In a study appearing in today's Health Affairs, RAND senior economists Stephen H. Long and M. Susan Marquis present new evidence showing that the share of workers and their families enrolled in employer plans has remained essentially unchanged since 1993.

"What we found overall is that employer-based insurance coverage has been stable and the sky is not falling," the authors comment. Analysts have suggested that the increase in the numbers of uninsured is due to a combination of population growth and welfare reform-related reductions in Medicaid rolls.

The study is unique in relying on two of the largest employer surveys ever conducted — — the National Employer Health Insurance Survey for 1993 (34,600 interviews) and the 1997

Robert Wood Johnson Foundation Employer Health Insurance Survey (21,500 interviews). The economists found that 58 percent of employees enrolled in their employers' plans in 1993 compared to 60 percent in 1997. They also found no erosion in the participation rate among eligible workers and in the share of workers who elected family coverage.

They stress, however, that "the overall stability in coverage rates and prices over time masks important variability in the circumstances faced by individual workers." Between 1995 and

1997 almost two million workers saw their employers drop health coverage. During the same period, firms employing four million workers added a health benefit.

Their paper is one of four from RAND appearing in Health Affairs' new issue. In the others:

• Marquis and Long examine other post-1993 insurance trends and confirm that we are in the midst of a revolutionary shift to managed care in employment-based health plans. By 1997 only 27 percent of workers were being offered an indemnity coverage option, down from

• Long and Marquis also compare health benefits in the public and private sectors. They show that the federal government leads the way in offering choices and in using financial incentives and consumer information to promote the selection of efficient plans. State and local governments fall short of Washington's example but are far ahead of private employers. The authors estimate that federal employees experience a $200 annual gap in employer health insurance contributions relative to those in the private sector (the Congressional Budget Office estimate is $450-$630). They point out, however, that federal employees are more likely to be eligible for, and to have choices among, health benefits packages.

• Researchers from RAND's Institute for Civil Justice assess the likely responses of health plans, providers and employers to legislation that would expand their liability for failing to cover needed care. The paper concludes that "the direct costs of liability are uncertain but the prospect of litigation may have other important effects on coverage decision making, information exchange, risk contracting, and the extent of employers' involvement in health coverage." The authors also examine the policy impact of those effects.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis.

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