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The authors examine the generosity of private employer health insurance coverage using data from two large national surveys of employers. Generosity is measured as the expected out-of-pocket share of medical expenditures for a standard population, given the provisions of the coverage. On average, those covered by employer-sponsored insurance can expect to pay 25 percent of expenditures out of pocket. There is little variability across plans in this share, though plans offered by smaller employers are somewhat less generous than those offered by larger employers. Individuals who incur high costs pay a smaller share of the bill than do those with lower levels of spending. The generosity of employer-sponsored plans increased slightly in the 1990s.

This analysis uses new questions in the Current Population Survey Annual Social and Economic Supplement to examine rates of offer and take-up of employer-sponsored health insurance over early 2014 and early 2015, as well as reasons reported for why individuals did not enroll. We find increases in offer and eligible rates of 0.5 and 0.9 percentage points, respectively, and a decrease in the take-up rate of 1.5 percentage points, while the coverage rate remained stable. We further find an increase in the proportion of workers covered by another plan and decreases in the proportions eligible for coverage but having a preexisting condition, employed as contract or temporary employees not allowed in the plan, and who have not yet worked for an employer long enough.

We use health care claims data from the Health Care Cost Institute to estimate the share of geographic variation in health care spending attributable to person-specific (demand) and place-specific (supply) factors. We exploit patient migration across 112 metropolitan areas between 2012 and 2016. Using an event study approach, we find that moving to an area with 10% higher (lower) spending leads to a 4.2% increase (decrease) in individual medical spending. Our estimate implies that 42% of variation in health care spending among the commercially insured is attributable to place-specific factors. We show that variation in both price and utilization jointly determine the place-specific impact on individual spending. All else equal, we find that moving to an area with 10% higher (lower) prices, on average leads to a 5% increase (decrease) in spending, while moving to an area with 10% higher (lower) utilization leads to a 3.6% increase (decrease).

A firm's decision to drop the offer of employer-sponsored insurance (ESI), reduce eligibility for ESI, or significantly increase employee costs would have serious implications for the health insurance status of currently covered low-income workers. The authors find that at least a third of currently covered low-income workers do not have affordable insurance options outside of the group market. Furthermore, a simulation analysis shows that 54 percent of those workers would become uninsured if their employers were to drop ESI. This would result in an additional 1 million uninsured adults if 10 percent of low-income workers lost their ESI offer, and at least 350,000 uninsured adults if 10 percent of workers in firms with fewer than 100 employees (the firms most likely to drop coverage) lost their ESI. The authors also find that expanding public programs to cover low-income workers would reduce the high uninsurance rate by half, but substantial minorities would remain uninsured.

Hispanic workers are particularly disadvantaged with respect to access to employer based health insurance. Low levels of education and correspondingly low earnings as well as language difficulties contribute to the limited access that Hispanic workers have to employer-sponsored health insurance. At the same time, Hispanic workers are often more stably employed than their non-Hispanic counterparts. This paper compares the impact of employment, earnings and demographic characteristics on the probability of receiving an offer of employment based health insurance by Hispanic and non-Hispanic workers and on the take-up of insurance when it is offered. The paper finds that, once human capital, immigration status, and employment characteristics are controlled, Hispanic workers actually have a higher probability of being offered employment-sponsored health insurance than non-Hispanic workers. Take-up of offers of employer sponsored insurance are lower for Hispanic immigrants than for non-immigrant, non-Hispanic workers but there is no difference in take-up between U.S. bom Hispanic workers and non-immigrant, non-Hispanic workers.

This report discusses about the Excise Tax on High-Cost Employer-Sponsored Health Coverage, Cost Estimate and Relationship to the Tax Exclusion for Employer-Sponsored Insurance.