A reappraisal of private employers' role in providing health insurance

Olveen Carrasquillo, David U. Himmelstein, Steffie Woolhandler, David H. Bor

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Abstract

Background: In 1996, according to official figures, 61 percent of Americans received health insurance through employers. However, this estimate includes persons who relied primarily on government insurance such as Medicare, workers whose employers arranged their insurance but contributed nothing toward the premiums, and government employees whose private coverage was paid for by taxpayers. Methods: To estimate the number of persons whose principal health insurance was paid for in whole or in part by employers in the private sector and the number receiving government-funded insurance, we analyzed data from the March 1997 Current Population Survey. Approximately 130,000 persons representative of the noninstitutionalized U.S. population were sampled. We considered people to be covered principally by health insurance paid for by private-sector employers if they had no public insurance coverage and were covered by insurance from a nongovernmental employer who paid all or part of their premiums. Those who were covered by Medicaid, Medicare, insurance resulting from former or current military service, or the Indian Health Service were considered to be receiving government insurance. Results: In 1996, 43.1 percent of the population (90 percent confidence interval, 42.7 to 43.5 percent) depended principally on health insurance paid for by private-sector employers, 34.2 percent (90 percent confidence interval, 33.8 to 34.6 percent) had publicly funded insurance, 7.1 percent (90 percent confidence interval, 6.8 to 7.6 percent) purchased their own coverage, and 15.6 percent (90 percent confidence interval, 15.3 to 15.9 percent) were uninsured. In only six states was more than half the population covered principally by health insurance paid for by private-sector employers. Conclusions: Current definitions of health insurance over emphasize the role of private employers and underestimate the extent to which government pays for health insurance.

Original languageEnglish
Pages (from-to)109-114
Number of pages6
JournalNew England Journal of Medicine
Volume340
Issue number2
DOIs
StatePublished - Jan 14 1999
Externally publishedYes

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ASJC Scopus subject areas

  • Medicine(all)

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