Statement Summary EBRI th alter e good the type risk groups, of treatment providing available. themBoth with public a greatand er fip nra ivate ncial payers incentivare e to refining choose an to d Individuals without health insurance are predominantly nonworkers, self-employed, plan increase attracte or d decrease a largeth peroporti estima on ted ofem poor ploymen healtth ri effects sks, the by cost large ofamounts. private inThe surance other may William S. Custer S. 2114 and S. 1227, as well as other proposals, incorporate two general approaches • Employer Mandates I .J EBRI simulation of a play-or-pay mandate also made the assumption that employers However, society may benefit by forcing individuals to purchase health insurance. enroll in the public plan. Conversely, poor risks would see their premiums decrease, implementing utilization management procedures that may alter incentives to workers in small establishments, or persons in families headed by a member of one of fall, prompting many employers Employee to continue Benefit Research to offer heal Institute th benefits. The characteristics crucial assumption used in this simulation was the costs of the mandated health for expanding employment-based health insurance to those groups not presently Table 1 whose actual or prospective health benefit costs were greater than the payroll tax would Individuals who choose not to purchase health benefits are gambling that they will not providers making it more and con liks eume ly th rs. ey P re rivate tain privat payers e ba er neefits beginthan ning und toeselectively r experiencecontract rating. wiTh th e net these groups (table 2). These individuals face the highest costs of obtaining T-83 health of benefits. the public Withplan out specifying are, therefore, the th actual e most compo impo nent rtant services determinant that would of the be willingness covered, of Requiring all employers to provide health benefits to workers and their dependents Total Employer Outlays for Group Health Insurance and Medicare Hospital Insurance, covered. One is to lower the costs faced by these groups in an effort to encourage them I am pleased to appear before you today to discuss employment-based health care need choosehealth to enroll care employees services. They in thmay e publ make ic plan that rathe bet rknowing than provide that care healwill th benefits be available to p impa rovide ct rs of th a in nd esth e Employer e inc hope entives Health of encouraging will Spending depend as cost-effective aon Perce sentage veral of factors Total practice Co in mc pensation, luding styles. While th1960-1990 e payroll these tax chan rat ges e, insurance coverage, especially when those costs are calculated as a percentage of family employers would decrease to drop thetheir numbe health r of u benefi ninsured ts. from 36 million to 10 million (table 3). separate • Presently,EBRI 138.7 simulations million Amewe ricans re , conducted 64 percent usi ofng those different under age estimates 65, receiv of e the healt average h insurance to purchase health benefits. The other is to require that they purchase health insurance reform proposals. My name is Bill Custer. I am the Director of Research at the Employee directly. them in the Again, case three of a catastrophic different estimates event. Thus, of thesociety averagemay annual bear cost at least of heal a part th benefi of thets risk income. th have through e loc th ae l community poten an employer tial to - reduce rat ores, union-sponsored Employer and theth rate eSpending peof rceheal ivplan. edth quality care Emplo cost yer of Spendi inflation, the ng public thplans. ey may Healthalso Care segment annual cost of health benefits per individual employee--S970, $1,450, and $2,430. The Because many of the uninsured work for small firms, exempting employers with fewer from either public or private on plans. Private HeaJ Both _ of these on M approaches edicareHospitalredistribute as a Percentage the costs and Benefit Research Institute (EBRI), a nonprofit, nonpartisan, public policy research per individual employee were used in the simulation--S970, $1,450, and $2,430. The that the individual chose not to insure against. S.1227 requires that the new Insurance public program offe Insurance r the same benefits as of Total mandated of the market, further differentiating the care received by those with private health cost than of 25each employees additional would depe only ndenr teduce was th ass eumed numbeto r be of u 60 nins percent ured tof o abou the itndividual 25 million. cost. the benefits of health care services. • The cost of health benefits as a percentage of compensation for all workers has grown from Year ($ billions) IS billions I Compensation organization Another m based echanism in Washington, for preventinDC. g adv EBRI ersehas sele loc ntion g been is to committed reinsure the to the poor accurate risk by Table2 cost of each additional dependent was assumed to be 60 percent of the individual cost. private insurance, plans beneficiaries . Providers of would publicbe prreimbursed ograms, andatthe levels uninsu at le red. ast equivalent to Medicare 4.4 percent in 1980 to 6.3 percent in 1990. For employers who offered health benefits, the cost Again, these estimates assume that wages and other benefits do not change as health This analysis assumes that there are no changes in employment as a result of a mandate, NonelderlyPopulationwithSelectedSourcesof HealthInsurance,byIndustry 196o An employer mandate is essentiall $ 3.4 y a payroll tax, $ 0.0 although the burden 1of .1%that tax is direct subsidization through a state risk pool. A number of proposals include measures analysis of public policy employee benefit issues. Through our research, we strive to Th of isthose simula benefits tion pwere roduced on average estimates 10.9 which percent found of payroll. that between 33 percent and 51 1965 reimbursement rules. Altand hough Size of states 5.9Familywould Head'a receive Employer,0.0 a 1990 federal matching gr 1.5 ant, they • Small Group Insurance Market Reform benefits are added. Clearly, if wages adjust, fewer individuals would become even though health benefits represent a significant component of total compensation 1970 12.1 2.3 2.3 not distributed equally across all employees, employers, or consumers. Some of the contribute that would to encourage the formulation the creation of effective of either and public responsible or private healr th, einswelf urance are, pools and to percent of all Americans would be enrolled in the new public plan if the payroll tax No Health 1975 would administer the program 25.5 and eventually assume 5.6 an increased funding 3.3 role. • Health insurance costs in the private sector are not currently distributed equally among all unemployed as a result of a mandate.. (10.9 percent of payroll among employers who offer health benefits) (A. Foster Higgins 1980 WorkStatus and Rrm Total 61.0 EmployerProvided11.6 Other Total 4.4 Insurance costs of mandated health benefits wo_lld be passed on to employees in the form of lower reduce the effects of adverse selection_ These pools would allow individual insurance retirement policies. In keeping with EBRI's mission of providing objective and impartial werSmall e set at groups 9 percent. often The facepe highe rcentage r costs of pe nonelde r participant rly enrolled because in tof he th public eir highe plan r pe would r 1981 Given payers.the Ultimately state and th federal e costs budget of employment-bas 71.7 constraint eds it health seems 15.9 insuran unlikely ce are that born real e provider by 4.8employees, Sizeof FamilyHead Total Private Total Direct Indirect Private Public Medicaid Coverage & Co., 1992). Clearly, if a mandate were implemented without a transition period, so 1982 82.6 16.8 5.2 wages, lower levels of other noncash benefits, or unemployment. Low-income workers analys plans is to , cap our the worcosts k does of not the poo contain rer rirecommenda sks, permittti in og ns. them to offer lower premiums than consumers, and taxpayers. The distribution of these costs depends upon the size of the capita range betw admieen nistrative 24 percent costs and and 45 insurance percent. compa The percentage nies' limited of the ability previo tous pool ly uni risks. nsured By EBRI's simulations estimated that between 200,000 in mi/lionsand 1.2 million workers could 1983 income from AmeriCare would mat 91.5 ch that available 18.7 from some private pla 5.4 ns. The Statement that other elements of total compensation (such as wages) could not adjust, the cost of 1984 employment-based group, the employer's 100.3 market power 20.6 in labor and output mark 5.4 ets, and the would have less opportunity to trade wages for health benefits and would be more would otherwise be possible. rwho emoving would barri gain ers cove that rage preve th nt rough insuran ers employme from pooli nt-b ng ased smallplan groups, ranges emplo from yment-based 43 percent Total 215.9 158.3 138.7 70.3 68.4 19.7 29.2 21.6 35.7 1 public become 985 plan's unemployed ability toas set a di fees recta1 n 0 rd esul 7.4mo t nof itor a manda utilizatte ionthat 22.7 and employe the pr rs essures provide of 5.5 po heal litically th • demographics Introduction of the insured workforce. labor would increase substantially, possibly causing some loss of jobs. 1986 FamilyHead Works 192.9 151.6 113.7134.6 67.5 26. 67.1 1 17.1 17.0 5,5 11.4 30.5 likely to experience the effects of an employer mandate in the form of unemployment. Before the Committee on Finance coverage to 78 percent. may expa Of the nd ntew o include enrollees many in tof he the public employed plan, between uninsured 10 mill in small ion and firms 45 and determ Unde ined r 25 budgets49.7 would 3likely 1.8 decrease 22.5 most 11.0 providers' 11.4 income. 9.3 The 5.3reduced3.8 14.0 1benefits 987 to their employees. The122.9 higher estimates wer27.7 e the result of higher 5,6 average costs The development of reinsurance markets, or state risk pools to subsidize the 25-99 25.2 18.5 16.8 8.4 8.3 1.8 2.5 1.9 5.0 1988 138.7 29.6 5.8 Some of the costs might be passed on to consumers in the form of higher prices. The • Small group reforms that institute community rating increase the costs for procuring health thei million r dependents would have (who previously constitutereceived 39 percent benefits of theth nronelde ough rly an employer-sponsored uninsured). health number 100 or of more private 1plans, 18.0 coupled 101.3 wit 95.3 h employers' 48.0 willin 47.3gness 6. to 1 drop 9. health 3 benefi 5.6 ts as 11.6 1of 989 the Prese mandated ntly, 64 p health ercent plan of Ameri and 157 cg ans .r 7eaterunder price age sens 65 itivity r 31.8 eceive of he the alth demand insuranfo ce 6.1 r labor. through an U.S. Senate insurance - for groups with relatively good risks while lowering insurance costs for relatively insurance costs for poor risks may alleviate some concerns about restrictions on 1990 174.2 33.6 6.3 remainder Family Head of the costs of a mandate would be borne by the investors and owners of the plan. The relative size of the public plan has important implications for the distribution costs increase, would limit cost-shifting to the private sector. eml_loyer- poor-risk Doesnot Work groups. or union-sponsored 23.0 6.7 plan (Employee 4.1 2.8 Benefit1.3 Research 2.6 Institute, 12.2 1992). 10.2For 5.2 Table 3 premiums. However, public and private reinsurance schemes distribute the cost burden firms Many subject proposals, to the mandate. including The S. 122 distribution 7, would impose of this burden community wouldrating vary with by industry, limited Source: U.S. Departmentof Commerce, Bureauof EconomicAnalysis, Survey of Current Business, January 1992 (Washington, EBRI analysis also found that the cost of an employer mandate would be borne Coverage Effects of an Illustrative Employer Mandate, 1990 of the costs of play-or-pay proposals. Hearing on most Self-Employed of the 138.7 million 17.6 nonelderly 12.7 Americans 7.7 3.4 with employment-based 4.3 5.0 1.2coverage, 0.7 the 4.1 DC: U.S. GovernmentPrintingOffice, 1992); The Nationallncome and Product Acoounts of the Uni_edStates, 1929-82 differently. If a private reinsurance market develops, the costs of providing expanded • Requiring all employers to provide health benefits to workers and their dependents would Under 25 16.2 11.5 6.6 3.0 3.7 4.8 1.2 0.7 4.0 adjustment region, firm allowed size, andfor ownership age and sex type. differences. Some analysts argue that mandating These (Wasfa hing cto torn s, DC: coupled U.S. Gover with nmentemployers' PrintingOffice,1986); desire and to Theoffer National be Income nefitsandthat Products attra Accounts ct and of retain the United primarily by small employers and their employees. EBRI Number estimated Covered th under at an illustrative de 25-99 crease the number 1.0 of uninsured 0.9 from 0.736 million 0.3 to 10 million. 0.4 0.1 0.0 0.0 O.1 level of benefits offered, the range of choices in providers, treatments, and sites of care States, Statistical Supplement 1959-1988, vol. 2 (Washington,DC: U.S. GovernmentPrintingOffice, 1992). access to poorer risks will be borne by the purchasers of insurance. The premium paid 1OOormore Employment-Based 0.4 0.4 0.3 Health Care 0.1 Reform 0.2 Proposals 0.1 0.0 0.0 0.0 communi Assum tyingratit ng hat or allelimina employ tieng rs w demograph hose healt ich c adjus are cos tmen ts tswere would greater raise than rates 9 pe forrcen many t of a skilled workforce, may mean Presen that many t employerS smallwould Exempt continue toUniversal offer health employer mandate would increase spending by employers on employer-sponsored are superior to any publicly provided benefits presently offered in the United States. system Mandatea Mandateb • Play-or-Pay Employer Mandates by individuals and employers for health coverage will include the premium paid by • EBRI simulations estimated that between 200,000 and 1.2 million workers could become gr Wage payroll oups and Salary and dropped createtheir adverhealth se selec beti nefi on.ts and paid the payroll tax (assuming a play-or-pay be heal nefi thts benefits even ifby the$33 costs billion of such to $86 benefi billion. ts as The a perwide centage range of payroll between exceeded the estima the tes pay isroll Workers 175.4 138.9 126.8 64.1 62.8 12.1 15.8 10.6 26.5 An EBRI/Gallup survey conducted in December 1991 found that 73 percent of (millions) (millions) unemployed as a direct result of a mandate that employers provide health benefits to their insurers for the reinsurance of poorer risks. On the other hand, the burden of the costs Under 25 33.5 20.3 15.8 8.1 7.8 4.5 4.1 3.2 10.0 mandate with an average cost of $1,450 per employee), such a proposal could increase tax. This would especially be true if the perceived quality of care in the public plan was related to assumptions about health plan costs. If employers with fewer than 25 Total 248.9 248.9 248.9 by Play-or-pay proposals limit the costs that employers would face under an employer employees. 25-99 24.3 17.7 16.0 8.1 7.9 1.7 2.4 1.9 4.9 Americans with health benefits rated their health benefits as excellent or good. Adverse selection occurs when individuals with greater health risks are of a public risk pool will depend on the financing mechanism for that pool. Most state Private 100 or more 117.6 100.9 95.0 47.9 47.1 6.0 9.3 5.6 11.6 overall Health employer insurancespending costs inby the app privat roximately e sector $45 are billio not currently n. Employe distri rs bu with ted fewer equally than 25 inferior to the quality of care received by privately insured patients. employees were exempt from the mandate, spending would increase by $12 billion to mandate by allowing employers to pay a payroll tax rather than provide health benefits. Directemployer 71.2 86.6 117.7 disproportionately enrolled in a particular plan. Community rating limits insurers' • risk EBRI pools simulations are now estimated financed that by state an illustrative insurance employ premium er mandate taxes. would increase spending among employees all payers. would The facecost increased of employer-sponsored costs of $18 billion.health insurance depends on the Indirectemployer 68.7 (percentage within industry and 75.3 firm size categories) 71.4 $33 Th billion. e empCosts loyer fo sha r re employer-spo of nationalnso healt red h eheal xpend thitures benefitshawould s remain also ed be virred tually istributed. constant The revenue generated by the payroll tax would be used to at least partially fund a William S. Custer, Ph.D. by Other employ private ers on employer-sponsored19.5 health benefits by 1$33 3.9 billion to $86 billion, 5.4depending ability to charge different premiums to groups on the basis of risk because the premium Conversely, limits on provider revenues may reduce the number of providers, their Public Total 100.0% 100.0% 100.0=/o 100.0% 100.0=/o 100.0% 100.0% 100.0% 100.0=/o characteristics of the employer's work force, risk factors attributed to the industry, and Workers who had previously been covered under another employer's plan would now since 1980, but national expenditures Director for health of Research have grown faster than income. As a upon the cost of the mandated plan. comprehensive public program. Medicare Fami Re ly sear Head chers Works evaluating 89.3 9 the 5.8 Robert 31.4 97.0Wood 9Johnson 6.1 9 30.6 F 8.1 oundation 86.8 (RWJF) 58.2 29.2 projects 52.8 for 85.4 charged If wages undeand r a community other compon rating ents scheme of total would compenslimi ation t the could risk facto not adjust, rs usedsome to ability to invest in technological innovation, and their ability to finance health care Under 25 23.0 20.1 16.2 15.7 16.7 47.1 18.0 17.8 39.1 the employer's market power in the local health care services market. There are Medicaid 17.2 15.5 13.3 be covered directly underEmployee their ownBenefit employe Research r's plan.Institute For example, under a mandate result, health benefits as a percentage of compensation (averaged over all workers 25-99 11.7 11.7 12.1 12.0 12.2 9.1 8.4 8.9 13.9 the medically uninsured found that small employers' primary reason for not offering CHAMPUSc 4.8 1.8 1.0 •unemployment EBRI simulations would estimated result. thatEBRI betwea en nalys 33 ispercent estimated and 51 that perc between ent of all 131,100 Americans andwould 965,000 be determine the premi.um. As a result, premiums for groups that represent good health services research. It is unclear how this would affect the quality of care in the short run. 100 or more 54. ,t_ 64.0 68.7 68.3 69.1 30.9 31.8 25.8 32.5 signifi Uninsured Es cti ant matedifferen s of ch ce ar_g s ., es in health in health care 36.0ins costs urance across covera regions, ge 24.6 andindustries costs o,f such and abetween p 10.3 lan varylarge ,e with whether an ave they rage receiv_ healthhealth plan benefits cost of $1,450 or not)pe have r indigrown vidual from employee 4.4 perc and ent noinemploye 1980 tor 6.3 enrolled in a public _lan under an illustrative play-or-pay proposal if the payroll tax were set health Family Heed insurance was the high cost of coverage--85 percent of employers not offering rjobs isks could would be rise lost with under the aimplementatio play-or-pay nproposal of commun withity a 9 rperce ating,nt while payroll premiums tax. Again, for as Many argue that the United States has overinvested in health care technology and Does notWork 10.6 4.2 3.0 3.9 2.0 13.0 41.8 47.5 14.5 and small employers. substantially, depending on the behavioral assumptions chosen. Simulations of these at 9 percent and all employers who had health benefit costs greater than 9 percent of payroll size percent Source: exemp Emp in loyee ti1990 ons, Benefit (Bureau a Research bout $20 of Insti Economic billion tutesimulat in ion cos Analysis, using ts Mwould arch 199 1992) 1be Current r(table edistributed Population 1). An Survey. A. from Foster one Higgins employer to insurance cited high premiums as an important reason (McLaughlin, 1991). Although groups aThe under mandat an rep eemployer requires resenting allemp mandate b loa yers d r with isks ,25these or would moreestim em fall. ploy at ee es So sto me provide assume of the healno th goo insurance td ransitio risks to e nm would plo period yeesworking chnor oose 25 any or not more to overtrained physicians. A reduction in expenditures for these purposes may free dropped their plans. The percentage of the previously uninsured who would gain coverage Self-Employed 8.1 8.0 5.6 4.9 6.3 25.5 4.2 3.2 11.5 proposals must determine which employers will continue (or begin) to provide health hoursper week. anothe survey r. conducted About 45in pe1991 rcent found of these thattransferred among employers costs ($9 who billion) offered would health be redistributed benefits, the Washington, D.C. the Under RWJF 25 demonstration 7.5 projects 7.3 did 4.8 not reform 4.2 local 5.4 small group 24.6 insuran 4.0ce markets 3.1 11.I through an employment-based plan ranges from 43 percent to 78 percent. purchase b adjus TheUltimately mt anda ment tehealth require in the other sall insurance ecosts mplo componen yers oftoemployment-based as prova ts ide result heal of thtotal insurance of thcompe e p to remium employees health nsation.insurance working increase, In more practi than while are ce, 19 born tho he mo urs eimpact rper ebyw of eemployees ek. thon e bad resources needed to finance care for those who have faced access barriers in the past. 25-99 0.4 0.5 0.5 0.5 0.6 0.6 0.1 0.1 0.2 insurance and which will instead pay the public plan to cover its employees. A recent CThe to average small Civilianhealth employe Healthand plan rs. Medica If cost l sm Program a was ll employers of10.9 the Uni percent formed we Ser rv of eice payroll. exempt s. 1fr Spending om the mandate, on employer-sponsored the total costs 100 or more 0.2 0.2 0.2 0.2 0.3 0.3 0.0 0.0 0.1 the way that current national proposals would, their goals are similar: to stabilize the in remplo isks the would ym form ent of purchase is lower likelywages to heal be thand lowe insu rsalaries, rance. than these The lower result esti levels mates would ofind other be icate. an benefit increa s,se and in th fewer e pool's jobs; However, in the long-run there may be less innovation in health care and fewer of the • EBRI simulations estimated that such a proposal could increase employer spending by study by the Urban Institute assumed that employers would base their choice of redis health tributed plans has among tripled all in employe the last rs decade. would be In only 1980,about spending $5 billio on n employer . health care cost Wagea of nd insuran Salary ce to small businesses and distribute these costs more equitably. June 9, 1992 by$4 consumers 5 billion ovein rall,thewhile form employers of higher with prices fewer for goods than 25 and employe services; es would and fa by ce taxpayers. increased costs average risk, increasing premiums and potentially creating a vicious circle that would best and the brightest entering the medical profession. Workers 81,2 87.7 91.5 91.2 91.8 61.5 54.0 49,3 74.0 whether or not to participate in the plan on cost alone (Zedlewski, 1992). If their average benefits totaled $64.8 billion. By 1990, those expenditures had almost tripled, reaching of $18 billion. The proportion of employers that would actually drop their health benefits if a play- Under25 15.5 12,8 11.4 11.5 11.4 22.6 14.0 14.7 27.9 end Previously with anuninsured unsustainable smallhealth employers insurance beganmarket. to offerThe insurance likelihood to their of this employees scenario The distribution of these costs depends on the relative market power of the employer in The question of whether uninsured workers and their families would be better off if 25-99 11.2 11.2 11.6 11,6 11.6 8.5 8.3 8.8 13.7 $186.2 per capita billion premium (Levit, would 1991). be lower under the pay option, employers would enroll their or-pay proposal were enacted depends on a number of factors. If the public plan were The 100 orab more sence of national 54.4 63 heal .8 th ca68 re.5reform68.does 1 not 58.9imply 30.5 a static health 31.7 care 25.8 32.4 during EBRIthe simul enrollment ated chang phase es inofem the ploy demonstration ment that woul projects. d occurHowever, as a result only of m 17 anper dac tin ent g of their healthinput insurand ance output were markets extended and to them their under relativeanmarket mandate power centers in the on health the issue care of actually occurring depends on the sensitivity of the demand for health insurance to • If wages and other components of total compensation could not adjust, some unemployment workers in the public plan. The study analyzed both a 7 percent and a 9 percent payroll considered inferior to private plans, employers might continue to offer private health delivery system. Public and private purchasers are independently developing and services employers would rmarket. esult. whoEBRI previously analysis estimated did not offer that insurance between 131 enroll ,100eand d even 965,000 in the jobs most could successful be lost that all employers offer health benefits (wages and other elements of total compensation Source: EmployeeBenefitResearchInstitutetabulationsof the March 1991 CurrentPopulationSurvey. changes in premiums among good and bad risks as well as on the ability of individuals whether they are uninsured by choice. Do workers select jobs that do not offer health tax. It found that under the 9 percent tax scenario nearly 40 percent of nonelderly Note:Details may notadd to totalsbecause individualsmay receivecoveragefrom more thanone source. under a play-or-pay proposal with a 9 percent payroll tax. The views expressed in this statement are solely those of the author and should not be attributed to the benefits in order to gain a competitive advantage in the labor market. An employer's implementing cost management strategies that could potentially have profound effects RWJF project targeted at small employers (McLaughlin, 1991). If the experience of these to were determine held constant). their own Therisk sensitivity status. of employer demand for workers to changes in the benefits in order to receive higher levels of cash compensation or other benefits? If Employee Benefit Research Institute, its officers, trustees, sponsors, or other staff. The Employee Benefit Americans would be enrolled in the public plan, and undei" the 7 percent scenario 52 willingness These considerations to continue heal have th led benmany efits may to argue depend that on tying the characte the financing ristics of ofhealth its local care on the cost, access, and quality of health care services. Changes in the way that projects is representative of national experience, small group insurance market reform price of labor is crucial in this simulation. The EBRI analysis used a range of estimates of Research Institute is a nonprofit, nonpartisan, public policy research organization. • The proportion of employers that would actually drop their health benefits if a play-or-pay employees are choosing a total compensation package that does not include health percent would be enrolled in the public plan. proposal were enacted depends on a number of factors, most importantly the perceived to heal the S. th122 labor ca 7remandates market. market results Employe that all in rs Ame an tha inequitable rica t n lack s receive confide distribution n coverage ce in thei of through r both ability benefits ei to ther manage aand public costs. their or a The Medica this sensitivity re reimburses based on physicians, economic which literature began (Hamermesh, to be implemented 1986). It inshould 1992, may be noted alter the by itself may result in a minority of small employers choosing to purchase health benefits, any measure that forces them to accept a package with health benefits will quality of the public plan. insurance. p number heal rivate th ca plan. of renonelderly cos In ts this maycase, be Americans mo communi re likely without ty to rad tin rop g health would healtinsurance h in benefi crease ts. has tCo he n increased ve cos rsely, ts of ins ito furance t35.7 he public million. for willingness of physicians of dill_ Tent specialties to accept Medicare patients and thus that other values supported by the economic literature could be cited that would make them worse off. 1 This survey is of predominantly medium- and large-sized employers. EMPLOYEE BENEFIT RESEARCH INSTITUTE 2121 K Street, NW Suite 600 11 . Washington, DC 20037-2121 17 0 Telephone 202-659-0670 FAX 202-775-6312