Jan 31, 2019 - Health

The quiet, steady rise of employer health coverage

Data: Kaiser Family Foundation; Chart: Chris Canipe/Axios
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.

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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