Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, 540 Gaither Road, Rockville, MD 20850, USA.
Health Serv Res. 2012 Jun;47(3 Pt 1):919-38. doi: 10.1111/j.1475-6773.2011.01368.x. Epub 2012 Jan 17.
To examine trends in employer-sponsored health insurance coverage rates and its associated components between 2000 and 2008, to provide a baseline for later evaluations of the Affordable Care Act, and to provide information to policy makers as they design the implementation details of the law.
Private sector employer data from the 2000, 2001, and 2008 Medical Expenditure Panel Survey-Insurance Component (MEPS-IC).
We examine time trends in employer offer, eligibility, and take-up rates. We add a new dimension to the literature by examining dependent coverage and decomposing its trends. We investigate heterogeneity in trends by firm size.
The MEPS-IC is an annual survey, sponsored by the Agency for Healthcare Research and Quality and conducted by the U.S. Census Bureau. The MEPS-IC obtains information on establishment characteristics, whether an establishment offers health insurance, and details on up to four plans.
We find that coverage rates for workers declined in both small and large firms. In small firms, coverage declined due to a drop in both offer and take-up rates. In the largest firms, offer rates were stable and the decline was due to falling take-up rates. In addition, enrollment shifted toward single coverage and away from dependent coverage in both small and large firms. For small firms, this shift was due to declining offer and take-up rates for dependent coverage. In large firms, offers of dependent coverage were stable but take-up rates dropped. Within the category of dependent coverage, the availability of employee-plus-one plans increased in all firm size categories, but take-up rates for these plans declined in small firms.
研究 2000 年至 2008 年期间雇主提供的健康保险覆盖范围及其相关组成部分的趋势，为平价医疗法案的后续评估提供基准，并为政策制定者在设计该法律的实施细节时提供信息。
2000 年、2001 年和 2008 年医疗支出面板调查-保险部分（MEPS-IC）的私营部门雇主数据。
我们考察了雇主提供、资格和参保率的时间趋势。我们通过考察从属覆盖范围并对其趋势进行分解，为文献增添了一个新的维度。我们通过公司规模研究了趋势的异质性。
MEPS-IC 是一项由医疗保健研究与质量局赞助、美国人口普查局进行的年度调查。MEPS-IC 获得了关于机构特征、机构是否提供健康保险以及多达四种计划的详细信息。
我们发现工人的覆盖率在小公司和大公司都有所下降。在小公司中，由于提供和参保率的下降，覆盖率下降。在最大的公司中，提供率保持稳定，下降是由于参保率下降。此外，在小公司和大公司中，参保人数都从从属覆盖范围转向了单一覆盖范围。对于小公司来说，这种转变是由于从属覆盖范围的提供和参保率下降所致。在大公司中，从属覆盖范围的提供保持稳定，但参保率下降。在从属覆盖范围类别内，所有公司规模类别中员工加一人计划的可用性都有所增加，但小公司的这些计划的参保率下降。
