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Employers, Workers, and the Future of Employment-Based Health Benefits

24 Pages Posted: 23 Feb 2010  

Stephen Blakely

Employee Benefit Research Institute (EBRI)

Date Written: February 2010


This paper summarizes presentations at EBRI’s 65th biannual policy forum, held in Washington, DC, on Dec. 10, 2009, on the topic, “Employers, Workers, and the Future of Employment-Based Health Benefits.” The forum brought together a wide range of economic, benefits, management, and labor experts to share their expertise at a time when major health reform legislation was being debated in Congress. The focus: How might this affect the way that the vast majority of Americans currently get their health insurance coverage? Most people who have health insurance coverage in the United States get it through their job: In 2008, about 61 percent of the nonelderly population had employment-based health benefits, 19 percent were covered by public programs, 6 percent had individual coverage, and 17 percent were uninsured. One point of consensus among both labor and management representatives: Imposing a tax on health benefits is likely to cause major cuts in health benefits and might result in structural changes in the employment-based benefits system. A common disappointment voiced at the forum was that the initial effort to reform the delivery and cost of health care in America gradually became focused on just financing and coverage of health insurance. The ever-rising cost of health insurance affects different employers and workers in different ways--with small employers and low-wage workers being the most disadvantaged. Small employers, if they offer health benefits at all, pay proportionately more than large employers for the same health coverage. While large employers tend to express continued commitment to health benefits, small employers see themselves strongly disadvantaged by the current system. Consultants report many employers privately want to drop benefits to control costs, but realize there are risks to doing so and none wants to be first. Employers express strong interest in wellness and disease management programs as a way to control costs, even though some experts say there is no evidence these work. Consumer-driven health plans are expected to continue their slow rate of growth.

Keywords: Consumer-driven health care, Employment-based benefits, Health care attitudes and opinions, Health care costs, Health care policy, Health care reform, Health insurance attitudes and opinions, Health insurance coverage, Wellness programs

JEL Classification: I1, I18, J3, J32

Suggested Citation

Blakely, Stephen, Employers, Workers, and the Future of Employment-Based Health Benefits (February 2010). EBRI Issue Brief, No. 339, February 2010. Available at SSRN:

Stephen Blakely (Contact Author)

Employee Benefit Research Institute (EBRI) ( email )

1100 13th Street, NW
Suite 878
Washington, DC 20005-4204
United States
202-775-6341 (Phone)
202-775-6312 (Fax)

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