Fronstin P
EBRI Issue Brief. 1999 Jul(211):1-19.
This Issue Brief provides background information on the employment-based health insurance system and its alternatives. The report discusses the advantages and disadvantages of the current employment-based health insurance system, the current tax treatment of health insurance, and the strength and weaknesses of recent proposals to introduce tax credits. It presents findings from the public opinion survey conducted by the Employee Benefit Research Institute on public attitudes toward health insurance and summarizes recent research on the effects of tax changes on employment-based health benefits and the uninsured. Employment-based health plans are the most common source of health insurance among nonelderly individuals in the United States, providing coverage to nearly two-thirds of this population in 1997. Health insurance is probably the benefit most used and valued by workers and their families. Sixty-four percent of respondents to a recent survey rated employment-based health insurance benefits as the most important benefit. Despite essentially five years of very low health care cost increases and the recent increase in the percentage of Americans with employment-based health insurance coverage, the uninsured population has continued to rise. This has resulted in a new interest among policymakers in finding ways to reverse this trend. One question that continues to be asked is whether the employment-based health insurance system is the appropriate mechanism for expanding health insurance to the uninsured. Employment-based health plans are popular because they offer many advantages over other forms of health insurance and types of delivery systems. However, there are also potential drawbacks to the employment-based system. The advantages include reduced risk of adverse selection, group-purchasing efficiencies, employers acting as a workers' advocate, delivery innovation, and health care quality. The disadvantages include an unfair tax treatment, lack of portability and job lock, little choice of health plans, and lack of universal coverage. The tax credit proposals for health insurance, which come in all shapes and sizes, would either enhance the current employment-based health insurance system or put it at risk. This has potentially enormous public policy implications, since the vast majority of Americans get their health insurance coverage through employers. Such a change may also have political implications, as public opinion currently may not support such a fundamental change in the U.S. health insurance system. A recent public opinion survey conducted by the Employee Benefit Research Institute found that 68 percent of Americans with employment-based health insurance were satisfied with the current mix of benefits and wages. The EBRI survey found that under a changing tax code scenario, there is still strong support for the employment-based system. Strong support for the employment-based system may be the result of respondents' lack of confidence in their ability to choose the best health plan if their employer stopped offering health insurance.
本问题简报提供了基于就业的医疗保险系统及其替代方案的背景信息。该报告讨论了当前基于就业的医疗保险系统的优缺点、医疗保险目前的税收待遇，以及引入税收抵免的近期提案的优缺点。它呈现了员工福利研究所在公众对医疗保险态度方面进行的民意调查结果，并总结了近期关于税收变化对基于就业的健康福利和未参保者影响的研究。在美国，基于就业的健康计划是未参保老年人中最常见的医疗保险来源，在1997年为近三分之二的此类人群提供了保险。医疗保险可能是员工及其家庭使用最多且最重视的福利。最近一项调查的64%的受访者将基于就业的医疗保险福利评为最重要的福利。尽管医疗保健成本实际上连续五年增长非常缓慢，且近期有就业相关医疗保险覆盖的美国人比例有所上升，但未参保人口仍在继续增加。这使得政策制定者们开始重新关注如何扭转这一趋势。一个持续被问到的问题是，基于就业的医疗保险系统是否是将医疗保险扩展至未参保者的合适机制。基于就业的健康计划很受欢迎，因为与其他形式的医疗保险和医疗服务提供系统相比，它们具有许多优势。然而，基于就业的系统也存在潜在的缺点。优点包括逆向选择风险降低、团体购买效率、雇主作为员工的支持者、服务创新以及医疗质量。缺点包括不公平的税收待遇、缺乏可携带性和工作锁定、健康计划选择少以及缺乏全民覆盖。医疗保险税收抵免提案形式多样，要么会加强当前基于就业的医疗保险系统，要么会使其面临风险。这可能具有巨大的公共政策影响，因为绝大多数美国人通过雇主获得医疗保险。这样的变化也可能具有政治影响，因为目前公众舆论可能不支持美国医疗保险系统的这种根本性变革。员工福利研究所最近进行的一项民意调查发现，68%有基于就业的医疗保险的美国人对当前的福利和工资组合感到满意。员工福利研究所的调查发现，在不断变化的税法情景下，对基于就业的系统仍有强烈支持。对基于就业的系统的强烈支持可能是因为受访者如果雇主停止提供医疗保险，对自己选择最佳健康计划的能力缺乏信心。
