Health Affairs, 25, no. 6 (2006): 1537 doi: 10.1377/hlthaff.25.6.1537 © 2006 by Project HOPE	New Online   Obama's Success & Next Steps   3 Health Policy Options for President Obama   A Hybrid Proposal   Bipartisan Compromise

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Forum

PROLOGUE

Forum On Employer-Sponsored Health Insurance

As employer-based insurance continued to prosper, earning a decent living in someone else’s employ and having health insurance became virtually synonymous. Thus, despite serious signs of strain on the employer-based system since the late 1980s, even savvy readers were shocked by some recent news in the Washington Post: Uninsurance among middle-class workers has shot up, while uninsurance among the poor has decreased (thanks to expanded public programs). According to Harvard’s Katherine Swartz, the proportion of workers ages 25–44 who earn the median income or more but lack health insurance has almost doubled since 1979; fully 26 percent of those in the age 25–34 subset are uninsured.

The central question for many participants in the health insurance debate remains, "How might the role of employer as health insurance provider be preserved?" But for the contributors to this forum, the question is, "What new role should employers assume so that their workers can obtain, and retain, health insurance—and employers can return to the business of doing business?"

According to Enthoven and Fuchs, the most reasonable new role should become apparent as current efforts to preserve employer-based insurance play out like a Shakespearean tragedy: known, tragic flaws taking their inexorable toll. They envision such deep erosion that a historically unpopular and radical repositioning of employers will finally become an acceptable option.

In their examination of the mind-set of mid- and large-size employers, Robert Galvin and Suzanne Delbanco report that those who still offer health insurance likewise doubt that current initiatives will ease their most serious burdens. Loath to drop insurance or lose autonomy, these employers are eager to work with health plans and policymakers to craft the novel solutions that let them exit their role as health insurance providers, without compromising their values or excluding them from the process of keeping their workers insured.

John Goodman invites us to entertain another possibility: the employer as a sponsor of portable, personal health insurance. Existing models suggest that employers could simultaneously leave the health insurance business and enable their workers to obtain the truly portable insurance that President Bush has called for—but that federal statutes actually discourage.

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