Private Insurance
Most Americans who have health coverage are enrolled in private health plans. The majority get this coverage through their employer, but some have to buy coverage on their own in the individual market.
Unfortunately, there are serious (and growing) problems with private insurance. Prices are spiraling upwards, leading employers to raise the share paid by workers, cut back on benefits, or drop coverage altogether. Those who don't have coverage through their jobs often find that buying insurance in the individual market is expensive, and many have trouble finding anyone willing to sell them a policy at all. As people lose coverage at work and find that they cannot afford to buy a policy on their own, more and more Americans become uninsured.
This section of our Web site keeps you up-to-date on what's happening in the private health insurance arena. "The Facts" helps you follow the latest trends in the private market, "Bad Ideas" shows you why some proposals move us in the wrong direction, and "Good Ideas" highlights positive approaches.
The Latest
From Families USA:
Why Employers Should Share the Responsibility of Paying for Health Care discusses five reasons why it makes sense to require employers to contribute to the cost of health coverage, known as an "employer responsibility requirement." (June 2009)
Investing in Health Coverage: It Just Makes Sense explores four key reasons why we all have a stake in making sure everyone has health coverage. (June 2009)
Hidden Health Tax: Americans Pay a Premium discusses how private health insurance premiums are higher, in part, because the costs of uncompensated care for the uninsured are shifted to those who have insurance, a "hidden health tax." The report quantifies this "tax" for family and individual coverage. (May 2009)
CoverTN, Tennessee's Barebones Health Plan: A Case Study uses Tennessee's barebones health plan as an example to examine how limited-benefit plans fail to meet the health coverage needs of consumers. (May 2009)
Too Great a Burden: Americans Face Rising Health Care Costs reveals how many Americans face very high health care costs and shows the magnitude of the health care cost crisis. The report provides data on how many people are in families that will spend more than 10 percent or 25 percent of their pre-tax income on health care in 2009. (April 2009)
Health Care Must Be Affordable for All Families, Regardless of Income presents crucial arguments for why health reform must ensure that health care is truly affordable. It proposes placing reasonable limits on out-of-pocket costs and providing subsidies, especially for those with low and moderate incomes. (April 2009)
States Act to Help People Laid Off from Small Firms: More Needs to Be Done discusses how, in response to pressure from advocates, some states are taking steps toward passing "mini-COBRA" laws to help laid off workers from small firms get the federal subsidy guaranteed through the American Recovery and Reinvestment Act (ARRA). (April 2009)
From the Alliance for Health Reform:
Health Insurance Exchanges: See How They Run is a webcast that looks at insurance exchanges and examines the following questions: What is meant by a health insurance exchange, and how might it work? Who would be allowed to seek coverage through the exchange? What rules would govern the conduct of plans offering coverage? What’s in it for the consumer? (May 2009)
From the Center on Budget and Policy Priorities:
Designing Benefit Standards for a Health Insurance Exchange explains that, in any exchange that is created as part of health reform, it is crucial to establish benefit standards so that all plans cover a comprehensive range of services, thereby ensuring that individuals and small businesses have a choice of affordable, comprehensive plans. These benefit standards would protect people with particular medical conditions from facing excessive costs, and they would better enable consumers to compare plans based on price and quality. (May 2009)
Ensuring Affordable Health Coverage and Health Care Services in an Insurance Exchange finds that any health reform proposal that requires everyone to obtain health insurance must establish mechanisms to make health coverage and health care affordable. It also identifies four key components that any successful exchange should have: minimum standards for benefit packages, limits on the degree of variation in different benefit packages, limits on the number of different plan choices, and a requirement that insurers in the exchange offer the full range of benefit packages. (May 2009)
Rules of the Road: How an Insurance Exchange Can Pool Risk and Protect Enrollees finds that a strong exchange can greatly reduce the problems many people currently face when they must obtain coverage on their own without the help of an employer. It then lays out four key components of an efficient insurance exchange, including minimum standards for the benefits packages offered and a limit on the number of different benefit packages. (April 2009)
From the Commonwealth Fund:
Meeting Enrollees’ Needs: How Do Medicare and Employer Coverage Stack Up? finds that elderly Medicare beneficiaries reported greater overall satisfaction with their health coverage, better access to care, and fewer problems paying medical bills than those under age 65 who are covered by job-based plans. This study was designed to examine whether a public plan could potentially improve access to necessary services and reduce the burden of medical bills for individuals under age 65. (May 2009)
Women at Risk: Why Many Women Are Forgoing Needed Health Care examines how rising health care costs coupled with eroding health benefits are having a substantial effect on Americans' ability to get health care, particularly women. In 2007, 52 percent of women reported having problems obtaining needed care due to cost, and 45 percent had accrued medical debt or reported having problems with medical bills. (May 2009)
From Health Affairs:
Trends in Underinsurance and the Affordability of Employer Coverage, 2004-2007 focuses on cost increases for the 161 million Americans who have job-based health coverage. Over the period studied, for all adults, expected medical spending rose by 34 percent, or $729. The study also explores the relationship between rising out-of-pocket costs for adults with job-based coverage and rising health care costs overall. (June 2009) Subscription Required
From the Robert Wood Johnson Foundation:
Coverage When It Counts: What Does Health Insurance in Massachusetts Cover and How Can Consumers Know? details the complex challenges consumers face when making choices about which health insurance plan to purchase. The authors use Massachusetts as an example to suggest a new method for evaluating health insurance plans and make recommendations for states that are working to increase transparency in health insurance pricing. (May 2009)
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