June 2001

Grant Results


In 1999, Health Affairs published a thematic issue that focused on the future of the employer-based health insurance system.

Key Results

  • The 268-page November/December 1999 issue of Health Affairs, subtitled "Future of Health Insurance," contained 26 articles, most of them related to employment-based insurance.

The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $183,009 to the People-to-People Health Foundation, now called Project HOPE, which publishes the journal.

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In the 1990s, the number of employees who had health insurance provided through their employment was declining; some employers opted not to provide coverage while others raised premiums or reduced benefits, causing workers to forego health insurance.

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Health Affairs, a peer-reviewed journal on health policy issues published by the grantee (which is now called Project HOPE), devoted much of its November/December 1999 issue to exploring reasons for the decline in the number of employees who had health insurance provided through their employment.

The articles themselves stemmed from research funded by a variety of sources, including other RWJF grants.

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  • The 268-page issue subtitled "Future of Health Insurance" contained 26 articles, most of them related to employment-based insurance (see the Bibliography). The authors of these articles spanned the political spectrum and a range of disciplines.

    The lead article ("Expanded Managed Care Liability: What Impact on Employer Coverage?") examined the possible ramifications of legislative changes that increase the liability of managed care organizations.

    The authors concluded that the prospect of litigation could have "important effects on coverage decision-making, information exchange, risk contracting and the extent of employers' involvement in health coverage.


  • Approximately 9,000 copies of the special issue were sent to Health Affairs' subscribers and distributed at health-related meetings.
  • Aetna US Healthcare bought 5,000 copies and the Health Insurance Association of America bought 275.
  • The entire issue was made available online on the Health Affairs Web site.
  • In conjunction with publication, Health Affairs conducted a media briefing in Washington, D.C., and issued press releases highlighting key findings from several of the articles.
  • The issue was cited in an Associated Press story carried by 40 newspapers with a combined circulation of more than 4.7 million, including the Washington Post and the Boston Globe.
  • The issue was mentioned in US News & World Report and American Health Line, an online newsletter.

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Health Affairs published its January/February 2001 issue on expanding health coverage with additional RWJF support (ID# 028567).

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"Health Affairs" Special Issue on the Future of the Employer-Based Health Insurance Systems


The People-to-People Health Foundation, Inc. (Millwood,  VA)

  • Amount: $ 183,009
    Dates: March 1998 to March 2000
    ID#:  033554


John K. Iglehart
(301) 530-8154

Web Site


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(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)


"Future of Health Insurance." Health Affairs, 18(6): 1–268, 1999. This RWJF-funded issue of Health Affairs was devoted largely to the future of the employer-based health insurance system. The issue index also appears online. Key articles related to the topic:

  • Blendon RJ, Young JT, and DesRoches CM. "The Uninsured, the Working Uninsured, and the Public." Available online.
  • Blumberg LJ. "Perspective: Who Pays for Employer-Sponsored Health Insurance?" Available online.
  • Butler S and Kendall DB. "Expanding Access and Choice for Health Care Consumers Through Tax Reform." Available online.
  • Christianson J, Feldman R, Weiner JP, and Drury P. "Early Experience with a New Model of Employer Group Purchasing in Minnesota." Available online.
  • Custer WS, Kahn CN III, and Wildsmith TF IV. "Why We Should Keep the Employment-Based Health Insurance System." Available online.
  • Fraser I, McNamara P, Lehman GO, Isaacson S, and Moler K. "The Pursuit of Quality by Business Coalitions: A National Survey." Available online.
  • Gabel JR. "Job-Based Health Insurance, 1977–1998: The Accidental System Under Scrutiny." Available online.
  • Galvin, RS. "From the Field: An Employer's View of the US Health Care Market." Available online.
  • Long SH and Marquis MS. "Stability and Variation in Employment-Based Health Insurance Coverage, 1993–1997." Available online.
  • Long SH and Marquis MS. "Comparing Employee Health Benefits in the Public and Private Sectors, 1997." Available online.
  • Lo Sasso AT, Perloff L, Schield J, Murphy JJ, Mortimer JD, and Budetti PP. "Beyond Cost: 'Responsible Purchasing' of Managed Care by Employers." Available online.
  • Marquis MS and Long SH. "Trends in Managed Care and Managed Competition, 1993–1997." Available online.
  • Pauly M, Percy A, and Herring B. "Individual Versus Job-Based Health Insurance: Weighing the Pros and Cons." Available online.
  • Reinhardt UE. "Employer-Based Health Insurance: A Balance Sheet." Available online.
  • Robinson JC. "Interview: At the Helm of an Insurance Giant: Aetna's Richard L. Huber." Available online.
  • Studdert DM, Sage WM, Gresenz CR, and Hensler DR. "Expanded Managed Care Liability: What Impact on Employer Coverage?" Available online.
  • Thorpe KE, Florence CS, and Gray B. "Market Incentives, Plan Choice, and Price Increases." Available online.

News Conferences and Briefings

Media briefing coinciding with publication of the Health Affairs November/December, 1999 issue and highlighting one of the lead articles, "Trends in Managed Care and Managed Competition, 1993–1997" by M. Susan Marquis and Stephen H. Long, Washington, D.C., November 8, 1999. Attended by reporters from major media outlets.

Print Coverage

"Giving Doctors the Final Word: An HMO Makes a Bold Change as Politicians Grapple with Health Care," in U.S. News & World Report, November 22, 1999.

"Survey: HMO Changes Bad for Elderly," Associated Press wire story appearing in more than 40 papers with a combined circulation of more than 4.7 million, including The Boston Globe, The (Cleveland) Plain Dealer, and the San Francisco Examiner, November 8–9, 1999.

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Report prepared by: Michael H. Brown
Reviewed by: James Wood
Reviewed by: Karyn Feiden
Program Officer: Paul S. Jellinek