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Employment and Health Benefits: A Connection at Risk
Although this kind of summary discussion can cover general patterns and major sources of variability in employee health benefits, it cannot portray the full diversity that currently characterizes employment-based health benefits in the United States.1Chapter 4 elaborates on the theme of diversity and on the complexities employers face in making and implementing decisions about health benefits in different organizational environments.
This chapter relies on data from four basic sources: the Bureau of the Census in the Department of Commerce, the Bureau of Labor Statistics in the Department of Labor (DOL), the Health Insurance Association of America (HIAA), and the Health Care Financing Administration (HCFA) in the Department of Health and Human Services. Although information from these sources is generally consistent, differences in definitions of terms, sampling procedures, and units of analysis require that some care be taken in interpreting data and analyses from different sources. Even data drawn from the same source may be subjected to somewhat different analytic procedures by different analysts, who are then likely to develop somewhat different inferences. Readers who want a more detailed understanding of the data sources used here should consult the methodology sections and table notes in the relevant source documents.
The Current Population Survey (CPS) of the Bureau of the Census is directed at households and does not include individuals in nursing homes, prisons, and other institutions. Because of changes in questions and population groups surveyed starting with the March 1988 survey, data covering health insurance status in 1987 and later are not comparable with data for earlier years. For analysis of the CPS data on health coverage collected during March of each year, this report relies on the analysis of the March 1991 data published by the Employee Benefit Research Institute (EBRI, 1992d).2
DOL statistics refer only to workers (not family members) who participate in an employer-sponsored health plan; the numbers include those em-
Chapter 1 notes that employment-based health benefits typically involve a single employer sponsor but that some involve multiple employers and unions. The data and discussion in this chapter do not distinguish sponsor characteristics.
For the March CPS, the basic question on private health insurance status asks respondents whether—other than government-sponsored policies—health insurance can be obtained privately or through a current or former employer or union and whether anyone in the household was covered by health insurance of this type at any time during the preceding calendar year. Follow-up questions ask who in the household was covered, what the specific source of coverage was, and whether it was financed in part or whole by an employer or union. In addition, the May CPS asks whether the respondent's employer offers a health plan, whether the respondent and dependents are covered by it, and if not, why. The analysis by Long and Marquis (1992) cited later in this chapter combines information from the March and May surveys.