Here's a figure based on information from the USA Census Bureau (see Table HIB-1 here). The move past times describe shows that employer-based wellness insurance covered 65% of the USA population inward 2000, together with 55% of the USA population inward 2010. This turn down seems to convey accelerated since the start of the Great Recession, only it was good underway already. On the other side, the part of the USA population covered past times Medicaid has risen from 10% inward 2000 to 16% now, together with the proportion of Americans without wellness insurance coverage has risen from 13.6% inward 2000 to 16.3% inward 2010. Other categories non shown inward the figure convey changed less. Direct buy of private wellness insurance is downwards a bit, from 10.6% of the population inward 1999 to 9.8% inward 2010. Medicare together with armed forces wellness insurance convey expanded a bit, amongst Medicare rising from 13.4% of the population inward 1999 to 14.5% inward 2010, together with armed forces wellness insurance rising from 3.1% of the population inward 1999 to 4.2% of the population inward 2010.
The overall designing of the Census Bureau figures are replicated past times other data, similar the scream upward surveys done for the National Institute for Health Care Reform, together with reported inward its March 2012 written report "Great Recession Accelerated Long-Term Decline of Employer Health Coverage," past times Chapin White together with James D. Reschovsky. As White together with Reschovsky emphasize:
It's worth remembering, for those who haven't read the history, that the predominance of employer-provided wellness insurance inward the USA economic scheme is an historical accident. Melissa Thomasson offers a dainty overview inward "From Sickness to Health: The Twentieth-Century Development of USA Health Insurance," inward the July 2002 number of Explorations inward Economic History, only that's non freely available on-line. However, Thomasson offers a brief overview at the Economic History Association website here."The recent sense amongst employer-sponsored wellness insurance could endure viewed equally an needlelike affliction aggravating a chronic condition. The needlelike illness—the sluggish economic scheme together with weak work situation—likely volition resolve at about point. But the underlying chronic condition—rising wellness attention costs—likely volition persist. Rising wellness attention costs assist explicate why employers convey instruct less together with less probable to offering employer-sponsored coverage equally a fringe benefit. Rising costs too convey prompted employers to require workers to contribute a larger part of premiums together with shoulder increased patient cost sharing at the signal of service through higher deductibles, coinsurance together with copayments. If wellness attention cost increases cash inward one's chips along to outpace wage increases, to a greater extent than workers are probable to conclude that wellness coverage is non worth the cost. ...
"There has been vigorous ground well-nigh the effects of national wellness reform on employer-sponsored insurance. The best estimates projection that wellness reform volition convey piffling cyberspace impact, only estimates vary widely. The debate, however, frequently misses a key point—employer-sponsored insurance is probable to cash inward one's chips along to erode amongst or without wellness reform, peculiarly amid lower-income families together with those employed past times pocket-sized firms. ... Perhaps to a greater extent than fundamental to the long-term futurity of employer-sponsored insurance is whether the wellness attention delivery together with payment arrangement reforms, which are other of import components of wellness reform, succeed inward slowing the growth of wellness attention costs together with wellness insurance premiums faced past times employers together with employees."
Thomasson points out that the number of Americans amongst wellness insurance went from fifteen ane one 1000 thousand inward 1940 to 130 ane one 1000 thousand inward 1960. Blue Cross/Blue Shield plans began to endure established inward the 1930s. Then inward World War II, the fateful determination was made to encourage employers to render wellness insurance, together with non to revenue enhancement individuals on the value of that wellness insurance they received. Here's Thomasson:
"During World War II, wage together with cost controls prevented employers from using reward to compete for scarce labor. Under the 1942 Stabilization Act, Congress express the wage increases that could endure offered past times firms, only permitted the adoption of employee insurance plans. In this way, wellness produce goodness packages offered ane agency of securing workers. ... [I]n 1949, the National Labor Relations Board ruled inward a dispute betwixt the Inland Steel Co. together with the United Steelworkers Union that the term "wages" included pension together with insurance benefits. Therefore, when negotiating for wages, the matrimony was allowed to negotiate produce goodness packages on behalf of workers equally well. This ruling, affirmed after past times the USA Supreme Court, farther reinforced the employment-based system.I convey no insight into how the USA Supreme Court volition dominion on the Obama wellness attention legislation. But the USA wellness attention arrangement continues to human face upward severe problems: tens of millions of uninsured Americans amongst their part of the USA population rising, rises inward wellness attention costs that continually outstrip inflation, together with the ongoing turn down of employer-provided wellness insurance, the master copy machinery through which a bulk of Americans convey received their wellness insurance inward the in conclusion half-century. Whether the Affordable Care Act is ruled constitutional or not, it's abundantly clear that it won't endure a terminal answer to these issues; indeed, it may good terminate upward existence a transitional slice of legislation that needs to endure thoroughly revisited together with reworked. For example, the Congressional Budget Office of late estimated that nether the Affordable Care Act, after taking into occupation concern human relationship that about firms volition expand wellness insurance coverage together with others volition contract or non offering it, past times 2019-2022, well-nigh 3-5 ane one 1000 thousand fewer people on cyberspace volition convey employer-sponsored coverage equally a resultant of the law.
"Perhaps the most influential expression of authorities intervention that shaped the employer-based arrangement of wellness insurance was the revenue enhancement handling of employer-provided contributions to employee wellness insurance plans. First, employers did non convey to pay payroll revenue enhancement on their contributions to employee wellness plans. Further, nether sure enough circumstances, employees did non convey to pay income revenue enhancement on their employer's contributions to their wellness insurance plans. The commencement such exclusion occurred nether an administrative ruling handed downwards inward 1943 which stated that payments made past times the employer straight to commercial insurance companies for grouping medical together with hospitalization premiums of employees were non taxable equally employee income. While this item ruling was highly restrictive together with express inward its applicability, it was codified together with extended inward 1954. Under the 1954 Internal Revenue Code (IRC), employer contributions to employee wellness plans were exempt from employee taxable income. As a resultant of this tax-advantaged cast of compensation, the demand for wellness insurance farther increased throughout the 1950s ..."
Note: Thanks to Danlu Hu for putting together the figure on wellness insurance coverage.