Employment-Based Health Insurance: Is Health Reform a ‘Game Changer?’

Abstract

Employment-based health insurance is the Rodney Dangerfield of health policy: it gets no respect. Prominent health policy scholars and the media routinely condemn the linkage between employment and health insurance. Liberals view the existence of employment-based coverage (“EBC”) as the major stumbling block to instituting a one-payer system. From the opposite end of the political spectrum, free market enthusiasts attack EBC for distorting decisions about employment and coverage, and obscuring the true cost of health care. Employers are lukewarm about their role in the health insurance market; as the former head of General Motors aptly observed, “when I joined GM 28 years ago, I did it because I love cars and trucks. I had no idea I’d end up working as a health care administrator.” EBC may not get much respect, but it is a fundamental and long-standing reality of American health policy. Approximately 160 million Americans obtain their health insurance through their place of employment, or the place of employment of an immediate family member. This article explains how EBC became such an important part of American health policy, and evaluates the likely impact of the Patient Protection and Affordable Care Act of 2010 (“PPACA”) on EBC. It concludes that PPACA is likely to have a range of unintended consequences.