The Health and Wealth of a Nation: Employer-Based Health Insurance and the Affordable Care Act

The Health and Wealth of a Nation: Employer-Based Health Insurance and the Affordable Care Act

The Health and Wealth of a Nation: Employer-Based Health Insurance and the Affordable Care Act

The Health and Wealth of a Nation: Employer-Based Health Insurance and the Affordable Care Act

Synopsis

The authors in this volume present a fresh approach to understanding the nature and causes of the jobs crisis, the economic and psychological consequences of high and persistent unemployment, and the policy approaches that can begin to make a difference, even in the current fraught political environment.

Excerpt

The Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, provided the first major health care reform in 45 years. The so-called Affordable Care Act (ACA) was enacted to provide high-quality, affordable health care for all Americans. Once all of its provisions become effective, circa 2014, the goal is to ensure that all U.S. citizens receive coverage for essential health benefits. The reform retains the basic structure of our current health care system and assigns shared responsibilities for achieving its goal among employers, insurers, government, and individuals. Employers gain additional responsibilities in providing insurance to workers, with additions ranging from minimum coverage and payment requirements (for large firms) to additional informational requirements. Health insurance providers gain new responsibilities that include new required service provisions, taxes, fees, and reporting obligations. Expanded government responsibilities include creating a new market for insurance—the American Health Benefit Exchanges (referred to henceforth simply as “exchanges”)— and making premium subsidies available to some firms and individuals. Individuals acquire the responsibility of carrying essential health coverage or facing penalties.

It is far too soon to assess the impacts of such sweeping legislation. We can, however, examine the potential for change in one area—employment— by examining how firms behaved with respect to employment-based health insurance before ACA deliberations and by using that behavior to predict the changes that might occur once the legislative requirements become fully implemented. It is within this context that the research in this book unfolds.

No man is an island, and this research upholds the axiom, for it took a small army of individuals to administer the survey, execute the research, and shape the investigation that produced this study. Funding for the study came primarily from the W.E. Upjohn Institute for Employment Research and the University of California’s California Program on Access to Care. Much of the research and writing was done while I was the executive director of the Human Investment Research and Education (HIRE) Center and a professor and chair of the Department of Economics at California State University, East Bay. Early revisions were undertaken, in part, while I was a visiting researcher at the Public Policy Institute of California, and final revisions were completed while I was employed at Mathematica Policy Research. All institutions provided supportive research environments.

The research springs from discussions and joint work with colleagues from many parts of my life. The survey upon which the study is grounded . . .

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