Focusing on the tail of the distribution, the percentage of covered workers in small firms and large firms who had to contribute at least 50 percent of the premium, they found that for single coverage, it was not very common. For family coverage in large firms, it was also not very common. For family coverage in small firms, around 30 to almost 36 percent of covered workers in small firms contributed at least 50 percent of premium. That helps explain why there is a lower percentage of workers taking family coverage in small firms.

Looking at the other end, that is, the percentage of covered workers who contributed 10 percent or less of the premiums, in 1999, at the start of the survey, a substantial portion of workers in small firms contributed nothing for their health insurance. That has actually been going down over time, as it has for the other categories as well.

He next focused on cost-sharing. One of the things that is going on with employer-sponsored health insurance is the movement to consumer-funded, consumer-driven plans. In his survey, these are defined as plans that have a deductible of at least $1,000 and can be matched with a savings account. So they are either a health savings account (HSA) qualified plan, or they are a high-deductible plan with a health reimbursement arrangement offered by the employer. Enrollment has grown recently in those plans, and it is going to go up again this year. These plans provide workers with higher deductibles. Higher deductibles are usually matched with somewhat higher out-of-pocket maximums. On the plus side for covered workers, in one of these plans, the employer may make a contribution toward an individual’s savings account. That is by definition true in a health reimbursement arrangement, because only the employer can contribute to those. For workers who are in an HSA-qualified plan, about 60 percent are in plans in which the employer makes a contribution toward their HSA, but not all workers are in that situation.

One other advantage in terms of out-of-pocket costs that comes from the HSA-qualified plans is that the out-of-pocket maximums have to be genuine maximums. That means that all covered spending actually has to count toward the plan’s out-of-pocket maximum. The increase in deductibles is not entirely about people going to consumer-driven plans. The share of workers with plans with a deductible of at least $1,000 has been steadily rising: it is almost half of covered workers in small firms and about a quarter of workers overall. About 20 percent of covered workers in small firms are in a plan with at least a $2,000 deductible, comprising about 10 percent of overall workers. Out-of-pocket maximums are also going up, and this is across all different health plans for people who have an out-of-pocket maximum. The distribution of people with single coverage who are in a plan that has an out-of-pocket maximum of at least $3,000 has

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement