Several ideas have been introduced, including a range of proposals in Congress, to address this issue. The measures can be lumped into differing philosophies about the direction the USA should move: either toward a health insurance market in which people buy policies on their own while armed with tax credits or deductions, or one in which people are able to buy insurance through group-like "exchanges," with some government oversight. Some of the plans likely would encourage employers to drop coverage because they would lose all or part of their ability to write off insurance as a business expense.
Federal legislation is highly unlikely this year, but the issue is at the forefront. Following are statistics on how the landscape of employer-provided health coverage is changing:
•According to an annual survey of employers by the non-partisan Kaiser Family Foundation, the percentage of all employers offering health insurance in the past eight years peaked in 2000 at 69% and has fallen steadily since, hitting 60% this year. Among small firms of three to nine workers, the percentage offering insurance has dropped even more — from 58% in 2001 to 45% this year.
•From 2001 to 2005, the number of uninsured U.S. workers rose by 3.4 million. Almost 19 million workers — 17% of all employees — were uninsured in 2005, according to the Kaiser Commission on Medicaid and the Uninsured.
•Among people with health insurance, the Census reports that 59.7% got it through their jobs in 2006, down from 60.2% in 2005. And they're paying more for it.
•The average amount workers pay toward the premium for a typical family policy rose from $129 a month in 1999 (about $160 in today's dollars) to $273 this year, a jump of 70% when adjusted for inflation, the Kaiser survey of employers shows. The increases come mainly because premiums have soared, rising at several times the rate of inflation in most years. In many cases, cost-cutting employers have increased the share of the premiums that workers pay.
•Premiums continue to go up, although the rate of increase has slowed in the past couple of years. This year, the average increase faced by employers was 6.1%, according to the Kaiser survey, well below the recent peak increase of 13.9% in 2003. Such premium increases weigh heaviest on lower-income workers.
Many large employers are uncomfortable with the growing cost of health insurance, but few want to get out of offering coverage entirely.
"They see it as a way to compete for skilled workers, and they do sense that they have a compact with the employee not to walk away from it," says Robert Laszewski, president of Health Policy and Strategy Associates, a consulting firm that works with insurers and other health care clients.
Many small employers also say they want to continue offering benefits.
Proposals to modify the health insurance system — or sever it from employment — are gaining currency across the political spectrum, from presidential candidates to Congress to business groups.
Some of the proposals now under debate would encourage people — armed with tax credits or deductions — to buy their own insurance on the private market, but would not require anyone to buy it or insurers to sell to all who apply.
Other proposals would require all individuals to have coverage and would create "exchanges" in which groups of residents and employees could buy health insurance, regardless of where or if they work. Insurers would be required to sell policies even to applicants with health problems.
In Congress, a bipartisan bill has been proposed by Sens. Ron Wyden, D-Ore., and Bob Bennett, R-Utah. It would hav