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E M P L O Y E E B E N E F I T S , C O M P E N S A T I O N
& P E N S I O N L A W
Vol. 3, No. 23: December 5, 2002
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Publisher: LSN Employment, Labor, Compensation & Pension Journals
a division of
Social Science Electronic Publishing, Inc. (SSEP)
and Social Science Research Network (SSRN)
Editor: PAMELA PERUN
Urban Institute
Mailto:pamela@planetnow.com
Copyright: SSEP, Inc. 2002. All rights reserved.
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Topic of This Issue:
Healthcare Coverage
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T A B L E of C O N T E N T S
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NEW and FORTHCOMING ARTICLES
"Changes in Insurance Coverage: 1994-2000 and Beyond"
Health Affairs, April 3, 2002
JOHN HOLAHAN
Urban Institute
MARY BETH POHL
Urban Institute
"Consumer-Driven Health Benefits: A Continuing Evolution?"
EBRI Notes, Vol. 23, No. 9, September 2002
JIM JAFFE
Employee Benefit Research Institute (EBRI)
"Employer Attitudes and Practices Affecting Health Benefits and
the Uninsured"
EBRI Issue Brief, No. 250, October 2002
RACHEL CHRISTENSEN
Employee Benefit Research Institute (EBRI)
PAUL FRONSTIN
Employee Benefit Research Institute (EBRI)
KARL POLZER
Consumer Health Education Council (CHEC)
RAY WERNTZ
Consumer Health Education Council (CHEC)
"Job-Based Health Benefits In 2002: Some Important Trends"
Health Affairs, September/October 2002
JON GABEL
Health Research and Educational Trust
LARRY LEVITT
Henry J. Kaiser Family Foundation
ERIN HOLVE
Henry J. Kaiser Family Foundation
JEREMY PICKREIGN
Health Research and Educational Trust
HEIDI WHITMORE
Health Research and Educational Trust
KELLEY DHONT
Health Research and Educational Trust
"Working on the Puzzle: Health Care Coverage for Low-Wage
Workers"
Health Matrix, Vol. 12, No. 1, pp. 157-179, 2002
LOUISE G. TRUBEK
University of Wisconsin at Madison Law School
WORKING PAPERS
"Employee Costs and the Decline in Health Insurance Coverage"
DAVID M. CUTLER
Harvard University
Department of Economics
National Bureau of Economic Research (NBER)
"Is Health Insurance Affordable for the Uninsured?"
M. KATE BUNDORF
Stanford University
School of Medicine
National Bureau of Economic Research (NBER)
MARK V. PAULY
University of Pennsylvania
Department of Health Care Systems, Wharton
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N E W and F O R T H C O M I N G Articles
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"Changes in Insurance Coverage: 1994-2000 and Beyond"
Health Affairs, April 3, 2002
BY: JOHN HOLAHAN
Urban Institute
MARY BETH POHL
Urban Institute
Contact: JOHN HOLAHAN
Email: Mailto:jholahan@ui.urban.org
Postal: Urban Institute
2100 M Street, NW
Washington, DC 20037 UNITED STATES
Phone: 202-261-5666
Fax: 202-223-1149
Co-Auth: MARY BETH POHL
Email: Mailto:mpohl@ui.urban.org
Postal: Urban Institute
2100 M Street, NW
Washington, DC 20037 UNITED STATES
ABSTRACT:
The number of uninsured Americans fell in 2000 for the second
consecutive year. The reduction has been attributed to the
continued expansion of employer-sponsored insurance. However,
the increase in employer coverage among adults was offset by
declines of other types of coverage. For children, increases in
public coverage plus the growth in employer-sponsored insurance
led to the reduction in the number of uninsured children. Over
the longer period (1994-2000), one of great economic growth, the
uninsurance rate was essentially the same at the end as at the
beginning. The rate of employer-sponsored insurance increased
sharply, so that more people had employer coverage. However,
these increases were offset by reductions in other forms of
coverage, particularly Medicaid and state-sponsored insurance
and private nongroup coverage, so the overall rate of
uninsurance did not change.
Keywords: health insurance, uninsured
JEL Classification: I10, I11, I18
______________________________
"Consumer-Driven Health Benefits: A Continuing Evolution?"
EBRI Notes, Vol. 23, No. 9, September 2002
BY: JIM JAFFE
Employee Benefit Research Institute (EBRI)
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=341082
Other Electronic Document Delivery:
http://www.ebri.org
SSRN only offers technical support for papers
downloaded from the SSRN Electronic Paper Collection
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Contact: JIM JAFFE
Email: Mailto:jaffe@ebri.org
Postal: Employee Benefit Research Institute (EBRI)
Suite 600
2121 K Street, NW
Washington, DC 20037-1896 UNITED STATES
Phone: 202-775-6353
Fax: 202-775-6312
Paper Requests:
Contact Alicia Willis at Mailto:publications@ebri.org, or 2121 K
St., NW, Suite 600, Washington, DC 20037-1896.
Phone:(202)572-7422, Fax:(202)775-6312. Full-Text downloads are
available from SSRN Online for $7.50.
ABSTRACT:
A return to double-digit annual growth in health benefit costs
is fueling interest in new structures for employment-based
health benefits. The basic goal of these structures--whether
they are called consumer driven or defined contribution--is to
control costs by delegating more direct responsibility to
consumers (and beneficiaries) of health insurance. Advocates say
this could reduce consumer resentment caused by restrictions
common to managed care plans, while critics say the plans will
only shift health care costs away from the employer and onto the
worker. This article examines some of the implications of
greater cost sharing and consumer-driven models as discussed by
policymakers, leading thinkers on benefits, employers, and labor
representatives at the Employee Benefit Research Institute's May
2002 policy forum. Topics discussed include the theory behind
the new models, the role of managed care in a consumer-driven
world, the need for patient information, and the role of public
policy.
Keywords: Employment-based Benefits, Health Insurance
JEL Classification: I11, J32
______________________________
"Employer Attitudes and Practices Affecting Health Benefits and
the Uninsured"
EBRI Issue Brief, No. 250, October 2002
BY: RACHEL CHRISTENSEN
Employee Benefit Research Institute (EBRI)
PAUL FRONSTIN
Employee Benefit Research Institute (EBRI)
KARL POLZER
Consumer Health Education Council (CHEC)
RAY WERNTZ
Consumer Health Education Council (CHEC)
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=348522
Other Electronic Document Delivery:
http://www.ebri.org
SSRN only offers technical support for papers
downloaded from the SSRN Electronic Paper Collection
location. When URLs wrap, you must copy and paste
them into your browser eliminating all spaces.
Contact: PAUL FRONSTIN
Email: Mailto:fronstin@ebri.org
Postal: Employee Benefit Research Institute (EBRI)
Suite 600
2121 K Street, NW
Washington, DC 20037-1896 UNITED STATES
Phone: 202-775-6352
Fax: 202-775-6312
Co-Auth: RACHEL CHRISTENSEN
Email: Mailto:CHRISTENSEN@EBRI.ORG
Postal: Employee Benefit Research Institute (EBRI)
Suite 600
2121 K Street, NW
Washington, DC 20037-1896 UNITED STATES
Co-Auth: KARL POLZER
Email: Mailto:polzer@healthCHEC.org
Postal: Consumer Health Education Council (CHEC)
Suite 600
2121 K Street NW
Washington, DC 20037-1896 UNITED STATES
Co-Auth: RAY WERNTZ
Email: Mailto:werntz@healthCHEC.org
Postal: Consumer Health Education Council (CHEC)
Suite 600
2121 K Street NW
Washington, DC 20037-1896 UNITED STATES
Paper Requests:
Contact Alicia Willis at Mailto:publications@ebri.org, or 2121 K
St., NW, Suite 600, Washington, DC 20037-1896.
Phone:(202)572-7422, Fax:(202)775-6312. Full-Text downloads are
available from SSRN Online for $7.50.
ABSTRACT:
This Issue Brief presents the findings of a study of what
employers think and do about providing health benefits for their
own workers and what they think about covering the population
without health benefits. Most Americans under age 65 received
health coverage through employers. Yet, about 16 percent of this
population was uninsured in 2000.
Government programs generally do not target workers whose
employers do not offer them health benefits or who cannot afford
their share of premiums. In the current policy framework, the
decisions that America's 6 million employers make about
offering, pricing, and designing health benefits, have a major
impact on the number of people with and without health
coverage.
With funding from the Robert Wood Johnson Foundation, a
literature search, a Web-based survey, and focus groups were
conducted to probe present and past attitudes and practices
toward health benefits and uninsured workers and their families.
The research reveals several challenges and opportunities
concerning the role that employers play in providing health
coverage.
Keywords: Employment-based Benefits, Health Care Policy,
Health Insurance Attitudes and Opinions, Health Insurance
Coverage, Uninsured
JEL Classification: I11, I18, J32
______________________________
"Job-Based Health Benefits In 2002: Some Important Trends"
Health Affairs, September/October 2002
BY: JON GABEL
Health Research and Educational Trust
LARRY LEVITT
Henry J. Kaiser Family Foundation
ERIN HOLVE
Henry J. Kaiser Family Foundation
JEREMY PICKREIGN
Health Research and Educational Trust
HEIDI WHITMORE
Health Research and Educational Trust
KELLEY DHONT
Health Research and Educational Trust
Contact: JON GABEL
Email: Mailto:Jgabel1@aha.org
Postal: Health Research and Educational Trust
325 Seventh Street, N.W.
Washington, DC 20004-2802 UNITED STATES
Phone: 202-626-2688
Fax: 202-626-2255
Co-Auth: LARRY LEVITT
Email: Mailto:llevitt@kff.org
Postal: Henry J. Kaiser Family Foundation
1450 G Street, NW, Suite 250
Washington, DC 20005 UNITED STATES
Co-Auth: ERIN HOLVE
Email: Mailto:eholve@kff.org
Postal: Henry J. Kaiser Family Foundation
1450 G Street, NW, Suite 250
Washington, DC 20005 UNITED STATES
Co-Auth: JEREMY PICKREIGN
Email: Mailto:jpickrel@aha.org
Postal: Health Research and Educational Trust
325 Seventh Street, N.W.
Washington, DC 20004-2802 UNITED STATES
Co-Auth: HEIDI WHITMORE
Email: Mailto:hwhitml@aha.org
Postal: Health Research and Educational Trust
325 Seventh Street, N.W.
Washington, DC 20004-2802 UNITED STATES
Co-Auth: KELLEY DHONT
Email: Mailto:kdhont@aha.org
Postal: Health Research and Educational Trust
325 Seventh Street, N.W.
Washington, DC 20004-2802 UNITED STATES
ABSTRACT:
Based on a national survey of 2,014 randomly selected public and
private firms with three or more workers, this paper reports
changes in employer-based health insurance from spring 2001 to
spring 2002. The cost of health insurance rose 12.7 percent, the
highest rate of growth since 1990. Employee contributions for
health insurance rose in 2002, from $30 to $38 for single
coverage and from $150 to $174 for family coverage. Deductibles
and copayments rose also, and employers adopted formularies and
three-tier cost-sharing formulas to control prescription drug
expenses. PPO and HMO enrollment rose, while the percentage of
small employers offering health benefits fell. Because
increasing claims expenses rather than the underwriting cycle
are the major driver of rising premiums, double-digit growth
appears likely to continue.
Keywords: health costs, employer, health insurance, spending,
prescription drugs, hospitals, HMOs, managed care
JEL Classification: I10, I11, I18
______________________________
"Working on the Puzzle: Health Care Coverage for Low-Wage
Workers"
Health Matrix, Vol. 12, No. 1, pp. 157-179, 2002
BY: LOUISE G. TRUBEK
University of Wisconsin at Madison Law School
Contact: LOUISE G. TRUBEK
Email: Mailto:lgtrubek@facstaff.wisc.edu
Postal: University of Wisconsin at Madison Law School
Madison, WI 53706 UNITED STATES
ABSTRACT:
The article proposes that an "incremental"
state-based/public-private approach to expanding access for
health care coverage is underway. Two major shifts are
encouraging this approach: the movement down of public programs
through devolution to the states, and movement out toward
increased reliance on private institutions to satisfy public
needs. Wisconsin's BadgerCare, a program to cover working
low-income families, is used as an example of how the
interaction of welfare reform with workplace health coverage
gaps created a state impetus towards expanded coverage. That
impetus combined with the flexible use SCHIP funding has allowed
states to pursue a viable strategy of expanded coverage. The
move to public-private coordination has allowed states to
develop private-public systems to provide the coverage. These
systems employ mechanisms that not only provide coverage but
also link across states through intermeshing a knowledge base
and actors. The mechanisms include local collaborations,
community-based delivery systems, networks, and outcomes
processes. The article concludes with a discussion of three
challenges to the incremental approach: linking public and
private plans, meeting workplace and workforce needs. and
integrating the safety net into the mainstream health care
financing system.
______________________________
W O R K I N G P A P E R Abstracts
_________________________________________________________________
"Employee Costs and the Decline in Health Insurance Coverage"
BY: DAVID M. CUTLER
Harvard University
Department of Economics
National Bureau of Economic Research (NBER)
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=318461
Paper ID: NBER Working Paper No. W9036
Date: July 2002
Contact: DAVID M. CUTLER
Email: Mailto:dcutler@harvard.edu
Postal: Harvard University
Department of Economics
Room 315
Littauer Center
Cambridge, MA 02138 UNITED STATES
Phone: (617) 496-5216
Fax: (617) 495-8570
Paper Requests:
Full-Text downloads are available from SSRN Online for $5.
ABSTRACT:
This paper examines why health insurance coverage fell despite
the lengthy economic boom of the 1990s. I show that insurance
coverage declined primarily because fewer workers took up
coverage when offered it, not because fewer workers were offered
insurance or were eligible for it. The reduction in take-up is
associated with the increase in employee costs for health
insurance. Estimates suggest that increased costs to employees
can explain the entire decline in take-up rates in the 1990s.
JEL Classification: I10, J32
______________________________
"Is Health Insurance Affordable for the Uninsured?"
BY: M. KATE BUNDORF
Stanford University
School of Medicine
National Bureau of Economic Research (NBER)
MARK V. PAULY
University of Pennsylvania
Department of Health Care Systems, Wharton
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=341850
Paper ID: NBER Working Paper No. W9281
Date: October 2002
Contact: M. KATE BUNDORF
Email: Mailto:bundorf@stanford.edu
Postal: Stanford University
School of Medicine
Stanford, CA 94305 UNITED STATES
Co-Auth: MARK V. PAULY
Email: Mailto:pauly@wharton.upenn.edu
Postal: University of Pennsylvania
Department of Health Care Systems, Wharton
3641 Locust Walk
Colonial Penn Center
Philiadelphia, PA 19104-6358 UNITED STATES
Paper Requests:
Full-Text downloads are available from SSRN Online for $5.
ABSTRACT:
In this paper, we investigate the meaning of 'affordability' in
the context of health insurance. Assessing the relationship
between the affordability of coverage and the large number of
uninsured in the U.S. is important for understanding the
barriers to purchasing coverage for the uninsured and evaluating
the role of policy in reducing this number. We propose several
definitions of affordability and examine the implications of
alternative definitions on estimates of the proportion of
currently uninsured who are unable to afford coverage. We find
that, depending on the definition, health insurance was
affordable to between one-quarter and three-quarters of the
uninsured in 2000.