What Does the Future Hold for the Employment-Based Health Benefits System?

The employment-based health benefits system is the most common form of health coverage in the United States, covering 167 million people under age 65 in 2017.Between 2013 and 2017, the percentage of individuals with employment-based coverage has been growing. The increase in employment-based health insurance among workers and their dependents may be due to the increase in the percentage of employers offering such benefits, which may in turn be due to a combination of the strengthening economy, lower unemployment rates, and relatively low premium increases.
According to the 2018 EBRI/Greenwald & Associates Health and Workplace Benefits Survey (WBS), nearly 60 percent of workers are satisfied with their current mix of health benefits and wages, and most individuals with employment-based health benefits are satisfied with their coverage.
The employment-based health benefits system has a number of advantages over various alternatives.These advantages may make it difficult to completely move away from the employment-based system.For instance, when it comes to insuring a group of individuals, employment-based groups are often considered “natural groups” in the sense that they were formed for reasons other than the purchase of health insurance. Insurers are more willing to provide insurance for a naturally formed group than for a group that was formed solely for the purpose of buying health insurance because the risks of adverse selection are mitigated. Employers also often act as an advocate for workers during coverage disputes between the insured and insurer, and they frequently involve themselves in matters of quality assessment of care and influencing health care matters in the policy development arena.
The employment-based health benefits system is far from perfect.One of the shortcomings is that it does not guarantee universal coverage, which a Medicare-for-all system could do.Many employers, especially smaller employers, choose not to offer coverage.Employers that offer coverage also need to continuously justify whether to offer coverage to workers.The percentage of employers offering health benefits ebbs and flows with the economy and other factors.De-linking health insurance from employment may address the shortcomings of the current system.
Public policies related to the Cadillac tax; Medicare-for-all; proposals that would allow insurance to be purchased in the individual market using employer funding; and market developments, such as the gig economy and high-priced medical advances like specialty medications, may all affect whether there is an employment-based health benefits system in the future.
The Congressional Budget Office (CBO) estimates that employer and employee contributions toward health coverage will account for $282 billion in forgone tax revenue during FY 2019 and nearly $3.7 trillion over 2019‒2028.In contrast, the FY 2019 mortgage interest deduction is expected to account for $75 billion in forgone tax revenue, while contributions to workplace retirement plans for that same time period are expected to be about $196 billion. The large dollar amounts associated with the tax exclusion of employment-based health benefits makes it an almost inescapable target for policymakers from both a budgetary and a political perspective.
While employment-based coverage is the largest tax expenditure in the U.S. budget, it is also the least per person when compared to other health-coverage-related subsidies.The average per capita subsidy tax expenditure was $1,722 for individuals with employment-based coverage, compared with an average subsidy of $6,111 among those getting a subsidy in the non-group market and $4,418 among those receiving either Medicaid or coverage through the Children’s Health Insurance Program (CHIP).
Capping, reducing, or eliminating the tax preference could generate additional tax revenue to reduce the budget deficit and/or pay down the federal debt.Or it could be used to pay for a new round of health reform.For instance, during the 2018 election, many democrats noted their support for “Medicare-for-all,” and reiterated such support with the introduction of the “Medicare for All Act of 2019” on February 27, 2019.In various single-payer or Medicare-for-all bills, employment-based health insurance would cease to exist as we know it.However, in various Medicare and Medicaid buy-in proposals, employers could continue to offer health coverage.Even the administration’s own proposal to expand the use of health reimbursement arrangements (HRAs) could seriously undermine employment-based health benefits.

The employment-based health benefits system arose not from any deliberate national health care policy but rather from a voluntary, market-driven response by employers to government regulations regarding wages and taxation during World War II. In the absence of more government involvement in health care, employer activism has increased through various types of coalitions. What we do not know is whether employers would trade off more government involvement in health care for less of their own involvement if given the opportunity, especially in a weak economic environment. Thoughtful consideration of policy proposals to expand the number of people with health insurance coverage should not only evaluate their effectiveness in addressing health care costs, quality, and coverage. Policy makers should consider the impact on the voluntary, market-driven, employment-based system.

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This Issue Brief was written with assistance from the Institute’s research and editorial staffs. Any views Despite the fact that employment-based health benefits are the most common source of health benefits and that the The The e Sa xis nde tenc rs a e nd of e Ecllonomi ison siengl s of e-sc paayle er in t prop heosa pur lsc h waould se of co gm roup ple the elya lt ov h insu erhaul t ranhe ce he cov ae ltr ha g ca er e re fin sult anc s in low ing and er a dv ee liv ra eg ry e Benefits System? $7,000 100% Figure 9, Distribution of Private-Sector De P fin aerd t Be icipa nfit 20 n On t 13 s in a ly 20n E 14 Dem fin 20 p e15 d loy Com ntrib 20 e16 n utio t-n B O 20 ansed 17 ly Retir Bot em h ent Plan, by Plan Type, Retirement Prospects in a Defined Contribution World." 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Pro80 po %sal Type Individual Eligibility Employer Eligibility q inc and ue luding st those ions he som rte a hllt a ah b e tt e w s dm e ould tne a o lle fit t he m rs m e ov b m e a e p ne k loy m efit s i or es offe tr e s, w atn ow a hic ra lm erdd h in ost unde indiv ine tur ridua s n o a cn HR ap fltly a eb n m p A le ur , ttc e a he ha a rg ns e sed int t im e for rp p a rrcp iv o tolic ion b v aing tey c m c e ov o a tw m k ee e rp a ree s g n HRA ns e fr o a co m tio ul sn a b d ot a seri nd nd h ac ousl b a b e fe u ne d tye g fit unde reia s. ta p ry la r m a ns nd ine , FSA a itp . olit s, ical Security and Medicare. This tax break is the largest “tax expenditure” in the federal budget. The Congressional Budget employers may be better at searching or negotiating for lower-cost health plans than workers would be in the individual 7.9% 2017 .................................................................................................................................................... 18 Replaces private insurance, his Ne In Su faca tg tt o or rg r ly ric o es in ta duc w ? ted lly o - The fo t C h trir ion it b d ne a us s of ti xt ine o n rte ss he :c P e ra p ss eul Fr op aio sons, e ula n w onst tio ill n b m in e (p . 62 t loy “he W p e ha e fir rr s w t cst e D n ould roe te)c s t e or ss fin he 16 iod n in Fu 7 mi 71.4% dis tuchis lli ront eon tH or inu old indiv y ing si for nidu cc e tohe a v tls he e r E unde a m ins ge p ur lo vre y aa r m n y gc e e a e nt t 65 tm - rB a a ha c a rtk sed iv e de t e . rH m e E e fo p m aloy rlt m ph B loy m s w e e en e ne rts a r-efit b a lp r s Sy sed ut ea d int st y e o pm ay ? ” 8% COBRA cp oe vr espe ragc et, ivaend . other matters. One of the provisions in Notice 2002-45 allowed HRAs to be used on a stand- $5,000 Office (CBO) estimates that employer and employee contributions towards health coverage will account for $282 billion Public Plan Option market. Lacking either an employ 7.3% ment-based system or universal coverage that mandates participation, this will be 60% 70% including employment-based 60% cWh W E highe pov la m ec p ek e loy rnow a rba g fe y ee t re t s m he in 201 Does t ts t ha o A a t na C p wA r7 ( or g ov . ek Fi ide Ie ttg he rw s v u rs t r ill ch ea os h b l1) ue e a e tn . of Fu t he he d In cont o pa r fir Me lt ov h b t st iding du tr ic e im ar ne a st re e e , he fit in his 14 Hold f as m a nd ltph b o e Me tr roc ee re d y ne tnt ic hta a ha fit p n a id. s ur o t b a n c r To y ha y r th e cot sed c ha te he he ss nging e rc ion w d ov e e Emplo m ger p rtea he a loy eg s p e te d ha a d e eir ir si tb e e g e e d c m n o ne t 1ly w p yfit loy it f th m fr h th o offe em ere s fe e ba rn e e ina n insu ne d et l b b fit - ty ili ha B s p te ry e tm a r la of c, p os n. 22 loy st ins e s a H e p ur d righ es. ra re H cnc e -b Id nt n th e eeing e d huc aa ed s thif ible lth te d EBRI Issue Brief, no. 476 (Employee Benefit Research Institute, March 14, 2019). $4,418 56.5% The employment-based health benefits system is the most common form of health coverage in the United States, 55.6% alone basis to reimburse workers for eligible 63.9% health insurance premiums, which included premium 55.2% s for health insurance 63.5% 55.0% in forgone tax revenue during FY 2019 and nearly $3.7 trillion over 2019 6.7% ?2028. In contrast, the mortgage interest Figure 11, Percentage of Persons With P 62.4% rivate Health Insurance Under Age 65 Enrolled in a 54.2% High-Deductible Health Plan one of the more difficult aspects to replicate. Two public plan option proposals, Schakowsky/Whitehouse and Bennet/Higgins, would co b ver e a agve. aila Prb ole hi btio tsa em nyp one loyer e sligib le Endnotes he c t Me ao om bsenc a td he lt p ic ?h p a a m n e id, ie la a W of s t nd n ahil s (H nd m o b e or d e 10 e D e lie em ny H g v p p P ov e e loy s p r) te c e he e op m a rn nt rir e e m le nt e d b e c m id -e nov b c t p a om not inv loy e sed ra ing olv e g ha e c es c o e v m for v m ee o a e a r n join he ra p nt n eg r y e a e in he he nd - e isxis a t m lt he a ta h insu or ilng lt th c la e h p rc cg a o ond la e rrm a e st nn , m s ic e t te on. t ions a m ha .x pe tB loy xpe H c e or a tD e w ptr H ndit o e p a P erc c s a n ov ha tur iv 20 ide rr e is e g 13 m in t e he r tp h a he a he a a nd lt y s in m h p m U. 20 e m c la S. nt r17 o e n rb a s w re , a sed udg ttfor he eits, t h d e tsu p hr t, e he e c oug irth condi c d yis e uc nt m h va a ta a ible lsg yo e rtd iou s of t ions e of he cs t ide indiv le . ay t a Ip tst le to e idua w a s of d p st ill r eop rla s ls o covering 167 million people under age 65 in 2017. Despite the fact that workers value health insurance more than any p Be urchn ased ef bits y wor S key rs d sirt ee ctlm? y from insurance companies in the individual or non-group market. deduction is e 60% xpected to account for $75 billion in forgone tax revenue, while contributions to workplace retirement or in a Consumer-Directed Health Plan, 2007–2018 ..................................................................................... 18 $4,000 56.2% 50%17 Single payer from providing duplicative health t C o op pa yrrtig icip ha t In te in t form he a pti ublic on: m Thi ark s r ete pp la or ce t . is Sm cop ay ll e right mpeloy d b ey rs t he would Em paloy lso eb ee B a eb ne lefit to Re offe sea r rtche h I p ns ublic titu tp ela (E n o BRI pt)ion to th . It maye b ire 50% c w $ b c ov oa 1,35 e it h e te lhe itrions a 0 m g fir fe p o p . st .loy re indiv r Sim tson w m im W ee ila nt ha idua tr-ha he t ly b w a , tl n com sed w e c he ov hil da o e c e ltov rnot h insu p a th a g er e e re k a p d a now gr nd re t op a o nc ha osa $2 ot is e s he ,700 w p b l inc re r he e e he m n tlude for he ia um elt d r h f g s e a s fo -ing m m c ao n il p v rty loy up e idis p r ce a ov e( op g c rF r e s w eigur ile - m rrae ina g ould unde la e et t2) e in 201 ion p d t. r 2 r su a 40 dr b e 0 p ov 9. si off mo d is e ie B ions re s ct . ew nt The re te o e of n 2007 g pov a r tohib he ve er rnm fa e it g a d e nd e e e m nt rp ae p 20 l p inv rloy c 18 ov a olv ep , e rit s f rte the ay m r su om le epn v b ete si r d c l w in he d r eop y nt ould tp a aa g ing x lt e h ca bof s eic r ke other e 6% mployee benefit, the system faces a number of potential threats in the fut 5.6%ure. Public policies related to the Emp plans S len a oye r. eS a e rn xpe d aer s c sA / tR edv ep d t . oca o Ela lis ct o ce n o u(nt M ed for ic aa rb e-ou fort- a$ ll196 ) b Aill ll ion U.S . fo res r iFY den 20 ts.19. benefits. B 1 em y Pa ployul Fro ees via ns thet in, smaPh.D. ll grou,p E ins mplo uranc ye e m e Ben arket e (a fikta R SH es OP ea m rch I arketns platcitut e). e W hile large employers could not offer the used without permission but citation of the source is required. See Table 2 in https://www.cbo.gov/system/files?file=2018-06/51298-2018-05-healthinsurance.pdf E su indiv for em m b p p le siloy loy idua d ss ize e e 50 of e re ld % s ne s w s fr xpe tb he yit o ndit v it h p m re he r ow tur m rhe fe iv n inv e aa id d rtw e e e he ra a t olv ins s $1,7 his l g alt 5.0% u e ov h p r m pare e nc ov 22 la rnt nm ns e is fo if g io on , ert n w nt he iv ia ndivi d e rH ide e ur n th D is id H ng ly ua P e no a a op in ls vt a hin r cw p ila e re or cit g b e ah e tle ss sed st uni ion i op a m tnd, fr y p p, loy om in a ng ein 201 spe m e 17 m e m c n e .4 ia p ta- 3, th loy lly nin b pa e e sed in a rgc re fu s fr e nt Ob l w cw o ov ta e m a o m a e y k 46 r. d a a r e g E op A .0 ce m d ono , p m p p c ing e lo in om r m c y is 5.0% e ic e c p tnt r ov r a s m e ar t nv e e (ion b Fi r da a i g rg y w onm ur eit d a e h a e for n ce 11 ne ide n n a at ) dll w .. ttv Thought ha he Ieror roni t a p k g tr e he c e a ra c s. su y lltf y ic ul no b , e si w id n hil y e Cadillac tax; 4.9% Medicare-for-all; proposals that would allow insurance to be purchased in the individual market using All individuals eligible to participate in the 4.7% 40% 10 40% p The Eublic mploy inc $3 p ,0e rla 00 e rs a a n o se rp e in e t ion, not m only p the loy y m a cb e oul le nt - d tb o d afin r sed op d c he or ov a ne eltrh insu a gg ot eia , w tr ea hic low nch w ee a r oul m he od a ng ltm h in w ak or e su k te rhe r as a nir c e nd e m cost tphe los t y ire h d ea e s e n w peligib nd ore kle nt e rs for s m c ould su ayc b h co e in t due v he er a tindiv o ge the . idu inc al rease 4.4% 36.3% t c t E long he he onsi mp rD e e loy d e ris e p n e ra te a rof a rs fa e ttlk ion o m d$6 of e tco ,111 n ing te f p offe xpa of tolic he a L rnding m a he y b highe ong or p ar lt op Te h b Me those st o ce sa hni dp ne ic rls e a cfit g m r a te e o l Re s t ium t t e e io it ng xpa le he s in t ba e a r nd se c su thr om he N tb he o o. si p ugh gd e r num 20 y oup tit 35.9% in t 13 ia v b e b - m he e 03. uy in t ra 36.1% r o -non k ihe f p n p e t e Then - 36.1% la — rg op og b r ou or tle rhose a 36.1% p in D m w m m it aor h he ra w e k re c it v ke tih mor e a m a d t lt Me u a bh insu rnd eing r d e ic 20 $4 ca tos he 16 r r,41 e at- nc , ly fo n 8 t e e h r ta xt ha -ec a m ov ll, th 21 r n o ee ng c a st re va e ss e C g t rhose p e e ion, ant r g sh og e u ould r ra p ry and e op m c Ce ula ur ta not iv he ls e itng s o ions onl A he c atit y s hi — he r m g h ay e The 2 mploy larg ee r fun dolla ding r a; ma oun nd tm s a arss ke oc t d iaetv ee dlop wit m h th ente s, suc tax e h xc alus s th ioen o gig f e em conomy ployme a nt nd -bhigh ased- p he ric ae ltd h b me ene dicfit al a s m dv aa knc es it es a lik n a e spe lmoc st ia lty marketplace (citizens, lawfully admitted 4.1% R S ep eeo w rt A wwv .w ail hite abil hoit us ye :. g To hi vs r /we pp -cor onte t isnt/ avup ailloa abd les /on 2018/ the02/ intaepr_13_e net atxp wew nw diture .ebri.or s-fy2019. g pdf. Note that contributions to 37.7% 40% 3.9% in t marhe ke tp, eb rut ce nt the ag ye a of lso eof mt peloy n a ec rs offe t as an a ring dv su oc ca h b te efor ne fit ws or (kFi eg rs d ureur 3) ing . Thi cov s,e in t ragu e rd nis , p mut ay e s b be ed tw ue e e to n th a c eom ins bur ina ed tio an o nd f ins thur e er. e c d inc fin om v ea d d lude lua uc b din rttop ible d a e t Me p a t ion o he s. ing pdrir ic ov I c f t n 2019 a eov is id ff he io e eor cr n know ta ins iv g c, e ov e ur tne he a e ap ss rnc rn a a p e g e e iis n a e a s t m lin tah he a d g r $ rd oug . k 1,36 r Qua e e W tss h th r hil e 4 ing lif fo e d ie e r e e tm d d he m C uc s Sm hil p ir a loy t d p ible nd im a er rll Em e e m p n’ r t a s m he for as H c nt en p a a on inpa lo e b ty a y ili r les e he t he th I r ty iie d si a H t en nt ns lt o tea h c a t g t u sst lt e , iv rh Re n a a a t e o nc r y o e ts ( w m ie n c or im c o a a P and st k k r b re e og cu s, q er r r a s t $rseme a 341 a m tua a ed m x a )lit - j ( or fr c a n C y op n e tH , d m e A I a a P rn o m y Sr)m d v m a .one e nge ae c lov a lnt em w ys p m e a tr p o y e a le nt o g fp r y re ur er om d ( , QS a s c b y h a ut he a n E a d se H ft sh a tR e lhthe ould A r ei h b )60 ra , le w t h ne c dhic on afit yh si ss )d a end r The aut 4%hor wishes to thank Jon Anderson, Joe Antos, Peter Baxter, Bernadette Branosky, Bob Foley, David Kasiarz, Jon m ine esc dic aa pta ions ble ,t a m rg ae y ta fo ll a r fpfe olic ct y w m he ak the ersr fr the om re b is ot a h a n e b m udg ploy et m ae ry nt a-nd based a p oli heta iclt ah b l pe erne spe fitcs tisy ves . t eC m a pin t ping, he rfe ut dur uceing, . or retirement plans do not receive the same tax preference as spending on health insurance or mortgage interest. In the case of Proponents also believe that the availability of a public plan would be necessary to drive private insurers toward true 30% 30% For stre ngt exahe mp nin le, ga e n e conomy mploy, elow r expe er une rienc ming ployw m ide ent spr ra eta ed s, a dis nd satris ela fatciv tion w ely low ith a pr e spe miu cm ific inc hera ela th p ses. laW n w ithill r e eit spe hec rt fin to dt he a ne w not otherwise eligible for Medicare. employees and dependents have ins t w a ahe llow he $ur 185 im n th a s c nc p d a e e e c e r ttd e on ac uc on ionomy n sm tthe ible the ir a v ll e for ow olun is m n ma st ou p r ttong loy ap ra y ye , t ,ifre m ina s t w nt a he o r lly offic kus n th e p te -ud e te H r iv tR v e he is e A cin onomy t s on s. fut em u Me p rae loy d tw of a ic m x ea -a ee r p k m e n re e tp b ns -floy e b e, ne r arsed e m efic m d e p nt ia bsy loy a r-ie si b st e a s t s c e r sed m s m o a.n co r e he aiy m a v d b lte e ur h co rc ide se the v w se e tha r or ad g t k e e e td he r t s for uc o yt tible no he he long ts w e ast ltit h in .e h supp r ne sue ra dle n tc m o ee offe ntarl Kessle $2r,, 000 and Lori Lucas for useful comments on an earlier draft of this paper. eliminating the tax prefer$1,722 ence could generate additional tax revenue to reduce the budget deficit and/or pay down the health in 30 sura % nce and mortgage interest, forgone tax revenue is never collected. In the case of retirement plans, tax revenue competition. Opponents view the public plan option as a step toward government-run health care and are wary of cost 11 he economy alt ?h p la C a n o and ppring, tthe hr ela ra eb td e or uc n to fin 24 ing, .2% mark or e dt , e alim tne heiw nune a he ting m alt pth p loy he la m ta n if ex p nt t rrhe e afe te ins r e ha nur c s c ee ron c oul dtoe inu ds not g ee dne t o rre a tspond r te end add d it ow to iona tn. hel I tis t a w su x ae rs b e s b ve ernue low oug 5 ht to p up re erd cb uc ey nt e m for te he m m be ost rs Medicare-X offered in the individual market access through the small group There are pros and cons of having an employment-based health benefits system. Furthermore, it is debatable as to c p he ov ur ac e lth rh b a ag sed e e ne e it on fit he s t trhe b o yindiv b p eur com c idua hapsi e l n tm ig tiv a trha ek e in t tt , co a he v s w e la ra e b g ll a or e a s d m t a te he rd ke uc irt . tow ible Itn e w s, a ould xpe nd ns b ce e os tor the sh b fir y a re st ing nr tim ollin me o r g in his e in a gene t or Me ry ad lly tic ha .arte a A A r d e yv c ea e ant ss r la ion ag te er w p , ould la Prn th esi b da e et n t 22.0% fe deral debt. Or it could be used to pay for a new round of health reform. For instance, during the 2018 election, Table of Contents 20.9% is forgone in the short term, but income is taxed when distributions are taken by retirees. shifting 20 fr % om public payers to private insurers (Fronstin and Ross 2009). A public plan could have the means to lower 20% beginning in 2020 in areas with one issuer insurance market. Medicare-X of of The t 20 he ne 16 p w , la b trn. r udg e eg nding Iula ns etu t d ions r e e d rfic ow s it a an to 4.1 r ra e end/or e m xpe ore c p p tlik e a ed y e r c ly d te o ow nt to b e n th b r e y fin spond te he a liz fe e e dnd d e t o re aof a a l d r n e ly 2017 e b t m h t. p is lo ( Or y Fi y ee g a it rur r t ca h e ould nd a4) n to a . t a b k W ee he n ind us eff n une ee dc iv tto idua for m pa pp y l b loy la for e n ye m c a e au nt a ne se r s b is w of low r eound tg he inn , rreing is c of k ruit of he on ing a los or lth r a ing a nd fe te fo ar rm. whether 20 t % here is an alternative to the employment-based system that would produce higher-quality care, better service, p Tr oft aum ir ee n p d p w ris ov it su h a ide ed s c vhis iaob ve le exe ra ac lt gut e er in for ve a t or id ve e dd e tuc o r. e tible mps b loym y lim entit -b ing ased the c ov nee tw raor ge k, of so w phy esi sh cia ould ns t not h 16.5% at e ar xp e e cc ov t e em rep dloy bye trhe s t o pla be n. ha v Ae nd as t unl he iky e 2% many democrats not 15.5%ed their support for “Medicare-for-all.” In both Sen. Bernie Sanders’ (I-VT) and Rep. Keith Ellison’s $1,000 Introduction .......................................................................................................................................................... 5 3 costs in a number of ways, b Pu ut b lisett c pla ing n op ptr io ov n idero rp h aiy gm h c eo nt st sl e dv ue e ls to a ptr o avlr id eer ad sy h o low rtag es Me , dicar oe ff er leed ve ls in is sm tahe ll g m rou ost p m lik are ket ly action Ja la r eS rtn. g e ae e in 1, 2020 http g ing roup For :w //or file c .ins k ont e str .a k s b rff n ac c .o e t e rg c , w od /he m a ur tta e n th ing s a ch me a tb he tigg g nt/ r20 e oup Tab r1 c8 e ha is le lle - le not Sc id nge tion, e a -by d for v-m eSr id a sely se eny m e-p Com d loy em le e poc r c as, inc tris e rd aot . n s luding - not Med eic d a so trhe em -fo ir e r su -sm all p-a p Plor le ub r tl ic fo em -r P p la “loy Me n-P e dro ric s, p a o rw e sa - hi for lsc h in fo -a r llmo ,” tu a r rnd e n o de ftte an ils. References and lower price, and what that alternative might look like. 10.4% ha emvp eloy in p me ant st -rb ea csed ess ions hea. lt h p The la ns Ur, bMe an I dns icatr iteut deoe es not stima tha es t veh a a tm 18 axi .3 mm uill mion fe out-of w-ep roc pe kop et le lim w itill fo ha r b ve e ne em fic pia loy rie m s. e nt-based (D-MI) single-payer or Medicare-for-all bills, employment-based health insurance would ce 9.0% ase to exist as we know it. 8.0% Sen10 . B %ennet/Rep. Higgins (Federal/Medicare) then in all areas by 2023. beginning in 2024 7.5% . in the sh 10% ort run. A public plan with premiums lower than private plans would either drive private plans to reduce costs 10% Why Do We Have an Employment-Based Health Benefits System? ............................................................................ 5 m Und eae ns r tihe m re p ine rtov er w a ing ly te d pc rom su opcose p h s ens d upp a re tior g on ula t a w tnd ion ith b s, t te he ne w int fit o s. try od pW e us of citth r ion o H eR spe f Atshe c w t tould “o Me prd e b im c ea ium a re llow for s, e tA d he ll A : y c ha t of ve 2 b01 ee9 n inc ” on re Fa esi br ng uar onl y 27 y m , 20 od19 est . lyI n for B 4 rown, Robert L., and Jianxun Liu. 2001. "The Shift to Defined Contribution Plans: Why It Did Not Happen in 4.8% Canada?" coverage under their proposal and assumes A theT dr opA in c ov GerL agA e com N e C s fE rom workers opting for the Healthy America H S ow eee http ver, sin v ://waw rious w.urb Me an. do ic rg ar /e site and s/de Me faul dic t/a file id sb /p uy ub -in p lication/ roposa 98432 ls, e /20018 mploy26_20 ers cou 18. ld 0c 5. ont 11_h inue ea lthy to offe _ame r he rica a_fin lth co al_1.p veradgfe . Even Small employers and their to be com $0 petitive or drive private plans out of business if they could not negotiate the same provider payment levels as Deli This v Ise su ry I e Bnn riefov su am tim on ar ize and s a H de isa clt uss h ion o Care f th Qua ese liis ty su es by a panel of experts at EBRI’s December 2018 Policy Forum the past v da ercious ade si (Fi ngle gur-e p a 5y ).e r or Medicare-for-all bills, employment-based health insurance would cease to exist as we North American Actuarial Journal 65-77. E pr m og ploy ra0% m m v eolun nt-Bt aa sed rily H ra eta he lth B r theane n b fit es a caus t Ri e sk em ? p ................................ loyers dropped cover................................ age. This is an assum................................ ption based on the expe ............ rience 9 the Trum 0% p adminiEsm tr pa loy tion’ ment-B s ow asedn p Coverra op geosal to expa All nd inditvhe idu u a Nl o se s n -el Gof ro ig uiphe ble atlt oh r pare tim icip b au te rseme in the nt em arr Me p alnge o dy icaid eem s /C /e H pIP n artts (H icipaRA ntss h ) ac vould e 5 0% 0% the p ?ublic A p stla an. ndB -a ylone cont H ra Rst A, ta ha ptublic coul d p la be n d us ee sidg ne to d p ur in suc chase h a c ov wa ey ra a gs t e in t o phe rev non ent -ig t rfr oup om m exploit arketing with no any unf cont airr ibut advion antages A Sdva ee http nt sages ://www .o ame f E ric m anp plro ogy re m sse .ont rg/- isB sue as s/e he d H althce are alt /reh Bene ports/2018/ fit 02/ s 22/447095/medicare-extra-for-all/ held in Wash 2005 ington, 2006 DC. Th 2007 e pane 2008 l was c2009 omprised 2010 of Pa2011 ul Frons 2012 tin, Dir2013 ector, H 2014 ealth Re 2015 search a 2016nd Ed 2017 ucation P 2018rogram, Argum ke now nt s it . for How De eve-rLi , in v nk aing rious H Me edalt icarh Co e and ve Mer dage icaid bF uy ro -in p m rE op m osa pls loy , em m ploy ent er s could continue to offer Employment-Based Coverage in Own Name Uninsured Employers frequently involve themselves in matters of quality assessment of care and influencing health care matters in of em Rp ep loy . Se ch rs not akows k dyr/op Sen p. ing cPov ube lir ca p gle an a o ft pe tir o n the A m CaA rk w ete pnt lac e int (co itie zen ffe sc , tl aa w nd fullm y a ad ym not itted b e va alid cces wse trh er o tu he gh U. thS. e SHO to e P xperience its Working Adults Non-Working Adults Children seriously undermine employment-based health benefits, as will be discussed in more detail below. Cong ?r essThe ionae l P mrp op loy os m ae lsnt t- o bE ased xpa nd hea Hlt eh b alth I ene ns fit us sy ranc se te C m o v ise rta he ge m ................................ ost common form of ................................ health coverage in the ................. United 9 or perverlim se it inc . The entiv He Rs m A m ight ust not be us ree ad liz te o a pny ur cp hra ese miu Am CA s-a cv oim ngs plia an st cp ola mns pa a re nd d to m u pst riv m ate ee p t la AC ns A. affordability requirements Clark, Robert, and Sylvester Schieb er. 2000. "The Shifting Sands of Retirement Plans." WorldatWork Journal 6-14. E The 6 mploy eme pe loy Bm ene ent fit- b Re ased sea rhce h I altns h b titeut ne efit ; Sa s sy brsina tem C or hale s a tte num , Resea berr of ch P ad rv ofe anss tao gre , s ove Centr e rv a of rio Hus ea lt alt h eIrns nautriv ae nc s. e These Reform s, health coverage. Even the administration’s own proposal to expand the use of health reimbursement Whitehouse (Federal/Medicare) permanent residents, not incarcerated). marketplace. t De he Se - lin e p olic http king ys d :he /e /v w ae w ltlop h insu w.m fee dnt erra a n a lre c re egn ifs a rtom . eW r.g it e oh m v/tp d he loy oc ume rm ise ent nts of m he /2018/ ay a lt ah ca d10/ dre r29/ ss e c t 2018 ost he s in t sh -23183 orhe tco m 19 /he ings 70 alth s a of -re nd timb he 19 ur c8ur 0s serme , en latnt r g sy -e as rra e te m m np g . loy eFo me e rr nts s b exa -e a m g nd p an to p - le o, ther-ay first recession since then. Source: EBRI estimates based on data in https://www.cbo.gov/system/files?file=2018-06/51298-2018-05-healthinsurance.pdf. States, covering 167 million people under age 65 in 2017. Between 2013 and 2017, the percentage of in order for the employer to meet the shared responsibility requirement. The HRA will not be subject to ERISA Georgetow So So n U uu rce: rce: niv D Em ece ep r m si lob y ter ee y u H Benefit ne em al ptlo h P Rese ymolic ent arch rate y In Ins stitute frot m it Bu ut est reau eim ; Jose ate of s Lab fro poh An m r Statistics, the Curr tos, Wils ent Seri Po es pon u LN latio S14 Hn . 0 Su T 00a rv 0y 0 ey lo 0., r M Sc arch hol 20a 1r 4 –in Hea 2018 Sup lt ph lem Cents. are and Retirement a Thi dvnk an tT aa gnk es P m rop ay os ma als ke ................................ it difficult to complet................................ ely move away from t................................ he employment-based................................ system. We will cove............ r the 11 arrangements (HRAs) could seriously unde Indivir dm uaine ls a g ees m p 5loy 5 to m 6e 4nt w- hb oa ased re U he .S. alth benefits. c W he aloser a chil caoltun eh ins e t- m tb te p a ur n s Sou loy e taion to he d nc rce m -g : e e ro U nt .S. is up - De no b-a p he a ar sed tl tme ta p h c lt or h nc t t -a o o a pr fv b l L e a e ab le ns r q o a ua rfr g Form om elit is y 5500 . jtob One he Su tla o m a m rjg spe ob are iest , s c 1979 i.e tt aof ., x e –1998 w this xpe or , Pens kindit e nc rion s c reur Be a ased e n nno e fin t it G a tu t he us ar te an ua n U. tyt Co ion w lly S. rp c b oo ra udg a nt tio s inu nt e , he Curr t, e i etfor t n o is t Po m p a p aa ls ur lat tto ion o ic ion tip he Su at rv f c e le e ya o in t 1999 st ali he tc –ions ost 2011. ir lhe y of p ae ltrh plan A public plan could exacerbate cost shifting from the public sector to private plans. It is well known that premiums for Fronstin, P Sa ou ul, a rce: Em nd ploy Ed ee na Ben Defit retResear zka. 20 ch In 18 stitu . " te Con estimate sums efr r oE mnga the Cu ge rrm ene t nt Po pin Hea ulation Slt uh rvey C, aMarch re: Fi 20 ndi 18ngs Suppleme From nt. the 2018 individuals with employment-based coverage has been growing. The increase in employment-based health if certain conditions are met. *EBRI estimates 1999 –2014. citizens or nationals residing in the U.S. or P ad olic vay n,t a Ag m ee s in t rican En his sec tertp ion a rise n Ins d t m itov ute e; ta o nd disw ad as vam nt od ageers in t ated he by ne Tax m t.i Sim on, Global Corporate Consulting Leader, The Under the Center for American Progress “Medicare Extra” proposal, employers would be allowed to continue to offer person when compared to other health-coverage-related subsidies. The average per capita tax expenditure was $1,722 e wm he pn th loyee rs t y co ha fa nge cilit a job te s. the W sh ora kre ing rs som of inf eto im rm ea s st tion aya in bout the h ire jaob lth c s baerc ea q us ua e liof ty he and althe h in alt su h ra ca nc re e . p rThe ovide Hre s a altm h I ong nsu a r agnc rou e p of 7 Trump Administration Proposal on Health Reimbursement Arrangements .................................................................13 employmE eB nt RI -b /Gr ased eenw hea ald lth& b A ene sso fit cia s a ters C e highe onsurm te ha r n th Enge ay g ew m ould ent in othe Hera w ltis h eC b ae re b Sur ecav us ey e." t he EB fe RId I esrsu al g e ov Bre ierf, no nment . 46 set 8 s prices See https 5://www.whitehouse.gov/presidential-actions/presidential-executive-order-promoting-healthcare-choice-competition- insurance among workers and their dependents may be due to the increase in the percentage of employers ? ? The An “e exc me pp loy tem d e bnt ene -bfit ased HRA he ,” a lw th b hereene efit ms sy p laloy wfs u et lr le y s w m ad a ould mriose tted b not fe o ra p bf er le rom m tao n a en cn ont ty r es d ribu e ilibe den te cr e a up te tna o $1 tion ,80 al he 0 tha altth c wor ark ee p rs c olic ould y but us e Segal Company. See this link to watch the video replay. coverage. If they do, they must provide coverage with a Figur n ac e 1 tuarial value of at least 80 percent, and they are also e P for m or p tindiv a loy bili etidu rys in o aand ls w rA dit c ec h e rount to ma p a llow loy bilim t y ee m A nt c p- tloy b(a Hsed eIrP s A tA co ov ) ca ont ed rd ar g ra e ec ss , t c ew om dit p h th p or ar ta e eb d b ili w etst y it h w ins a he n a ur n it evre s a c ra om nd gee su p s t rov b o siide cd ov y re of sr. aMa $6 ge,111 ny for b p e arlie m e-v ong eexis tha tting hose t em cond g pe lotit y tin e iorg ns s a through M (Ee m dp icloy are e. eI f t Behis ne fit con Re tinu sea erd c h unde Instrit a u tp eublic ). plan option in a health insurance exchange for the under-age-65 across-united-states/ Advantag offe es of ring Em su pc loy h b meene ntfit -Bs, w ased hic Hh e a m lta h B y in t ene ur ifit nn b tsh ................................ e eU d .Sue ., a n to d w a hc oom are bn ina ot toion o t................................ herwf t ise he strengthenin................................ g economy, lower ..15 t ro atp he ay r fr the om ir a out vol -of unt -pa oc ryk, em t c ao rk st e tsh -da riv ring en r ae nd/or sponse ce rb ta y in p emr pe loy mium ers t s, suc o gov h ea rn s t mho ent se re for gula shtor ions r t-ter em ga he rding alth insu wagers a anc nd e, Less Chance of Adverse Selection required to contribute at least 70 percent of the premium. Today, the vast majority of employers already offer plans subsidy in the non-group Sou marrce kes t a of He nd $4alth ,418 a Ins mong uranc thoe se , Ind receivid iving ue als ithe Un r Me de dic r a Ag id e o 65, r cove 2017 rage through the Children’s for are w be or ttke err s c able ha tnging o per fo job rm s; h thow e role eve of r, p m ot onit entor iaing l emqpua loy lie tyr s om f he aya no lth c t offe are rt h he an ind alth b iv eidua nefitls s. , t he benefits offered may be population, private plans would Med isee care c bost uy-is inc n for rea en se titla ed s he to/a ellt ig h c ibla e rfe o rp bren ovef ide itsr s inc underr eased rates to those plans. As long as 8 unemployment rates, and relatively low premium increases. C taOB xatRA ion d , dis ur aing bilitW y in orsu ld rW anc are I, Ia . nd In th dent e a ab l a senc nd v ei si oon f mor inseu rgaov nceer. nm W ehe nt n o invff olevre ing mea nt n e in he xcep atlt eh c d baerne e, fit em H pRA loy, er In contrast, the percentage of private-sector workers with retirement plans participating in only DC plans increased Shor Seet c http oms ings ://wof wwt.he irs .E gm ovp /lo pub ym /irs ent -d-ro Ba psed /rr- 02 He -41. alth B pdfe nefits System ..............................................................................17 that meet these requirements. When it comes to insuring a group of individuals, employment-based groups are often considered “natural groups” in G H lea e ss b a lt ecl, h 70 om Jon % Ins pru eR. rhe anc 19 ns e99 iv P e. r og t"h Job a ra n w m -B a ( eC sed re H Ioffe P H ) e(ra Fi eltd g h I uin t rns e he 6 ur ). a cnc ur e re : nt 19 j7 ob 7-, 1a 99 nd 8: The the b e Ane ccfit ide s fr ntio am l Sys the te p m ot Und entia el e r Sc mrp uloy tiny er ." m Ha eya lt co h A st ff m aor irs e . Sen. Stabenow (D-MI) older adults Medicare Parts A or B. No provision. premiums in the public plan were lower than those in pFigur r Figur Figur Figur ivatee 11 e 5 e 7 e 3 plans, individuals would flock toward the public plan, Why Do We Have an Employment-Based Health Benefits System? a ec m tiv ploy ism e rha s m s inc ustr e aa lssed o offe thr r ou a g gh va roupr iou hea s t lth p ypela s of n, bcut oa w litor ions ke. rs c Would hat w de e cd lin o enot it aknd now ge is t cw ov he er the agr e e in t mphe loy non ers w -gould roup from 16 percent to 72 percent. The percentage with both DB and DC plans was 22 percent in 1979 and 23 percent in H 9 ealth Literacy Issues the sense 18 tha (6) t : the 62y- 74. we re formed for reasons other than the purchase of health insurance. Insurers are more willing to HIPAA does not address portability for workers w Indit ivh id ou uatl she aga es lth in 50 tsu o 6r4 a n wc he o c aov re e no ra t ge through their job, which has Arguments for De-Linking Health Coverage From Employment .................................................................................19 See ? http Asc:c // or wd wing w.irs to .gto he v/ p 20 ub 1/8 EB irs-dro RIp // G nr-e 02 enw -45. ald pdf& Associates Health and Workplace Benefits Survey (WBS), nearly 60 ultimately resulting in fewer private plans. Private plans would drop out of the market as they determined they were Pr P Comp e 62% e P rmiu ce ern ce arison t m ag ntInc e ag of P e r of Su e of Priv ase erso b s sid Amo n as tie e With - s n Se Un g ct Employ Priv d or er Es a Curr tte abli e He re s n sh With alth t L me aw Wi Ins 10 or nts uTha rth anc Mor V t Of e ariou Un ef Empl ed r s e He P r os Ag o alth y sib e e 65 ele s, Workers w m tra a ould d rk ee off mor t . ha E vm e p the e loy g e op ov rs e tira on nm re of e not ne t nr inv allow ollin olve g ed m in Me te o noffe t in he dicra b re a ot ltE h th h xtcra a er e e st vfor a en n w d le -a ss he lone of n th tH he eRA ir ir e ow a m nd p n inv loy exc eol r e p offe vte em dr e s bnt e the ne if g m fitiv a H e RA p n th la n d to e tirhe ec tsa ly. m e It was during World War II that many employers began to offer health coverage to workers. Because the National War 201 There 4 aa nd re p ae nu ake m db e at r 3 of 5 p wa ey rc s etnt ha in t t the he su mb id si-d 19 y 80 could s. be used differently while trying to maintain employment-based provide insurance for a naturally formed group ottha her n for wise en a tg itrloup ed to t M ha ed t iw caars for e Parm t Ae o dr solely Em for plo yter he s o p fur elp igose ible of indb ivuy iduing als implications for the gig economy and contract workers, who are less tied to traditional employment relationships. Our resea pr ecrh h cent as found of workteha rs a t only re sa 39 tisf p ieed r cw ent ith th of e wir or ckur errs e nt we m reix o ext f he rem ae ltly h b ore ne vefit rys ca on nd fide wa nt g e tha s, a t nd them y ost could indiv chidu oose als t he wit h una 10 ble to compete with the public plan. As private plans drop out and fewer individuals are covered by private plans, 60% Conclusion ...........................................................................................................................................................19 Enrolled in a H Ins Wigh u ork ranc -e D r E e ed , arnin u bc y Es tibgs, le tabli Sce He and sh alth narios me Infla Plan nt tion Siz or e , , 1988 in 2013 a Con – – 2019 2017 sumer-Directed Em Sp eloy e http erop cs w la sp :ss /or ould / w of tuni ww w ct.or ont y d, o kl.g e e rspe r ibut s. ov /ce aia gtll e he y nc in a ie sasm / e w e b e saa am / ke oe m unt cp onomi loy to erMe sc - ae d nnv ic d-air ard o ev nm E isxt ee rrs nt a / g . tuid h Thought ata nc the e/ yte ful ccon hn ctonsi ic ribu al-d re te el e rta a ots ion o t ehe s/13 ir f ow -p 03 olic n cov y pe rop rag os e aw lshe to n their L Ga ab le or , W Boa illia rd m fr , oze Lesl ie w a Pg ae ps, e ke, m and ploy Ja ec rs so k Vaught nDe rw he ai. ys t 19o 99 g. etUn ardound ersta nding the w atg he e c Shif onttr ols in from D or ed fin ere tdo Bae tn tre afit ct tsc o a D re ce fin w eor d kers coverage. First, the subsidy could be limited to only individuals below 400 percent of the federal poverty level (FPL), eligib13 le to enroll under Medicare Part A or may pay premiums on their behalf, health insurance because the risks of adverse selection are mitigated. In a purely voluntary system, such as the U.S. best availa em bp leloy he m ae ltnt h p -bla an in sed he the a lt no h b n-eg ne roup fits a mra er k sa ett.isfied The witIh th nstit eu irt e c ov of eMe rag de ic . ine (2004) concluded that nearly one-half cost shifting available from employment-based plans would be reduced or eliminated. This would put undue pressure DB plans steadily lost ground as the preferred plan type for a number of reasons: employee es c xpa hoose nd the the num Me bd eic r a of rep E ex op trle a p w rog ith he rama.lt h insurance coverage should not only evaluate their effectiveness in (Helms 2008). In 1943, theM N ed at ic ion are al Wa buy-in r fL oa r bHe or B , B w alth oa hor w d Plan, o(u N ld W bL e B 200 el ) ir gule ib7 le/ – d 2018 en th ta itt led em if p aloy ge e 65 r co ifnt en ribu rollt m ions ent it so ch he oicae lto h f in thsu e rance m 11uch like C ont subrsi ibut dieion P s in tla he ns no . Pn a-p ge rr oup pre m pa arre kd e tfor . Und a ce on r fe this re nc sce e na ent rio, itletd o, ta El t RIaSA x e A xpe ftendit r 25ur Ye es fa ars: A ll t o Fr $1 am 25.6 b ework ill ion ( for Figure Re Anot fer he enc r e ex sa ................................ mple regarding de-lin................................ king health ins 20 ur 13 anc20 e ................................ 14 from 20 e 15 mploy 2016ment 2017 rela................................ tes to the lack of choic ........................... e of a health plan 20 system, the risk of adverse selection is relatively high because those most likely to seek insurance for health care are See https://www.irs.gov/pub/irs-drop/n-17-67.pdf of all adult Americans were health illiterate. The Institute of Medicine report cited studies that determined that limited on The the ad m public inistr p at la io n to r n expe aisce ts a prov round ider 80 reim 0,00 bur 0 e seme mploy nt e ra rs w tes a ill o nd ffreari ses stand a q -a ue lone stion HRA as t s b o yw 20 he24 the a r nd tax r bea ytond es w . ould A 99.8 s a ne ree sd ul tto , 99.3 99.2 99.4 99.3 Rep. Higgins (D-NY) older adults or older. individual and not the employer. addressing health care costs, quality, and coverage. Policy makers should consider the impact on the were notE su vab lua jec ting t to P w ea ns ge ion Re contrfor ols b m, ecconv ause ene of dI b RS y The rules t Brha ookin t de ge s I mns edt ihe tuta ion, lth insu the rSt anc anefor to d not Inst b iteut te re for ate d E caos nom taxa icb le Polic y a 7m ). ong Sec w ond ork , esu rs w bsiit dh e ies c mould ploy m not ent only -based be lim cov iteerd a g te o : indiv Worid ke ua rs d ls o benot low ha 40 v0 p e ae lo rcte of nt p FP laL n b cut hoic could es thr als oug o b h t e he cap e pm ed p loy at m the ent - 50 20 % % 100 96.3 96.3 HDHP (no HSA or HRA) CDHP (HDHP with HSA or HRA) also ?t hose The 18.6% most em p liloy kely m teont ne -be ad sed he he alta h ca lth b ree. ne As a fits sy resu stlt e, mw ha hes a n insu num ring berg of roup ads, in vantsu agr 95.1 e es ove rs are r una vario bus le ta o ltsi er ngle nativ out es. hig These her- E 12ndnotes .............................................................................................................................................................21 healt ?h li tG erov ace yr nm has b ente e re n show gulation to b n hade a a p ss rofound ociated im wit ph w act or on se pla he n c alth h st oice at us (Cl, ahighe rk and r us Sce hie of be he r a 20 lth c 00)a r(e Ip ser polit vic o e20 s, 02 and ) worse 93.4 inc som Emrp ee loy a se 10 er .7 mi ts w o su ould lli po pn ind or ha t su ve iv c idua th hig he c lshoic he wrould e ra of te b s. offe e cov ring ere Me d b dy ic a su re c h a Extn HRA ra to t he byir 20 em 27 a plond yee 6.8 m s. 92.5 If th illio en fe y did, we trhe wy or w ke ould rs (a bnd e rtehe quir ir ed to See https://www.ebri.org/health/publications/issue-briefs/content/private-health-insurance-exchanges-and-defined- voluntary, market-driven, employment-based system. income. Re As a sea rre csu h, lta, nd betche aus TI e A of A-b Cus RE ine F I ss ns rte ita usons te aCurr t rte he ela nt t LN e aw d a ttion o caom l Pp re ess ting Club. for scarce workers and government policies on value of less-comprehensive insurance, such as premiums associated with HSA-eligible he $272 alt.0 h plans. Under this based system. Nearly 60 percent of workers wit Pre h he mium a lIn th i creas ns esurance Wo ha rkv ee r E a ar nc inhoi gs Inc cre e ase of shealth p Ove la ran ll In , b flat ut io nonly 19 percent risk or unh ade va aln thy tag indiv e 17.1% s mia dy ua m lsa , kaellow it ding iffictult hose to indiv comp idua letels ly tm he ov sa e m aw e a op y p fror om tuni the ty e to mb pe loy co mve ent re-d b a bse y a d he syst alt eh m ins . Fo urra nc inset apnla cn. e, 18% 50% 16.7% clinical out ( 90 Va co nD me es. rheIi a t a nd lso fou Olsen 1997 nd that) .indi viduals w Indiit vih lim duals iw te hd o he are arlt es h lit iden er ts a c oy f sa ta nd tesc hronic illness have less knowledge of c dont epernd ibut ent e s) at w leould ast 7 ha 0 p ve er c treandtit of iona the l e Me mpdloy icam ree nt Ex-tb ra a sed pre m he ium alth co . If e vem rapgloy e. e Irts d is id no not sur offe prisre he tha alt t h b thee re ne w fit ould s eit b he e rfe aw s t ehe r y contribution-health-plans-is-it-d%C3%A9j%C3% 16 A0-vu-all-over-again--5092 wages and taxation unrelated to health care, employers began to offer health coverage to their workers, and 46.0% the sc hae vna e a rio, choic tota el t of ax e at le xpe ast ndit thr uere e s fa heall t lth p o $1 lans 01.9 b . W illion. hen w In c orkont ers d raso t, ha lev t’e s a a ss choic umee tof he he sua blt si hd p y la for n, e itm isp loy typm ice ant lly- b be ased twe en a Hence, ew mhe ploy n it m c eom nt-b ea s t sed o ins heuarlt ing h insu a gr roup ance of is indiv a pot idua entls m , e ea m ns plo for ym sp ent re-a bd aing sedr g isrkoup ams a onrg e b oft ote h he n consi althy d earnd ed unh “nate uarlt ah l y electing to establish the Medicaid buy-in d Me ised aica se m re a n aand ge m Me ent di tc ha an t id h Buy ose -w In ith hig her health literacy. While the report did not examine the impact of health 40 16 % % 43.7% p cur eop rele nt lw y it dh e o or m p thr loy oug meh t nt-he ba s Me edd he icaa re lt h cov Extrae p ra rog ger . a m Em , t phe loy ye w rs ha ouldv e b e b e re eq n int uiree dr e to ste m da in t ke e he ithe conc r meap in t tof ena “d ne cfin e-of ed- effort 45% 14.7% H 13acker, Jacob S. 2002. The Divided Welfare State: The Battle over Public and Private Social Benefits in the United number of persons with employment-based health cove77.2 rage started to increase. After the wage controls ended, the coverage80 is eliminated and individuals with employment-based coverage move to the non-group market. Under this he Unp alth m ubliasin he te dna find ncing e or s g fro aniz m a the tion (H 2018 MO EB) R I/ and Grea e nw pre afe ldr & re d A sp sr oov cia ide tesr H or eg aa lth niza and tion (P WorkP pO) f lacer om Bene the fits sS aurve me ins y. urance carrier indiv ?idua g C ls. r ha oup Thi nge s” s is s in t in t an he he a rsense g wuor mkep nt tla ha categ ta m he ins ay yt w ha m eo v re v e ing for cont m aw r eibut d a yfor fr ed or m e to a t sons the he cr ur ot ise rhe eof nt r tD e ha m C n p plo la the y ns m , peur inc ntc-luding h ba ase sed of in sy he csrte a ea lt m sed h insu , e spe wor ra ckn ia ecll re ya . nd a Ins s iur t ers option, who are eligib 74.6 le t74.6 o participate in the 73.9 73.5 th literacy on knowledge of health insurance and purchasing decisions, the conclusions drawn from the report raise the c pont aym ribut ents ion (D — thC a) t is he , a pla th” ym ceov nte s e rag qe ua al to th nd giv eing ir spe wor nding kers in t an he HRA ye ta hra b t e the fory e ceana n c us tm e etn o t, pur adcjha ustse edc for ove inf rag la et ion in the and non firm - size States. Cambridge University Press. A num14 be %r of Medicare and Medicaid buy-in proposals were introduced in the 115 Congress 39.4% . Sen. Debbie Stabenow employment-based system continued to expand, in part because income and payroll taxes became more prevalent; the ( sc or e na thr roug io, if t h th hee su sab m sie d y self we -ins re ur lim eit de e dm to ploy indiv er)idu —a a lslt b houg elow h 40 consu 0 pem rceernt -d rFP ive Ln he , tota all th p tax e lan xp s a endit re bur eing es for inc r this easi g ngly a roup d wd oul edd a s 40% 14 Sen. Schatz/Rep. Lujan (D- marketplace, and who are not concurrently relates to a er m m ep or m loy e o re indiv er w ap ill idu ping reaclis ita o ttic io p rn a a ov pp ide nd roa d ins c ehe m ur a s t a nd nc o e for he fo a D r lt C h insu a p na latn ur rs aa( nc lG lye a for le . , m Pa ep dk g er a oup nd Va tha nD n for erhe ai 1 gr9 oup 99) t(hOst at w asz as fo ewsk rm i 20 ed 01 solely fo ). r 12.1% Figur ob S ve ious e Fie g q 70 s ur ue est 1 ion o in http f how s://w w w ew ll se .ebr ri.o ved rg indiv /docsidua /defaul ls w t-ould sourc bee/ ein t bri-he no te non s/e-b gri_ roup no 36.9% te m sa _07 rke-tno a8 nd -july how 16. long pdf?s it fvrs wn= ill t9e akce5292f for _0 36.7% g cha roup nge m s a— rk e or t m the ay y b w eould an a b tt er a re ctqiv uir e e m de ta o np s of ay a m p ov er ing cent to ag DeC of hep aa ltyh. roll, Em de pp loy ending ers ne on verfir m m ov sieze d . in t Sm he a lle dirre e cm tion o ployf g ers, t iving hose (D-MI) and Rep. Clay Higgins (D-NY) both introduced proposals to expand eligibility to Medicare to older individuals not 11.2% cost of health care began to increase dramatically; and social insurance programs, such as Medicaid and Medicare, did increN a 30 se M % ) to $445.7 billion. A M ll o edf th icaid e se buysc -inenarios a enross lled um ine o t tha hert h indiv ealthidua cover lsa d ge. o not otherw No is p er ocvha isinge on. their behavior in a Hn o elm ps, Rob t12 ion. % ert. 2008. "Tax Policy and the History of the Health Insurance Industry." In Using Taxes to Reform Health Subsidy Limited to Individuals < 400% FPL the purpose of buying health insurance because the risks of adve $125 rse .6 selection are mitigated. Employers also 33.9% 20.8% 10.1% individua 35% ls and insurers to match themselves up with approp10.1% riate products. w Fi w 15or it gur h fe ke er w s 1, e aSour r fix tha ed c n 10 e cs of ont 0 rH full ibut ea -lt tion ih I metns o em ur pur p aloy nc che a e, se eIsndi , he wv a ould idua lth insu lb s Und e e ra xe ne m cre p A for tg fr e om a 65 num , t20 heb 17 se er ................................ r of equir rea eson mes. nts.H istorica................................ lly, they were hesitant..... to 6 18.2% yet eligible for the program, while Sen. Brian Schatz (D-HI) and Rep. Ben Ray Luján (D-NM) introduced a Medicaid buy- See http 60s://www.ebri.org/d N oew cs/ p du eb faul lic p t- la sn o urce/ebri-issue-brief/ebri_ib_455_offerrates-6aug18.pdf?sfvrsn=6958352f_2 not y ?e t eA xis num t. ber of economic explanations have been proposed as well (Brown and Liu 2001) (Ostaszewski 2001) responseI ns to utrhe an c ce h: ange Pitfa in subsidie lls and Prom s. ises , by Henry J. Aaron and Leonard E. Burman. Washington, DC: Brookings Worker Preference for Employme 55.3 nt-Based Cov31.1% erage often act as an advocate for workers during coverage disputes between the insured and insurer, and they 10% 22% 15.5% 8.1% drop group coverage in favor of offering 51.6 individua 29.1% l policies because the non-group market was not considered a viable iE nm tp ha loy t w erould s de caide llow w indiv hich he idua a ollp ts e h p tioligib nla , rn to o es le tr u for ctff u e t red he r e m public ploy em es a arknd etpw lahe cet he to rb t uy o offe into r Me a cd hoi icacid. e of Ap t la this n a p t oint all. , The the H em igg ploy ins er 8.0% 13.3% 30% 49.4 13.3% 16 (Salisbury 1997) (VanDerhei and 48.9 Olsen 1997 49.2 ), including a changing business environment and the risk Institution. 7.5% frequently involve themselves in matters of quality assessment of care and influencing health care matters in See https://www.kff.org/report-section/2018-e 7.3% mployer-health-benefits-survey-section-4-types-of-plans-offered/#figure42 Fi Und gur ee r 20 Me 2, % 50 P de icra creent Eaxt ge ra of , lik W eor th ke e rH s, N ealt on hy - W Am ore kr eir cs, a p arnd opos Chil al, drte he n Wit re ish E no m gp ua loy ra m nt ee ne t- t Bhaase t e dm Hp eloy alte h C rs w ovould erag e c, on 20 tinu 13e – 20 to 17 offe ...r 7 According to the 2018 EBRI/Greenwald & Associates Health and Workplace Benefits Survey (WBS), nearly 60 percent of 8% 11.7% 6.9% alternative to the employment-based system. And, more recently, even with the advent of private health insurance It is of Urt be an sugg n Institu e tst e (e He d a tha lthy t the pr it va ax te -p nr oe nfe grr oru e pd status of employment-based health coverage led to the rise in its Other changes to the tax treatment of 25.3% employment-based health benefits may have more profound effects. They p choic roposa e of l cou plan m ld pot aye no ntia t ll m ya im tch th pacte eem mpplo loy ym ee e nt choic -based e, if g heiv alt en a h b ew ne ide fitrs cg hoic iven th e of ep spe lan o cifi pc tiions ty of . tMovi he leng gisw laor tivkee rla s in ngu to ag ae . 6.3% associated with funding and managing pension plans; issues with firm size; and the increase in global 6.1% 6.1%6.1%6.1% 6.1% 10.8% 12 Shortc the om polic ings y d eo vf elop the me nt Em arploy ena. ment-Based Health Benefits System health b 25%enefits. Employers facing the highest p 14% remiums in the group market, because they have a less-healthy w 17orkers are satisfied with their current mix of health benefits and wages, and m 5.5% ost individuals with employment-based America) ins 22.5% urance market A 9.2% ll lawfully present people younger than 65. No provision. exchanges, employers did not embrace them as the initial hype would have expected us to believe. pr e Rv ea cle ent nce exa and mplc eom s op f r re ehe latins veilv ye ne new ss e (mp Galo be ye l 1999 r coali)tions and inc tha lud t ite ha the s e Hnc eaour lth Trans aged fo em rma ploy tion ers t Allio anc offe e (rw itw a w nd .hta to he pa rlth.c ovide om) m or and e E I he inc p m p a lude p olit ltloy h ins o, 6% etr he Ric s w ur Tr a hould nc aurm d e p e A b xc . e a2 d h a 00 m a llow nge ini 2. " st e d T r w a he ould tto ion’ Re pa s ow a y vllow eprr si e n p on m wiu ror Ta op m kx’s e os s on rs t aP l to e o ebre c vhoose ha expa rse lf o nd Re f e frsu tom ligib he lt ." us a le m Re e indiv ong of gula H idua aRA tll of ion sls , 46 t indiv he if e -53 a nr idu v .oll aila a m l ta b ele nt x c he isr a e tlt he dh p it sc,ho la ans nd ice . p of Fu rop t rhe tos he arls m or to e, 40 competition faced by employers in recent years, which has led to the subsequent need for more flexibility in Figure 3, Percentage of Private-Sector Establishments That Offer Health Insurance, by Establishment Size, p 4.1% 4.4% 7.7% 10% population, may find 19.3% it Su ad bsv ida y L nim ta ited geto ous t Indivo idud alr s < op 400% cA o FPL lv l e la & rw a Cg fap u e lp . ly e dp Frur esten he t rim ndo ivrie d, ua t $101 he ls i .9 nv a thlue e propo Esi mt pion fo loyers rw offe ouldr ing have cto hv e eo rp atg io en — to he Of cour alth b se, ene the fits eam rep loy satm isfeie nt d- b wait sed h th he eira lt co h b vee ra ne ge fit (s s Frons ystetm in a isnd farD frre om tzk a p e 20 rfe 18) ct. . One One -of hatlhe f a rsh e or ext tc 3.9% rom em 3.8 ings i ely % ors t ve ha ryt sa it tdis ofe ie s d 3.6% c the om apllr 20 ia e% he nce ns bie vtw e c eov en eAm raga ez o tha n, n th Berkesy hire ot 2.5% he Ha rw tha isw e a w yould , and ha JPv M e o (rg She an ils Cha and se H kno aught wn a 20 s H 0a 4) ve . n H (ow wwe w v.e ha r, vtehe nhre ea is lthc staill re .com). The allow individual premiums to be paid from health savings accounts (HSAs). indiv insuridua e 10 rs m % l. igh Wt hil st ea trhe t to reoffe arer m a am ny or fa e cdtiv ores t rse o c choic onside e of r, he em ap ltloy h p ela rs c ns ould in the ra is indiv e pridua emiu l m ma s ror ke tc ost to a stha trarcing t ne to w inc bue sinne tivss iz ea nd 17.4% ? The retire em me pn loy t pm lae n d nt-e bsi ag sed n. 6.6% health benefits system is far from perfect. One of the shortcomings is that it does not 4% 28.0 2.1% 2013–2017 ............................................................................................................................................. 7 2.6% 30 United States would be automatically to offer Medicare Extra, and r There ecruit is a nd no rq eue tain w stion th orke arts the — m Ha RA y cpha rov nge ision if a gnd ives e whe mn th ploy ee e rs t conomy he me a wnes t ako ens dr op and tra une ditim ona ploy l he 2.1% ma elt nh cov t rate 2.4% e s r raig se. e and go to a not with th gua erir a n cto evee r uni ag25.7 v ee , ra snd al cov ano etrhe agre , 38 w hic perh a cen Me t ar deic so are m -e for w- ha All c t sa ould tisfie dd o. . Fu Em rtp he loy rm mo ernt e, -b he asae ltd h in hesu altrh b anc ee ne bfit ene s c fit ov s a err e 62 b y far Lyke, Bob. 2008. "Tax Exclusion of Employer-Provided Health Insurance: Policy Issues Regarding the Repeal Debate." new coalitions may also 5.2% be a way to outsource benefits administration as employers are finding health care purchasing and disagreement among histor23.5 ians as to the role of taxation in the growth of employment-based health coverage. indiv to adidua dress ls t in o ce re nr aoll in sed dMe emd aic nd a. re . Me Sinc dica er e only -for -old all m er a indiv y or id m ua ayls not would offe b r ew e or ligib kerle s a for choi the ce Me of dhe icaarlt eh p prog lans ra.m , and because 22.7 guarantee unive 21.7 rsal coverage, which a Medicare-for-all system could do. Many employers, especially smaller 15% 4.5% eligible for Medicare Extra. Newborns and workers would have the option to 2% “DC health”-type plan. One of the concerns is that employers will try to structure their plans in such a way to send t phe er cm ent ost of im the por p ta op ntula be tio ne n un fit wdhe ern w 65 or yekaerrs old s are, c leonsi aving dertihe ng ra e m job ainde decris w ion. ith e Pit rior her- yindiv ear s id uua rve lly ys h pua rc vh ea found sed cov thearta w ge or or ke rs desigC n RS Re to bep inc ortre fo asring Cong ly cr oe mp ss.le C x. o ngressional Research Service, Library of Congress. According to Helms (2008), the NWLB decision on health benefits mirrored IRS rulings that insurance benefits were not While ma 20 ny employers did not set out to shift the risks associated with funding retirement onto wor 25.5% kers, this has old Figur er eindiv 4, Une idua m ls p loy use mm ent or e R a hteea, lt20 h c 05 ar–e2018 than you ................................ nger individuals, t................................ o the degree that olde ................................ r individuals chose the 25.2% .............. Medicar e 8 Cente erm fo prloy Am eer rs, c ican hoo se not to offer coverag ine d. iv iE dm uap lsloy tur e nris t ng ha agt e offe 65 wro c uov ld b ee rage also ch ne oo e sd 23 e .9% t ito oc vont er em inp uous loymlen y j tus -bats ify ed 23.6% 23.4% 22.2% 0% high-risk employees to the individual market. The regulations include a number of provisions to prohibit such a Me ared m ica uid, ch mo or trhe e c yonfide remain un nt in t ins he ur ire e dm (p Filoy gur ee rs’ 1) a. b ili Itn o y to ursele volunt ct the ary b , e est m p alo va yim lab ele nt -p bla ased n th a sy n in stem the , m ir aow nyn a em bp ili loy ty e tr o s, do so. It 10% 20.3% Congr 0%essional Proposals to Expand 19.9% Health Insurance Coverage t co erb ta einl try e aoc tecdu a rrs t eda . xThere able inc mo am y e b. e le Ac ss co ons t rding hatto cH aa n b cke e rle (a 2r 00 ne2) d , fr itom wa ts not he expe untril t ienc he e Re wit vh th enue e sh Acift t of from 1954 D B tha to t D the C Internal program, the average cost of health benefits in the workplace would fall. Progress (Medicare Extra) Medicare bu17.6% y-in automatically enrolled. coverage. Ostaszewski, EK mr pz loy yst meo nf. 2001 t-Based Co. ve" ra Ma ge croeconomi Indivc id uA ally spe Puc rch ts of ased Private Retirem Me en dicaid t Programs." North AmU e nr in ic su a re n Ac d tuarial whether to offer coverage to workers. The percentage of employers offering health benefits ebbs and flows 15.9% Trump Administration Propo 0.2% sal on Health Reimbursement Arrangements 10 Subsidy for Employment-Based Coverage Eliminated and Individuals Moved to discriminatory practic14.1% e. However, what if only emp thloyers fac th ing the highest premiums in the group market adopted e mspe ay c ta iaklly e a s m ch aa lle nge r e m in c ploy ulte urrs, e c bhoose efore w not ork te o rs a offe rer rce ov ad ey ra tg oe a . c c Only ept so 23m .5 p ethin ercge nt ot he of r etm ha pn a loyn e ers w mp itloy h fe mw en et r -tbhaased n 10 health 12.9% Fi Cg o ur nclus e 5, Prion emium Increases Among Employers With 10 or More Employees, Worker Earnings, and Inflation, $445 .7 Re A num venue be rC of odp er m opaos dea ls it c wle ea re r ( int afr tod er u ac nu edm in t behe r of 11 confli 5 ac nd tin11 g I6 RS ru Cong ling re s p sses rom th pa te t d w C ould ong r ha ess ve t o diraedcop t atnd a b indir lankeectt e im xcpeapcttion) s retirem -2% ent plans that apply to a possible similar shift away from employer involvement in health benefits. Notably, over 5%Journal 52- N64. on-G roup Market (<400% FPL Only) with the economy and -1.1% other factors. De-linking health insurance from employment may address the Unlike the Congressional and Think Tank proposa3ls discussed above, the employment-based health benefits system HRAs? If such a phenomenon occurred, the non-group market would not become more stable and may see average e bm ene ploy fits sy ees a ste nd m. 49 E .2 p mpe loy rce ernt s m of ae y m stpill loy ne ee rsd w to ith 10 offer– 24 heaeltm h pbloy ene ee fit s offe s to b re ed c c om ovp ee ra tit giv e e to inw tor he k e la rs in 20 bor ma17 rke (tFi , g au nd ret 3) he. n A es a ed Source: 1988 Ada– p2 ted 01 f9 ro ................................ m http://files.kff.org/attac ................................ hment/Table-Side-by-Side- ................................ Comparison-Medicare-f................................ or-all-Public-Plan-Proposa............. ls, 8 The on t tim hae t e , m e em D m pC loy p p loy loy p 0m lam e e ns rnt e spe nt in -b -ta b rnding od sed ased u che e he on da fe lt ae h lta m h b tbu p erloy ne e ene s su e fit e fit s c he s sy (h a Fi ag lt s s ur h b tt ee a m re 8 g ne a )e.rtose fit - dThese s w at not e afu s nds, fnot b rom ills inc t a o aut n by lude o e m d ce ount alibe tsi icngle e r ea nr dt e - ol ap s e na lm ayte m e ion nt rp p loy ,a ra l he op nd ee osa a a inc ltut ls h c om o s-a uc er e sc e . h a p a L la olic s Me ytkion ey (d b 20 tic ut o a 08 m r re aa )t - k he for geoe rD - a s so fr C ll, om a Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2018 Supplement. -4%shortcomings of the current system. may be 0% impac Fe te wd er b Thy an r 10 eg Eula mploy tions t ees hat 10 a –r24 e w Emor ploy king ees their wa 25 y – 99 thErm oug ployh th ees e Trum 100 p –a 999 dm Em in pis loyte re a stion. 1,00 In O 0 or cM tob oree Er m p 20 loy18 ees, premiums increase, while the group market would see a reduction in average premiums as higher risk groups left. t ro esu offe lt h, ttrw p b sor :e // ne k w ew fit rs ws t a .atm o ter he bie cse ac nom p cro om p ge rp es ta it snie i.o ve rg s a m /isa rse y u es m va /u h rc y ea h le b lty h c ss indus ar e/ likre ep tly ry o , rtto s g/e ha 2og 01 v8 r ea / 0 c p2 ov hic /2e 2 rr /a e 4g 4 g7 e ion, 0 t 9hr 5/a oug m nd/o edh ica r the rot e-ex ir h e tw rra or fa -fo k crp t -or a la llc s /e , . a , n W a dnd or ka erre s m muc ayh pm reor fee r Note: Individuals may receive coverage from more than one source. Sa Thi lisnk bury Tank , Dallas L P., ro ed po . 19 s97 al. sTa x Reform: Implications for Economic Security and Employee Benefits. Washington, DC: p faublic r as t p o lacn o onc plude tion, ta hnd at tMe he d“ic his arte o ra ic nd al a Me rgd um icaeid ntb a uy bout -in p th ro ep im osa por ls.t aThe nce v of artious ax a nd prop reo gsa ula ls for tory a p olic public ies m pla ay n o be p tov ion a erst nd at ed.” p a la vns olun mto arre y , D m Ba -lik rke et - — dr g iveene n r ra elly sponse in re cbog y e nim tion o ploye f th rs teo fa gc ov t e tha rnm t m ent an y re w gula orkte ions rs w re erg ea not rding sa w ving agea s a nd nd inv ta ex st aing tion d weur ll in th ing eir 6 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 regulations were issued by the departments of Treasury, Labor, and Health and Human Services — at the direction of Figurh et t6, ps:N //e wtw P we .u r rC ba an p.o itra g /Fe sitd es e/rd aef l Sub ault/si fid les ie/s A pub slsoc icatiia on te /9 d8 W 43i2t/ h He $0 2001a 8lt 26 h _2 Ins 0 $1 1 00 u 8.0 ra5n .1 c1 e_h C$2 ea ov 00 le th ry a_a ge m for er $3 ic 00 a P_f eop inale l_1 Und .p $4 d 00 fer Age 65 $500 , lik tha etly e tm o pbloy e uni ers of nsur feerd he thaaltn w h bor ene kefit rs in l s sim ap rg ly e rt o com takp ea a nie dvs, w antahe ger eof he the alt h cov tax-pe re ra fe gre re is d m stu at cus h mor of te his ubiq foruit m ou of sc, otm houg pens h asom tion. e Employee Benefit Research Institute. W B Me Dot C or d h th p ld ic ?la ans W re e a P /Me Ur on r ublic IbIt d a . he n I ic Tod p a ir olic id n ow st a b ie iy tuy n ut , s r .t- e he in w e a la nd e te m ould dC p e tloy o nt not tm e he re for ha n Cta -v b d A ea ill m sed a ae c d r iir t che a e ax c n P ; a t lt Me im h b rog p da ic e rc e n a ts e rs ha on e fit -for s sy the v-ea st ll offe ee ;m m ppr r lop is e oy d tosa m he the e nt ls m ir -t os ow b ha a tsed tn he c w om ould he a m lta on h r lt ah insu llow e for for m m i ns rof ap ur nc rhe op a enc a os sy lte h a st tls c o eov . m b . e eThe r ageUr in ban 7 Employers may require that there be a viable non-group market for their employees to go to before moving to HRAs. ($billions) an Execu So tiv urce: e Or Md erce err, N bay tion Pr ae l S si ud rvey ent of Em Trum ployer p — -Sp on to sor eed xpa Heal nd th P the lan sus , an e d Bureau of sta nd of L- ab alone or Statistics. Health Reimbursement Arrangements 2018 Source: ................................ Medical Expenditure Panel ................................ Survey - Insurance Component ................................ (MEPS-IC). .................................................... 10 of These these disw aor grk ee erm s w ent ills bre a ia se ble a q to ue gst etion a cove s t rao ge w a he s ta he spouse r it wa s t or he de p ta ex nd tre ent at m on en atnot or he scra r ecm ity p loy of m we or nk te -b rs d ased ur ing plan W (or Fild guW rea r II Source: Figure 11 in https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201811.pdf and Figure 3 in Employers w Source: ould EBRI cont siminu ulatio en t s.o be able to offer coverage as they do now. However, these proposals could affect the I the nst it Unit utee ’p s H dur St c eh a aa tlte sed hy s, c A in t ov me ehe r riing c a indiv p 16 rop 7 mi idua osa lli l l w m on a ould rpkeeop t rus e lep ing la unde ce e m crur p aloy g re en e65 tr P fun a in 201 tie dnt ing P 7 ;r , a oa nd tnd ectm io m an a o rst kend tindi dA ev v ffidua e olop rda ls m b e le wnt itCh e s, suc arem A ph clo t a y of s t m20 e he nt 1 -g 0 (A big ased CA ) p=2019 data is projected. Stability in premiums may be one requirement, which may make it less likely that multi-state employers move to HRAs A parallel can be drawn between the culture change required here and the one that has largely taken place in the shift (HRAs) by e hm ttpp s:loy //ww er w.c s of dc.ga oll si v/nchs/ zes. data/ nhis/earlyrelease/insur201306.pdf Sheils, John, and EBRI Is Randy sue Bri He afu is re ght g. ist20 ere04 d in . t"hThe e U.SC . P os att e nOf Ta t and Tx ra-d E exe mark mp Otf fH ice e.a Ilt Sh B SN: e 0ne 887fit –1s I 37X n 2 /9000 084." 87 – 1H 37 eX a/lt 9h Af 0 $ .5f0a +ir .5s 0 W4-106 - W4- t 10 ha )t. le d to the employment-based health benefits system we have today. However, whether the decisions regarding e he exc xtae ha ltnt h b nge to e ene s a w conomy hic fit nd s h a Me erm e a d p sa nd ic loy a tis id/C high efr ie s c d H - p I ont w P ric it w h th inu eit dh a e m e tir e o d pcic ublic offe oa vl a err a d p he g v la e a a n o . n ltc h b e ps lik tion a ene efit spe long s a cs w i a w ltit y eh M ll a mes t e dd ic he ic aa t ions rm ea -A nne , dm va ra nt y in a aw g ll a e hic -lik ffe h th ec tp e w riv yhe a offe tte he p rr la it tn he . s for re is p e aop n le Fi giv ge ur n th e 7, e C vom aria pta ion riso in p n orf Sub emiusi md ie grs Und owth a erc rCour ssr e st nt a tL ea s. w The With Va quarlit iou y of s Ptoss he ible bene Sc fit es offe narios re ................................ d is another considera ............. tion. For 10 from defined benefit (DB) to defined contribution (DC) in retirement benefits. In 2014, 4 percent of private-sector 112. © 4 2019, Employee Benefit Research Institute –Education and Research Fund. All rights reserved. taxation of employment-based health benefits made over 60 years ago were explicitly intended to increase coverage or under age em 65 ploy . m Ot ehe nt-rb taha sed n th he ea inc lth b lus eion o nefits sy f anst tidis emc rin imtin he a tfut ion ur per. ov isions to prohibit employers from dropping sick ins tance, the prevalence of narrow -network plans in the non-group market may be something that continues to hold workers with a retirement benefit were participating in only DB plans, down from nearly 62 percent in 1979 (Figure 9). e e e e e e e e A e e e e e e e e e e e eb b b b b b b b b b b b b b b b b b b brr r r r r r r r r r r r r r r r r r r re i. i. i. i. i. i. i. i. i. i. i. i. i. i. i. i. i. i. i. i.s o o o o o o o o o o o o o o o o o o o oe r r r r r r r r r r r r r r r r r r r rg g g g g g g g g g g g g g g g g g g g a rIIIIIIIIIIIIIIIIIIIIc s s s s s s s s s s s s s s s s s s s sh s s s s s s s s s s s s s s s s s s s s u u u u u u u u u u u u u u u u u u u u re e e e e e e e e e e e e e e e e e e e ep B B B B B B B B B B B B B B B B B B B B or r r r r r r r r r r r r r r r r r r rrief ief ief ief ief ief ief ief ief ief ief ief ief ief ief ief ief ief ief ief t fr o• • • • • • • • • • • • • • • • • • • •m M M M M M M M M M M M M M M M M M M M M th a a a a a a a a a a a a a a a a a a a ae r r r r r r r r r r r r r r r r r r r rc c c c c c c c c c c c c c c c c c c c E h h h h h h h h h h h h h h h h h h h hB 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1R 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4I,,,,,,,,,,,,,,,,,,,, E 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 d1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 u9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 c a • • • • • • • • • • • • • • • • • • • • tion N N N N N N N N N N N N N N N N N N N No o o o o o o o o o o o o o o o o o o o ....................a 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 n7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 d6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 R esearch Fund © 2019 Employee Benefit Research Institute 11 13 14 18 16 10 20 15 19 12 17 21 6 2 9 7 3 4 8 5