When the Patient Protection and Affordable Care Act was drafted, it contemplated preservation of employer-based health coverage that came about in the 1940s and which continues to serve as the primary form of coverage for working age Americans. In preserving employer-based coverage, the Affordable Care Act assumes most people will continue to obtain their incomes – and their health coverage – via full time employment.
It also assumes small employers will for the most part want to provide health benefits to their employees provided they have access to quality, affordable plans, reinforced by the law’s reforms of small group markets and pooling their purchasing power via the health benefit exchange Small Business Health Options Program (SHOP).
However, there are multiple, large scale shifts altering employment in the United States and the health benefits that have historically come with it for more than six decades:
- Employment-based coverage has been on a downward trend since 2000, particularly among small employers. It will likely continue to fall unless the state exchange SHOPs scale up to generate enough market power to drive down premiums.
- Unemployment remains high five years after the 2008 economic crisis amid declining work force participation.
- A rise in part time jobs since 2007 that typically don’t come with employer-sponsored health coverage.
- An upswing in self-employment, aided by increased Information and Communications Technology (ICT) access and adoption.
Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email