The Evolving Dynamics of Employer-Sponsored Health Insurance: Implications for Workers, Employers, and the Affordable Care Act
The Evolving Dynamics of Employer-Sponsored Health Insurance: Implications for Workers, Employers, and the Affordable Care Act
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DOI：
10.1111/1468-0009.12229
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发表时间：
2016-12-01
影响因子：
6.6
通讯作者：
Mishra, Pranita
中科院分区：
文献类型：
--
作者：
Graves, John A.;Mishra, Pranita
内容：雇主赞助的保险（ESI）是美国医疗保险的主要形式，但人们对进入和退出ESI的过渡以及营业额是否随着时间的推移而增加知之甚少。我们使用2005-2007年至2010年的收入和计划参与调查数据，为18-61岁的成年人拟合多状态动态过渡模型。2013年和2012- 2014年期间的初步医疗支出小组调查结果：从2010年开始的2年期间，34.6%的成年ESI患者经历了变化，高于2005-2007年的31.7%。转变最常发生在年轻人，西班牙裔成年人，低收入成年人，健康状况良好或较差的人以及服务业工人中。但即使是那些离职率最低的群体老年人、已婚人士和有大学学历的人两年的离职率也高达30%。在2005年至2013年期间，ESI保单持有人在换工作后重新获得基于雇主的保单的概率下降了15%。与此同时，ESI投保人作为另一个家庭成员的计划的依赖者登记或成为无保险的可能性增加了两倍。我们发现很少有证据表明，在这些动态的变化在第一年（2014年）的平价医疗法案（ACA）的主要覆盖reforms.Conclusions：越来越多的美国人依赖于依赖ESI覆盖面通过家庭成员，以保持连续的保险时，他们自己的雇主为基础的福利结束。那些从ESI过渡的人也不太可能参加非团体计划，并且有两倍的可能成为无保险的人。ACA的第一年没有看到实质性的变化，在可能性，一个ESI保险的成年人成为无保险或切换到一个替代的公共或私人计划。需要新的ACA外展工作，以确定和登记大量和越来越多的个人谁面临年底的ESI福利全年。
Context: Employer-sponsored insurance (ESI) is the predominant form of health insurance coverage in the United States, yet little is known about transitions into and out of ESI or whether turnover has increased over time.Methods: We fit multistate dynamic transition models for adults aged 18-61 using Survey of Income and Program Participation data from 2005-2007 to 2010-2013 and preliminary Medical Expenditure Panel Survey from the period 2012-2014.Findings: Over a 2-year period beginning in 2010, 34.6% of adults with ESI experienced a change, up from 31.7% in 2005-2007. Transitions occurred most frequently among young adults, Hispanic adults, low-income adults, those in fair or poor health, and service industry workers. But even the groups with the lowest turnover-older adults, married adults, and those with a college degree-had 2-year rates of change of up to 30%. The probability that an ESI policyholder regained an employer-based policy after a job change declined by 15% between 2005 and 2013. Meanwhile, the probability that an ESI policyholder enrolled as a dependent on another family member's plan or became uninsured increased twofold. We found little evidence of changes in these dynamics during the first year (2014) of the Affordable Care Act's (ACA) major coverage reforms.Conclusions: Increasingly, Americans are relying on dependent ESI coverage through a family member to maintain continuous insurance when their own employer-based benefits end. Those who transitioned off ESI were also less likely to enroll in a non-group plan and were twice as likely to become uninsured. The first year of the ACA did not see material changes in the likelihood that an ESI-insured adult became uninsured or switched to an alternative public or private plan. New ACA outreach efforts are needed to identify and enroll the large and increasing number of individuals who face the end of ESI benefits throughout the year.