|
|
| Home | Current Issue | Archives | Topic Collections | Search | Blog | Subscribe | Contact Us | Help |
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Trends |
PROLOGUE
Trends In Employer-Sponsored Health Insurance
The resonant image of the enfeebled giant has been a favorite of storytellers since Goliath made his claim to fame in the Book of Samuel. No surprise, then, that the putative demise of the embattled employer-sponsored health insurance system has become an irresistible story line for critics Left and Right since enrollment growth began to wobble in the 1980s. The plot has thickened with the retreat of managed care. The growth of costs has not been controlled, and employers and insurers seem to have lost their appetite for fighting back. Instead, they are thinning benefits and offloading risk onto patients. The number of uninsured Americans grew by almost 1.3 million from 2004 to 2005, according to the Census Bureau’s March 2006 Current Population Survey (CPS), and the number of firms offering retiree coverage has been dropping by more than a percentage point per year since 1997.
But is the sky really falling? There is room for doubt. A closer look at the March CPS data, for example, reveals that the number of people with workplace coverage actually grew by more than half a million in 2005, while the number of people with individually purchased insurance—lately the fashionable alternative to employer-sponsored coverage—declined by almost as much. As James Robinson points out in the lead paper in this special issue of Health Affairs, the profitability of the commercial insurance industry has soared in the past few years, even as private enrollment slipped by a tiny fraction. And although cost growth remains a formidable challenge, it also represents unquenchable market demand that has brought constantly increasing revenues to providers and suppliers in the nation’s largest single economic sector, as well as access for patients—although it is shamefully inequitable—to an unprecedented range of improved, life-changing treatments. If this is a crisis, things could be worse.
What matters chiefly, though, is not how the current ambiguous state of affairs is perceived by commentators and opinion makers. The important thing is to try to understand what is really going on here. To this end, the journal is pleased to present the following group of papers. Robinson usefully surveys the scene from the point of view of the insurance industry, relating trends in employment-based coverage to the evolution of private plans’ role in Medicare and Medicaid. Helen Darling, Marsha Gold, and Robert Hurley offer responses to his analysis. Next, Patricia Keenan and colleagues drill down into the coverage numbers to show an incipient tiering pattern in private coverage by age and income that has potentially troubling implications. Thomas Buchmueller and colleagues round out this first section of papers with a closer look at retiree coverage trends.
| Home | | | Current Issue | | | Archives | | | Topic Collections | | | Search | | | Blog | | | Subscribe | | | Contact Us | | | Help |
|
© 2001-2006 Project
HOPE–The People-to-People Organization |
||||||||||||||||