Jan 21, 2020 - Politics & Policy

Employers, not patients, have the most health insurance choices

Illustration of three doors shaped like red crosses, labeled A, B, and C
Illustration: Sarah Grillo/Axios

Most people don't have nearly as much choice over their health insurance plans as Republicans and moderate Democrats sometimes suggest.

Between the lines: People who get their insurance from their employer — the majority of people with private insurance — are often given few plans to choose from, if they're given any choice at all.

What they're saying: This came up in former Vice President Joe Biden's interview with the New York Times' editorial board.

  • "If you like your plan, you can keep it, assuming — I should add the obvious — if your employer doesn’t take it away from you."

The comment is a nod to how much control employers have over their employees' health insurance.

  • Many workers are presented with just one plan option, meaning they don't have any choice at all. Others will have multiple plans, but all from the same insurance company.
  • Employers frequently shop around for better deals, but employees are stuck with choosing between the limited choices their employers present to them.
  • And while competition is improving in the individual market, most people who buy insurance on their own still have only a handful of insurers to choose from.

Biden has proposed a public insurance plan that would be open to people with employer-based insurance — which experts say could lead to some employers deciding not to offer their own coverage.

  • For workers who have generous employer coverage now, a public option with limited provider participation would probably be a bad deal.
  • But if most doctors and hospitals participate in the public option, workers may not end up with any fewer choices than they have now.

Between the lines: "In the current political debate, choice has mostly been about whether you can choose private insurance or a public Medicare-like plan. But, that in many ways obscures the choice that probably ultimately matters to most people, which is choice of doctor or hospital," the Kaiser Family Foundation's Larry Levitt said.

Go deeper: Employers aren't changing their health benefits

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