w14839 - NBER WORKING PAPER SERIES EMPLOYER-SPONSORED...

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NBER WORKING PAPER SERIES EMPLOYER-SPONSORED HEALTH INSURANCE AND THE PROMISE OF HEALTH INSURANCE REFORM Thomas C. Buchmueller Alan C. Monheit Working Paper 14839 http://www.nber.org/papers/w14839 NATIONAL BUREAU OF ECONOMIC RESEARCH 1050 Massachusetts Avenue Cambridge, MA 02138 April 2009 This research was funded by the Robert Wood Johnson Foundation’s Economic Research Initiative on the Uninsured. The views expressed herein are those of the author(s) and do not necessarily reflect the views of the National Bureau of Economic Research. © 2009 by Thomas C. Buchmueller and Alan C. Monheit. All rights reserved. Short sections of text, not to exceed two paragraphs, may be quoted without explicit permission provided that full credit, including © notice, is given to the source.
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Employer-Sponsored Health Insurance and the Promise of Health Insurance Reform Thomas C. Buchmueller and Alan C. Monheit NBER Working Paper No. 14839 April 2009 JEL No. I11,I18,I38 ABSTRACT The central role that employers play in financing health care is a distinctive feature of the U.S. health care system, and the provision of health insurance through the workplace has important implications well beyond its role as source of health care financing. In this paper, we consider the "goodness of fit" of ESI in the current economic and health insurance environments and in light of prospects for a vigorous national debate over shape of health care reform. The main issue that we explore is whether ESI can have a viable role in health system reform efforts or whether such coverage will need to be significantly modified or even abandoned as reform seeks to address important issues in the efficient provision and equitable distribution of health insurance coverage, to create expanded health plan choices and competition in health insurance markets, and to structure incentives for the more efficient use of health services. Thomas C. Buchmueller Stephen M. Ross School of Business University of Michigan 701 Tappan Ann Arbor, MI 48109 and NBER [email protected] Alan C. Monheit School of Public Health University of Medicine and Dentistry of New Jersey (UMDNJ) 683 Hoes Lane West Piscataway, NJ 08854-5635 and NBER [email protected]
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1 Employer-Sponsored Health Insurance and the Promise of Health Insurance Reform Thomas C. Buchmueller and Alan C. Monheit I. Introduction The central role that employers play in financing health care remains a distinctive feature of the U.S. health care system, and the provision of health insurance through the workplace has important implications well beyond its role as source of health care financing. Currently, as it has for the last half century, employer-sponsored insurance (ESI) dominates the US health insurance landscape. For example, in 2007, over 60 percent of the non-elderly population was covered by ESI, representing 90.1 percent of all private coverage (Fronstin 2007). Most employers provide health insurance to their workers and approximately 90 percent of full-time private sector
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w14839 - NBER WORKING PAPER SERIES EMPLOYER-SPONSORED...

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