A reappraisal of private employers' role in providing health insurance

Background in 1996, according to official figures, 61 percent of Americans received health insurance through employers. However, this estimate include s persons who relied primarily on government insurance such as Medicare, wo rkers whose employers arranged their insurance but contributed nothing towa rd the premiums, and government employees whose private coverage was paid f or 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 Ma rch 1997 Current Population Survey. Approximately 130,000 persons represent ative of the noninstitutionalized U.S. population were sampled. We consider ed 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 resultin g from former or current military service, or the Indian Health Service wer e considered to be receiving government insurance. Results In 1996, 43.1 percent of the population (90 percent confidence inte rval, 42.7 to 43.5 percent) depended principally on health insurance paid f or by private-sector employers, 34.2 percent (90 percent confidence interva l, 33.8 to 34.6 percent) had publicly funded insurance, 7.1 percent (90 per cent 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) we re 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 overemphasize the role of private employers and underestimate the extent to which government pays for health insurance. (N Engl J Med 1999;340:109-14.) (C) 1999, Massachuset ts Medical Society.