Health insurance is a fundamental part of the health care system in the U.S. as access to health insurance (or more broadly, health coverage) determines access to health care. In the current system, ability to have health insurance determines access to what many experts and consumers consider basic health services such as preventative care, a primary care physician, and timely health interventions to prevent unnecessary suffering or escalation of health problems. A study by the Kaiser Family Foundation shows that individuals without health insurance are more likely to have hospitalizations for avoidable health problems “and experience declines in overall health”. Because health insurance is the financial structure linking individuals to the health care system, any discussion of health care reform must begin with an examination of the current state of health insurance in the U.S.

US Health Insurance System - Payers & Players

• Most Americans have some form of health insurance - all Americans pay into the system but not all benefit

• Who are the insured (who pays)?

  • The insured can just as easily become uninsured

  • Most without health insurance are from working families, trying to succeed

  • Everyone pays but not everyone benefits: the uninsured also pay for health coverage, just not their own

• Who provides health coverage (who plays)?

  • Americans get their health coverage from one of three sources: an employer, the government, or an individual purchase from a private insurance company

Employer-Sponsored Coverage

• Workers recieving employer-sponsored health coverage: trends & demographics

  • Most non-elderly Americans get their health coverage from an employer

  • Employer-sponsored coverage recipients are mostly White, middle to upper class adults in families with full time workers

• Firms offering employer-sponsored health coverage: trends & demographics

  • Firms offering coverage are generally large and high wage

  • Firm size, region, industry, and employee demographics affect likelihood of employers offering health coverage

  • Social and economic disparities are evident in the employer-sponsored health coverage system

  • Most firms offer only one plan, but almost half of covered workers have a choice of plans

• Costs of employer sponsored coverage

  • Cost of premiums for single and family coverage

  • State and local governments rank amongst industries paying the highest premiums

  • More than half of workers with employer-sponsored coverage are under the plan type showing the highest premium rates

  • More workers are paying in the highest premium bracket and fewer are paying in the lowest premium bracket than before (2001 to 2007 comparison)

  • Premium growth exceeds rate of inflation and increases in wages

  • Small firms cite premium costs as main reason for not offering employer sponsored coverage

• Shifts & Trends in Employer Sponsored Coverage

  • Health of economy and growth in premiums affect employer health coverage offer rate

  • Shifts from 2005 to 2006 show a departure from general trends

  • Job market, domestic politics, and international trade also impact rate of employer-sponsored coverage