One of the most controversial issues in health reform is the concept of an employer mandate—a requirement that most employers would either have to provide health insurance for their employees, or pay a percentage of total payroll costs to the government. Health Affairs and the Robert Wood Johnson Foundation (RWJF) explore the concept—as well as the current state of employer-sponsored insurance (ESI), which provides coverage for 61 percent of the non-elderly population—in the latest in a series of Health Policy Briefs that provide objective, non-partisan analysis of policy proposals related to health reform.

The series brings together experts from the Harvard School of Public Health, the University of Michigan and Health Affairs to consider arguments both for and against the of employer mandates. The brief shows that in recent years, health insurance coverage has eroded, leaving one in four full-time workers without insurance sponsored through their employer. Supporters of an employer mandate argue that it would spread the risk and cost of insurance among a larger population, and that requiring all employers to provide insurance would level the playing field for businesses. They also say a mandate would help reduce job-lock, where employees avoid changing jobs in order to maintain their current coverage benefits. Opponents assert that a mandate on employers would burden businesses—especially smaller businesses—with additional expenses at a time when they are already struggling from a contracted economy. They say that increasing employers’ costs for mandatory benefits would lead to more job losses.