Drew Altman, Kaiser Family Foundation
Jan 31,2019
Data: Kaiser Family Foundation; Chart: Chris Canipe/Axios
After
many years of steady decline, the proportion of people under 65 with employer
health coverage has started to increase. About seven million more people gained
employer coverage between 2013 and 2017 — nearly as many as the 10 million
people who were covered through the Affordable Care Act's
marketplace last year.
Why
it matters: Since people with employer coverage are the
largest insured group in the country, the next wave of health reform will be
more politically successful if it resonates with their concerns.
- That's why
Kamala Harris' comment this week about doing away with
private health insurance, as part of a Medicare for All plan, exposes the
danger for Democrats if they don't convince people who like their private
coverage that they have something better to offer.
The
big picture: As the chart shows, the share of the
non-elderly population with employer coverage fell between 1999 and 2010. But it’s actually
been rising in recent years, especially between 2013 and 2017, the
last year for which we have data from the National Health Interview Survey.
- Both a
stronger economy and the ACA’s individual and
employer mandates are likely reasons for the increase.
By
the numbers:
- The increase means that 156 million
people were covered by employer-based insurance in 2017.
- That makes it by far the single
largest form of coverage, followed by Medicaid at 74
million.
Between
the lines: The size of this group is a reminder of the
biggest challenge for Medicare for All: it can't be too disruptive of the
health coverage people already have.
- In our
polling, national health plans that allow people to keep
their private employer coverage if they choose to are more
popular than plans that would be mandatory for everyone as some
Medicare for All plans are.
It's
also worth remembering that the big problem for
these 156 million people isn't getting to universal coverage — it’s their deductibles
and drug prices and premiums and surprise medical bills. Whether they are Trump
voters in Indiana or longtime Democrats in California, they are looking for
help paying their medical bills, not big ideas they cannot connect to their
everyday problems.
The
bottom line: The 2020 presidential candidates would do
well not to forget that the employer market is where the largest share of
Americans are experiencing problems with health care costs. And as debate about
Medicare for All heats up, advocates will have to deal with the love-hate
relationship 156 million workers have with their employer-based coverage.
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