4 0% ,5 THE NEAR ELDERLY AN500–1,999 D EL 59 DERLY ARE STAYING IN THE WORK FORCE LONGER: The la37 bor-force 4 participation rate is exampl 2000 e, i19.8% n 2008, 6 15.8% 3.3 percent of 13.2% indivi 18.3% duals with a gra1987 duate or profe 10.7% ssional de 15.0% gree were20.3% in the la 42. bor forc 8% 26.2%e, com 29.5% pared the private and public sectors. The EBRI Databook on Employee Benefits 41.8% is a statistical labor force 60% from the CPS conducted by U.S. Census Bureau. These numbers are used to calculate the percentage of [Note: To order U.S. Government Acco2,000–4,999 un 8 tability Office (GAO) publications, call (202) 514 2-6000.] 42.9% disease; high cholesterol; or hypertension, high blood pressure, or stroke. (Figure 6). 42% Similarly, the survey found that individuals with traditional coverage were more likely than individuals with a Somewhat satisfied 25 34 *** 50% According to findin2,000–4,999 gs from th 78 e 2009 EBRI/MGA Consum 41.4% er Engagement in Health Care21 Survey, 59 percent1 42.4% of adults https:// 2002 ww 18.0% w.ta-retir 16.0% ement.co 13.4% m/Resources 15.8% /TCRS%20200 1990 9%20Women 11.0% Retireme 14.3% nt.pdf 19.3% 20.7% 37.5% reference work on employee benefit programs and work force-related issues. 40.9% increasing for those age 55 and 5,000–9,999 older. Th 9 e percentage of civilian noninstitutionalized Ameri4 cans age 55 or older who with 22.7 percent of those without a high school diploma. this population that is in the labor force. The percentage of civilian noninstitutionalized Americans age 55 or older who Not too or not at all satisfied 6 12 *** 41.1% CDHP to COBRA Continuation Coverage Assistan Education 2006 be is a 22.4% extre strong factor m5,000–9,999 13.9% ely or very i19.4% n 79 an satisfied wit individual 14.2% h’s partic out-of-pock ipatio 1992 en ce t costs for in t Under the Ameri he labor 12.2% prescription force at o 13.6% dr lder ug a c s an21 an Recovery and ges: In d oth 18.2% divi er h dua e1 alth c ls with 21.8% are, a higher nd 34.9% levels 40.4% ages 21–64 with employment-based health coverage had a choice of health plan (Figure 1). Slight differences in 10,000 or more 40.31 5% 11 39.9% were in the 50% labor force declined from 34.6 percent 1975 to 29.4 percent in 1993. However, since 1993, the labor-force Likelihood of Recommending Plan to Friend or Co-worker 39.8% were in the labor force declined from 34.6 percent 1975 to 29.4 perce 39.6%nt in 1993. However, since 1993, the labor-force 10,000 or more 83 16 1 2008 23.9% 17.8% 15.7% 20.3% 1997 11.8% 13.4% 17.9% 24.0% 40.6% 29.8% 40% 40.6% Reinvestment Act of 2009 – Si of e overall ducatio withn a the he re significa alth pla nn tly . more l These idif kely to feren be tes with Updated ces persist e in the labo ven r force afte than r co Information nt th rolling for ose with choi lower ce of levels hea of lth edu plan. cation. For exam This ple, Vanguard Group Research Note Don't know : “Recov ery in 401(k) Balances” 11 7 39.1% Contact EBRI Publications, (202) 659-0670; fax publication orders to (202) 775-6312. choice wer40% e found with respect to 39.1% 39. gen 1% der, age, marital status, and race/ethnicity. However, t 40.h 3% e biggest differences in Race/Ethnicity and Age—Labor-force participation increased for almost all a 40.3% ge/race/ethnicity groups Extremely or very likely 60 39 *** 40.1% participation rate has steadily increased, reaching 39.4 percent in 2008—the highest level over the 1975–2008 period. Don't know 68 24 8 39.8% Satisfacti participation ron and Choice of He aAges 75 or Older te has steadily increased, re alth Plan aching 39.4 perc 2000ent in 2 12.4% 008—the 38.highest 6% 17.8% level over 19.8% the 1928.3% 75–2008 period 36.2% Source: EBRI/MGA Con 38.3%sumer Engagement in Health Care Survey, 2009. Subscriptions to EBRI Issue Briefs are included as part of EBRI membership, or as part of a https://institut disparity among indiv incre iduals wit ased f ional.vanguar rom 1 h a choice of plan, 98d.com/ia 7–2008 for m/ th pdf 70 pe ose witho /CRRKREC.pdf rcent of ut a t hhigh ose wit ?cbd school ForceD h tradi omain=true ditional cov ploma, as t e h rage w eir rate ere dec extr line em d whi ely or le tve he r rate y satisfied for choice of plan 40% were founSomewhat lik d by househol ely d income, education, and firm size. 26 In general, in 36 dividuals *** with higher examin Orders/ ed from 1987–2008, with white and other Americans having the higher rates (Figure 8). While the labor-force Employee Benefits Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. Internal Year RevWhi enue te Service Black Hispanic Other 2002 10.3% 37.7% 17.7% 19.5% 22.4% 29.9% 37.7% (Figure 1). 37.3% $199 annual subscription to EBRI Notes and EBRI Issue Briefs. Individual copies are available 38% There is a rather large liter Not too or 37. ature sho 5% not at win all lik g that satisfact ely ion with health insuranc 14 e is higher 25 among i *** ndividuals with a with t those wit he healt h higher l h plan, com evels op f e arded ucation with 59 staye percent o 37.2% d the same f those or enrolle increase d d in a . CDHP and 51 percent of those with a HDHP. WOMEN ARE THE DRIVING FORCE FOR LONGER PARTICIPATION 37.1% IN THE WORK 37.3% FORCE: For those ages 55–64 (the household inc 1987 30% 6.9% ome are 7.9% more likely 5.3% than th 8.0% ose with lower 37. 2006 househ 1% old 13.7% income to r 21.2% eport having a c 21.0%hoice of 24.9% health pla 36.6% n. participation rates of black and Hispanic Americans age 55 and older lagged below those of white and other Americans, 36.2% 38.0% www.irs.gov/newsroom/article/0,,id= with prepa 204505,0 yme0nt .html for $25 each (for printed copies). Change of Address: 37. EBRI, 1100 13th St. 9% Aon Consulting. 2009 Benefits and Talent Survey. Free. To request a co 36. p7% y of the survey, please go to the following site 36.6% Likelihood of Sta 36.5% ying in Plan if Had Opportunity to Switch 37.5% choice o Subscriptions f healt 30% h plan, compared with those without a choice. Findings from the 36.5% 2009 37. 5% EBRI/MGA Consumer 36.0% Among those 1990 6.9% without 6.4% a choice of 4.9% plan, 10.4% 59 percent of tho 2008 se with tra14.5% ditional covera 18.5% ge were26.6% extrem 37.3% ely or 31.0% very satisfied 34.7% near elderly), this is being driven almost exclusively by the increase of women in the work force; the male participation One-quarter of those with household income less than $30,000 reported having a choice of plan, compared with 36. NW, Suite 878 0% , Washington, DC, 20005-4051, (202) 659-0670; fax number, (202) 775-6312; their rates still increased from 1987–2005. The one exception is for Americans age 75 and older, where “other” The labor-force participat Extremel ion rate 35.8%y or for m very likely en age 55 and older followed the same 68 pattern, fal 51 ling fr*** om 49.3 percent in and fill in the required information: http://insight.aon.com/?elqPURLPage=4552 The Consumer Engagement in Health Care Survey has historically found that individuals with traditional health 36% 36% 36 36.3% 3% This u 1992pward tr 6.3%end is not 4.9% surp 5.2% rising and 5.0% is likely to co 35 4%ntinue because of worker 36 36.4% 4% 36 3% s’ need Ages 75 or Older for access to employment-based 35.4% 36.3% Engagement in Healt 36. h9% Care Survey also in 35. dicate hi 3% gher satisfaction with a number of aspects of their care among with the plan, while 34 percent of both e-mail: subscri CDHP anp d HDH tions@ebri.o P enrolle rg es w Meembe re rship Information: extremely or very satisfied Inquiries reg with the arding EBRI plan. Whe rate is n it flat to come decli s to healt ning. Ho h sta wever, tus and hea among those a lthy beh 35.1% avior, th ge 65 and o ere ar 35.9% lder e also (the some di elderly ff)erenc , labor e- s in c forceh p oice articipation is i of health plan: ncrea There sing is for 69 U.S. De percent o partm 20% f i en nt of dividuals Laborwit Em h $ ployee 150,00 Be 0 or nefits Sec more iu nrity A household 35. d8% ministration incom 36.e. 1% With respect to education, one-half of Americans’ rate was downw Somewhat likely ard from 1987–2008, while the other race/ethnicity 23 categories ha 29 d sli *** ght increases. 1975 to 37.7 perce 35. 7 6%nt in 1993 before in 34.cre 7% asing to 46.0 percent in 2008. The 2008 level is still below the 1975 level, 1997 6.8% 8.7% 6.6% 9.1% No High Graduate insurance cov 20% erage were more likely tha 34.9% n those with a CDHP or a high-deductible health plan (HDHP) to be extremely health insurance and for 35. m 4%ore earmembership and/or contributions to EBRI-ERF ning years to accumulate assets in define should be directed to EBRI President/ASEC d contribution (401(k)-type) plans— individuals with a choice of health plan. Individuals with a choice of health plan are more likely than those without a Not too or not at all likely 35.0% 10 20 *** a correlatio both males an n between sel d females. f -r eported health status and 34.0% 34.9%choice of health plan. Two-thirds of individuals reporting indivi www.dol. duals gov/ witebsa/co h a high scho bra.htol di ml ploma or less had a choice of health plan, compared with 62 percent of individuals with 35.0% Employee Ben 2000 7.7% efit Research 7.4% In 3.6% stitute. Fu 5.8% ndamentals of E 34. m 6% ployee Be School ne 34.fit Pro 7% Hg igrams h School . Sixth Som Edition. e $19. Bachel 95or (EB 's R Pr I ofessional but is clearly higher than the low point in 1993. Women’s labor-force participation rate for this age group was Chairman Dallas Salisbury at the above address, (202) 659-0670; e-mail: salisbury@ebri.org or very satisfied 34% with some, although not 34.6% 34.6% all, aspects of their health care. Specifically, satisfaction with choice of doctor especial This analysis a ly after the 2008 do lso controlled wnturn for choic ine the of h stock market ealth plan wh an en e d economy. xamining Older wheth Americ er indivi ans, partic duals woul ular d re ly those commend thei who worked r Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. choice to be extremely or very satisfied with the quality of health care received. About three-quarters of those with a excell 2002entEducational Level a healt 7.1%h had a 6.1% choice3.8% of nd Age— plan, compared 6.1% Within ewith ach ag abe Year out one group, t -hal h De la ifpl o om fbor- indivi a force dD uals ipl p om artic in a poor or ipatio Col n r lefair gaeD te incr health eeases g(Fi reegas the l ure 2 D)e . gere vel e 34.0% some college, 66 percent of those with a college degree, and 69 percent of those with a graduate degree. Sixty-nine members get 10% 10% a 55 percent discount) plus shipping. EBRI member organizations, or those interested in bulk purchases 33.7% 33.5% essentially flat from 1975 to 1993 (23.1 33.4% percent and 22.8 percent). But after 1993, the women’s rate also increased, has not varied by type o *** Difference b f health plan. etw Sati een Choice of sfaction Plan and No Ch differences with oice is statistically respect to quality significant at p of medica = l care received was EDUCATION A MAJOR FACTOR: Education is a strong factor in an individual’s participation in the labor force at older in th health e pla private n to sector, have a friend or co far less acc -worker an ed th ss to guara eir likelihoo nteedd le of vels staying in of inco th meir e (suc plan h as when pensions) or given an opportunity to s health insurance wit ch. 2006 8.6% 8.9% 7.8% 8.4% 1987 5.0% 8.2% 7.7% 10.3% 16.7% choice were extremely or very satisfied with the quality of care received, compared with 69 percent of those without a of educational attainment increases (Figure 9). In most cases, the trend within each age and educational group was Web Docu However, t Editorial Bo herard: e was ments Dallas L little . Salisbur differenc y, publisher e in th;e Stephen Blakely likelihoo 32.8% d of, h editor aving . Any a choi views ce expr of eshealth sed in this p plan ublicat by t ion and th he prese ose o nce of f the author chron s sho ic uld percent of individuals with a graduate degree had a choice of health plan. The impact of household income and 0.01. of Fundamentals, should contact Alicia Willis at (202) 659-0670 or e-mail: publications@ebri.org reaching its highest level in 2008 at 33.9 percent. 32% 5.2% initially 2008 higher 9.2% among in 11.3%dividuals 10.8%with tra 6.2% ditional coverage. 1990 But in 2 4.9% 007, the gap in 6.7% satisfaction 8.7% betwee 8.4% n those 4.8% in 21.8% ages: Individuals with higher levels of education are significantly more likely to be in the labor for 4.3% ce tha 4.4% n those with bene Overall, i not be fits whe n ascribed to the officers, divi nduals i they rn e C tire; DHP co s and HDHPs nseque trustees, ntly, t membwere fou h ers, or ey hav other sponsors of the E e n a d to gr be le eater ss lik need to ely mploye than those work to e Benefit Research help in t make their assets last longer raditiona Institute, the EBRI Educ l plan 4.1% s both to 4.5% reco ation and or to mmend 32.2% 3.5% choice of plan (Figure 5). The survey also shows that those with a ch 32.1% 32.1% oice of h 3.1% ealth plan ar 3.6% e more likely to report that 0% 3.0% 32.1%** Difference 2.7% between Choice of Plan and No Ch 2.8% 2.8% oice is statistically 2.9% 2.9%significant at p 2.9% 3.3% 3.3% 3.5% = 0.05. conditions, sm relatively flat to oking, or increasi 2.8% 2.7% ex n 2.7% g fr ercise. om 1987–2008, with vario 2.5% 2.7%Ther 2.8% 2.7% e was a diff 2.4% 2.4% erenc 2.4% u 2.6% e s ag in 2.7% choic e and e e2.8% of du health cational com plan by bi body nations havi mass in ng small dex (BMI) wit decreas h abo es. For ut 2.5% 2.2% Alliance educatio Bn on ernst choice o ein: “Inside f plan t his likely to e Minds o be f Pla highly n Sponsors: correlaA ted. ssessing the State of Defined Contribution Plans Today” 0% Source: Employee Benefit Research Institute estimates 1992 4.6% 6.0% 7.6% 9.7% 15.2% Research Fund, or their staffs. Nothing her31. ein is to be co 6% nstrued as an attempt to aid or hinder the adoption of any pending legislation, regulation, traditional plans and those with CDHPs disappeared because satisfaction increased significantly among those with lower levels of education. continue their plan to to a bu friend or co ild up (or to r -worker a ebuild) assets nd to stay with that they th diei d r current h not (or wer ee alt not abl h plan eif to given ) acc the chanc umulate whe e ton switch. they w Thes ere you e nger. * Difference between Choice of Plan and No Choice is statistically significant at p = 0.10. they are extremely or very satisfied with respect to various aspects of their health care, such as: ease of getting a Internation example, amo al Foun ng th dation ose ag of Employee Ben es 55–64 withoue t a hi fit Plans. gh schoo Top T l dirploma, t ends in Vo he luntary labor-force pa Benefitrticipation s: Survey R rate tren esults. IFEBP ded downward fr60 om the 1987–2009 M perc or interpretative ent of normal an ru ale, or as rch Cud ov r legal, rent Popul erwei accounting, ati ght on Sur in actuarial, o divi veyduals r s. r other such prof eportin 1997 g a choice of essional advice. 4.0% health pla 7.7% n, compared with 8.1% 56 11.4% percent of obese 15.2% Within each age group among those age 55 and older, labor-force participation rates have been increasing and were at www.abdc.com/ABDC/pdf/Final_DCI-6150-0110.pdf?uuid=0e401dc8-05ae-11df-816b-9eec7bcbba8c 30% CDHPs. This remained unchanged through 2009. Differences in satisfaction with respect to the overall health plan However, differences not weonly monetary re present for incentives ar individuals bot e at h wit work h h and wit ere—the hout a re also choice is an increased desire of health plan. among Americans to work R doctor’s ega rdin a gppoi firm si ntment; out ze, 43 pe-rc ofe -pock nt of w et cos orke tr ss i for pr n firm ess wi criptio th 2 n– dr 9 ugs; out employe-e os that o f-pockeffer t costs ed hfor other healt ealth insurance r h care; eporte choic d having a e of 2000 Year 4.2% 7.2% 9.1% 13.0% 16.5% members, indivi from 1987–2008. duals free and 4 ; nonmem 8 In perc contra ent o bers st, among t f un , $5 der 0. Int weie ght h rnat os e ages indivi ional dFoun 55–69 wi uals. dation of th some co Employe llege, e Be the pa nefit Prti lan cipation s, Publ rate t ications rended upwar Department, d . P.O. 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 their highest levels in 2008 since at least 1975 (Figure 2). ForYear those age 65 and older, the rate increased from 13.7 per- TREND WILL CONTINUE UPWARD: This upward trend among the working near elderly and elderly is not surprising and remains, but has been closing over time. And there continues to be a gap in satisfaction with regard to out-of-pocket EBRI Notes is registered in the U.S. Patent and Trademark Office. ISSN: 1085 -4452 1085 -4452/90 $ .50+.50 longer, particularly among those with more education, for whom more meaningful jobs may be available that can be doctors; and overall satisfaction with the their health pla 2002 n. Simi Yearlarly, th 4.2%ose with 6.0% a choice of plan 7.6% are more l 12.2% ikely t 14.6% han choice o Investment Co f health mpany I plan, com nstitut pare: “En ed with duri 83 ng C percent o onfidence f workers in the in 401( firms wit k) System: Investor h 10,000 or m Attitudes ore workers. and Actions” As reported in the Box 68 Only those -9953, ag Milwauke es 65–74 ha e, WI d a consistent 53268-9953, pattern o (888) 33 f in 4-creases in th 3327, optione l 4; abor-force pa fax: (262) 78 rtic 6-ipation 8780, e rate ac -mail: ross each cent in 1975 to 16.8 percent in 2008.55–59 For those un 60–64 der 65, the 65– rate 69 reached 70–74 73.1 per 75+ cent in 20 65+ 08 for those ages 55–59 is likely to continue because of workers’ need for access to employment-based health insurance and for more earning 8 55–59 60–64 65–69 70–74 75+ 65+ costs, with those having traditional coverage more likely to be satisfied with out-of-pocket expenses than those enrolled done well into older ages. 2006 5.7% 7.6% 9.9% 10.6% 19.4% As a result of the differences in the odds of having a choice of health plan, the population with a choice of health plan introductio those without n, large a choice to r firms are more l eport they wo ikely to ul offer a d recomm choic end e of their heplan alth plan to a than friend or co small fir -worker a ms. Just 13 nd thpercent ey wou of smal ld stay in th l firms eir www.ici.org/pdf/ppr_10_ret_saving.pdf White Black Hispanic Other bookstore@ifebp.org, educational group. Other www. wis ife, with ebp.org in a n age group, educational attainment did not have a clear correlation with the (up from 65.1 percent in 1975), while among those ages 60–64, the rate reached 54.1 percent in 2008 (compared with years to accumulate assets in defined contribution (401(k)-type) plans—especially after the 2008 downturn in the stock in a CDHP. Source: Employee Benefit Research Institute, from U.S. Department of Labor, Bureau of Labor Statistics, Labor Force Statistics from Source: Employee Benefit Research Institute, from U.S. Depart 2008 ment of Labor, 5.7% Bureau of Labor St 8.0% atistics, Labor Force St 11.3% atist13.0% ics from 19.3% is skewed toward higher-income households, more educated individuals, and workers in large firms, while the plan if they had the opportunity to switch plans. offered two or more c © 2010, Emplo hoices, whereas yee B45 percent enefit Research Institute of large firms -Educ did so. ation and Research Fund. All rights reserved. labor-force participation rate from 1987–2008. 48.2 percent itn he Current 1975). Populat ion Survey–Civilian Labor Force Participation Rate, online at www.bls.gov/data/home.htm market and economy. Many the Current Source: Populat Employee ion Americans Benef Survey--Civili it Research I also want an Labo nstit r ut Force Part e est to imat wor icipat es frk om 1987–2009 ion longer, es Rate, www.March Current bls pe .gov cially amon /data/hom Populat e.htg t mion hose wit Surveys. h more education. Source: Employee Benefit Research Institute estimates from the 1987– 2009 March Current Population Surveys. ebri.org Notes • February 2010 • Vol. 31, No. 2 ebri.org Notes • February 2010 • Vol. 31, No. 2 ebri.org Notes • February 2010 • Vol. 31, No. 2 ebri.org Notes • February 2010 • Vol. 31, No. 2 13 11 14 8 ebri.org ebri.org ebri.org A monthl ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org Notes • February 2010 • Vol. 31, No. 2 No No No No No No No No No No No No No y ne ttttttttttttte e e e e e e e e e e e es s s s s s s s s s s s s w • Februa • Februa • Februa • Februa • Februa • Februa • Februa • Februa • Februa • Februa • Februa • Februa • Februa sletter from r r r r r r r r r r r r ry y y y y y y y y y y y y the EB 2010 2010 2010 2010 2010 2010 2010 2010 2010 2010 2010 2010 2010 • Vol. 31, No. 2 • Vol. 31, No. 2 • Vol. 31, No. 2 • Vol. 31, No. 2 • Vol. 31, No. 2 • Vol. 31, No. 2 • Vol. 31, No. 2 • Vol. 31, No. 2 • Vol. 31, No. 2 • Vol. 31, No. 2 • Vol. 31, No. 2 • Vol. 31, No. 2 • Vol. 31, No. 2 RI Education and Research Fund © 2010 Employee Benefit Research Institute 16 10 12 15 18 17 19 7 9 6 4 2 5 3 Figure 6 Satisfaction With Various Aspects of Health Care and Views of Health Plan Among Adults Ages 21–64 With Employment-Based Health Coverage, by Choice of Health Plan and Type of Health Plan, 2009 Total Choice of Plan No Choice of Plan a b c a b c a b c Traditional HDHP CDHP Traditional HDHP CDHP Traditional HDHP CDHP Satisfaction With Quality of Care Received Extremely or very satisfied 74% 64% *** 72% 77% 69% ** 76% 69% 59% *** 60% Somewhat satisfied 21 28 *** 21 20 26 ** 18 24 30 ** 31 Not too or not at all satisfied 5 8 *** 7 3 5 * 6 7 11 ** 8 Ease of Getting an Appointment With a Doctor When Needed Extremely or very satisfied 73 66 *** 74 75 69 * 76 69 62 * 68 Somewhat satisfied 23 28 ** 21 21 26 * 19 25 30 * 25 Not too or not at all satisfied 5 6 6 4 5 5 6 7 6 Satisfaction With Out-of-Pocket Costs for Prescription Drugs Extremely or very satisfied 55 33 *** 33 *** 58 38 *** 36 *** 49 28 *** 26 *** Somewhat satisfied 31 38 *** 35 29 38 ** 37 * 34 39 32 Not too or not at all satisfied 15 28 *** 32 *** 13 24 *** 27 *** 17 33 *** 43 *** Satisfaction With Out-of-Pocket Costs for Other Health Care Extremely or very satisfied 52 22 *** 29 *** 56 26 *** 33 *** 44 17 *** 19 *** Somewhat satisfied 31 36 ** 35 29 40 *** 36 35 33 32 Not too or not at all satisfied 17 42 *** 36 *** 15 35 *** 31 *** 21 50 *** 49 *** Satisfaction With Choice of Doctors Extremely or very satisfied 77 72 ** 81 *** 79 76 84 74 68 * 72 Somewhat satisfied 18 22 ** 17 17 20 14 20 24 * 23 Not too or not at all satisfied 5 6 2 *** 4 4 1 6 8 5 Overall Satisfaction With Health Plan E Ex xt tr rem emel ely y or v or ve er ry y s sa atisfie tisfied d 6 66 6 4 43 3 *** 52 52 70 70 51 51 *** 59 59 ** 59 59 34 34 *** 34 34 *** Somewhat satisfied 27 39 *** 35 24 35 *** 32 * 32 43 *** 41 Not too or not at all satisfied 7 18 *** 13 6 14 *** 9 9 23 *** 25 *** Likelihood of Recommending Plan to Friend or Co-worker Extremely or very likely 55 34 *** 45 *** 62 43 *** 53 * 43 25 *** 23 ** Somewhat likely 30 34 * 31 * 26 33 ** 31 37 36 32 Not too or not at all likely 16 32 *** 24 *** 13 25 *** 16 20 39 *** 45 *** Likelihood of Staying in Plan if Had Opportunity to Switch Extremely or very likely 64 42 *** 50 ** 69 49 *** 57 ** 56 34 *** 32 *** Somewhat likely 25 31 *** 30 22 30 ** 30 * 29 32 31 Not too or not at all likely 11 27 *** 20 ** 9 21 *** 13 15 34 *** 37 *** Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. a Traditional = health plan with no deductible or <$1,000 (individual), <$2,000 (family). b HDHP = high-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. c CDHP = consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. *** Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.01. ** Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05. * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.10.