Tracking Employment-Based Health Insurance

Dates of Project: 1996 to 2003

Field of Work: Studying effects of changes in the health system on employer-based coverage in the 1990s

Problem Synopsis: Employment-based health insurance is the major private driver of what happens to people in terms of their health and health care. That coverage is influenced by many private and public sector developments—including the growth of managed care, changes in taxation policy and public coverage options.

Synopsis of the Work: RAND Corporation researchers surveyed more than 22,000 public and private employers in 1997 asking about the structure, benefits and costs of their health plans, and published some 20 peer-reviewed journal articles describing trends and variation across communities. Findings supported the work of two RWJF national programs, the Health Tracking Initiative and the State Coverage Initiatives.

Key Findings

According to RAND’s published findings:

  • There was substantial community variation in the rate at which employers offered health insurance and the cost to workers.
  • Managed care expanded its share of employer-sponsored coverage from 1994 to 2000, especially in areas where costs are rising significantly.
  • When the public sector provided options for insurance coverage or health care, employers were less likely to offer coverage.
  • Small group insurance market reforms enacted by the states did not have a significant impact on employer-based coverage.