Download or read book The Impact of the Recession on Employment Based Health Benefits written by Paul Fronstin and published by . This book was released on 2011 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This paper examines the relationship between health benefits and union status and the impact of the recent recession on that relationship. Since union workers account for a declining share of the working population in the private sector, further erosion of unionization is likely to coincide with overall erosion in the percentage of workers with employment-based health benefits, despite the fact that union workers are more likely than nonunion workers to have health coverage through their job. Furthermore, any future decline in the size of the public sector that is unionized, or declines in the public sector in general in response to lower tax revenues, will only exacerbate the overall erosion in the percentage of workers with employment-based health benefits. Union workers are much more likely to have employment-based health benefits than nonunion workers. In 2009, 80.4 percent of union workers were covered by health benefits through their own job, compared with 52.2 percent of nonunion workers. Overall, 91 percent of union workers had coverage either through their own job or as a dependent, while 70.6 percent of nonunion workers had any employment-based coverage. In 2009, 5.6 percent did not have any health insurance coverage. Among nonunion workers, 20.2 percent were uninsured in 2009. Both union workers and nonunion workers were affected by the recession, but it affected nonunion workers more than union workers. Union workers covered through their own job fell from 82 percent to 80.4 percent between 2007 and 2009, a 2 percent decline. In contrast, the percentage of nonunion workers with coverage through their own job fell from 55.9 percent to 52.2 percent, a 6.5 percent decline. Overall, the percentage of union workers with any employment-based coverage fell from 93.4 percent to 91 percent (a 2.6 percent decline), while among nonunion workers it fell from 74.3 percent to 70.6 percent (a 5 percent decline). Differences in reasons for being uninsured are also examined for union and nonunion workers. The analysis ends with a discussion of trends in premiums. The PDF for the above title, published in the July 2011 issue of EBRI Notes, also contains the fulltext of another July 2011 EBRI Notes article abstracted on SSRN: “Capping Tax-Preferred Retirement Contributions: Preliminary Evidence of the Impact of the National Commission on Fiscal Responsibility and Reform Recommendations.”

Download or read book The Impact of the Recession on Employment Based Health Coverage written by Paul Fronstin and published by . This book was released on 2010 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This paper examines changes in health coverage among workers during the recession that started in December 2007. Data from the Survey of Income and Program Participation are used to examine health coverage prior to the recession, and as recently as July 2009. Monthly changes are examined for 2007 and May 2008-July 2009, with emphasis on changes that occurred between September 2007 and April 2009. Health coverage through the work place is by far the most common source of health insurance among the population under age 65. In 2008, 160.6 million individuals under age 65, or 61.1 percent of that population, were covered by employment-based health benefits. Fifteen percent were covered by Medicaid or the State Children's Health Insurance Program (SCHIP), 6.3 percent purchased coverage directly from an insurer, and about 3 percent were covered by Medicare or Tricare/CHAMPVA. Nearly 17.5 percent were uninsured. Since the recession started in December 2007, the uninsured have grown. The unemployment rate was as low as 4.4 percent in May 2007, but by July 2009 it had reached 9.4 percent. The percentage of the nonelderly population with employment-based coverage was 61.3 percent in May 2007, and by July 2009 it was down to 58.2 percent. The uninsured rate was 12.3 percent in May 2007, and by July 2009 it was up to 16.4 percent. Between December 2007-May 2008, the percentage of workers with coverage in their own name (the policyholder) fell from 60.4 percent to 56.8 percent. The period between May 2008-July 2009 shows a continuing decline in the percentage of workers with employment-based coverage in their own name, falling to 55.9 percent. The benefits that are being offered have also changed. Deductibles, copayments for office visits, and prescription drug copayments have been increasing. In general, workers least likely to have employment-based coverage at the beginning of the recession were more likely than other workers to experience a decline in the percentage with such coverage one year later. Younger workers were more likely to lose coverage than older workers. Hispanic workers were more likely to lose coverage than whites or blacks. Part-time workers were more likely than full-time workers to have lost employment-based coverage. The percentage of workers with own name employment-based coverage declined the most among those employed by for-profit private-sector employers and those employed by the federal government. Workers with the lowest earnings were the least likely to have employment-based coverage in their own name and experienced the largest decline in coverage.

Download or read book Health Benefits at Work written by Mark V. Pauly and published by University of Michigan Press. This book was released on 1999-06-04 with total page 204 pages. Available in PDF, EPUB and Kindle. Book excerpt: Who really pays for health benefits? An accessible explanation of the economic theory behind this question

Download or read book Employment and Health Benefits written by Institute of Medicine and published by National Academies Press. This book was released on 1993-02-01 with total page 381 pages. Available in PDF, EPUB and Kindle. Book excerpt: The United States is unique among economically advanced nations in its reliance on employers to provide health benefits voluntarily for workers and their families. Although it is well known that this system fails to reach millions of these individuals as well as others who have no connection to the work place, the system has other weaknesses. It also has many advantages. Because most proposals for health care reform assume some continued role for employers, this book makes an important contribution by describing the strength and limitations of the current system of employment-based health benefits. It provides the data and analysis needed to understand the historical, social, and economic dynamics that have shaped present-day arrangements and outlines what might be done to overcome some of the access, value, and equity problems associated with current employer, insurer, and government policies and practices. Health insurance terminology is often perplexing, and this volume defines essential concepts clearly and carefully. Using an array of primary sources, it provides a store of information on who is covered for what services at what costs, on how programs vary by employer size and industry, and on what governments doâ€"and do not doâ€"to oversee employment-based health programs. A case study adapted from real organizations' experiences illustrates some of the practical challenges in designing, managing, and revising benefit programs. The sometimes unintended and unwanted consequences of employer practices for workers and health care providers are explored. Understanding the concepts of risk, biased risk selection, and risk segmentation is fundamental to sound health care reform. This volume thoroughly examines these key concepts and how they complicate efforts to achieve efficiency and equity in health coverage and health care. With health care reform at the forefront of public attention, this volume will be important to policymakers and regulators, employee benefit managers and other executives, trade associations, and decisionmakers in the health insurance industry, as well as analysts, researchers, and students of health policy.

Download or read book Employment Based Health Benefits written by Paul Fronstin and published by . This book was released on 2012 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Employment-based health benefits are the most common form of health insurance in the United States. The purpose of this paper is to examine the state of employment-based health benefits among workers with respect to offer rates, coverage rates, and take-up rates. It also examines how the state of employment-based health benefits has changed since the mid-1990s, reasons why workers do not have employment-based health benefits from their own employers, and how these reasons have changed since the 1990s. Both the offer rate (the percentage of workers offered a health benefit) and the coverage rate for employment-based health benefits declined between 1997 and 2010. Between 1997 and 2010, the percentage of workers offered health benefits from their employers decreased from 70.1 percent to 67.5 percent, and the percentage of workers covered by those plans decreased from 60.3 percent to 56.5 percent. The take-up rate (the percentage of workers taking coverage when offered by their employers) declined from 86 percent in 1997 to 83.6 percent in 2010. In 2010, 58.7 percent of nonelderly individuals were covered by employment-based health plans, with 68.6 percent of working adults covered, 35.3 percent of non-working adults covered, and 54.8 percent of children covered. The percentage of the population with employment-based health benefits has been declining, most recently due to the 2007-2009 recession. The percentage of individuals under age 65 with employment-based health benefits fell from 62.4 percent in 2008 to 58.7 percent in 2010, and the percentage of workers with coverage through their own employers fell from 54.2 percent in 2007 to 51.5 percent in 2010, its lowest level since 1994. In 2010, 46.7 percent of wage and salary workers ages 18-64 reported that they worked for employers that did not offer health benefits. Another 14.7 percent worked for employers that provided health benefits but were not eligible for those benefits. Among workers who were not eligible for their employers' health plans, 38.7 percent were uninsured in 2010, and 41.1 percent had employment-based health benefits as dependents. Two-thirds of workers not eligible for their employers' health plans reported that they worked part time in 2010, up from one-half in 1997. In 2010, one-quarter of workers reported that they were offered health benefits but they chose not to participate. Between 1997 and 2010, the percentage of workers who declined coverage because of cost increased from 23.2 percent to 29.1 percent. In 2010, two-thirds reported that they declined coverage because they had other coverage, down from 78.9 percent in 1997. The estimates presented in this paper can also serve as a baseline against which to measure the impact of the Patient Protection and Affordable Care Act of 2010 (PPACA) on employment-based health benefits in the future.

Download or read book Effects of Changes to the Health Insurance System on Labor Markets written by Janet Holtzblatt and published by DIANE Publishing. This book was released on 2010-10 with total page 8 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the U.S., health insurance (HI) coverage is linked to employment in ways that can affect both wages and the demand for certain types of workers. That close linkage can also affect people¿s decisions to enter the labor force, to work fewer or more hours, to retire, and even to work in one particular job or another. This economic brief shows that the overall impact on labor markets (LM) is difficult to predict. Although economic theory and experience provide some guidance as to the effect of specific provisions, large-scale changes to the HI system could have more extensive repercussions than have previously been observed and also may involve numerous factors that would interact ¿ affecting LM in potentially offsetting ways.

Download or read book The Impact on Employment Based Health Benefits of the Shift from a Manufacturing Economy to a Service Economy written by Paul Fronstin and published by . This book was released on 2010 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This paper examines one structural change in the work force that has contributed to the decline in employment-based health benefits: the movement of workers from the manufacturing sector to the service sector. Between 1987 and 2002 not only did the percentage of workers in the manufacturing sector decline, but the probability that a worker in this sector had employment-based health benefits dropped as well, from 79 percent to 70 percent. The PDF for the above title, published in the June 2004 issue of EBRI Notes, also contains the fulltext of another June 2004 EBRI Notes article abstracted on SSRN: "The Inflation Rate and the Actuarial Balance of the OASDI Trust Funds."

Download or read book Employers Workers and the Future of Employment Based Health Benefits written by Stephen Blakely and published by . This book was released on 2010 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This paper summarizes presentations at EBRI's 65th biannual policy forum, held in Washington, DC, on Dec. 10, 2009, on the topic, “Employers, Workers, and the Future of Employment-Based Health Benefits.” The forum brought together a wide range of economic, benefits, management, and labor experts to share their expertise at a time when major health reform legislation was being debated in Congress. The focus: How might this affect the way that the vast majority of Americans currently get their health insurance coverage? Most people who have health insurance coverage in the United States get it through their job: In 2008, about 61 percent of the nonelderly population had employment-based health benefits, 19 percent were covered by public programs, 6 percent had individual coverage, and 17 percent were uninsured. One point of consensus among both labor and management representatives: Imposing a tax on health benefits is likely to cause major cuts in health benefits and might result in structural changes in the employment-based benefits system. A common disappointment voiced at the forum was that the initial effort to reform the delivery and cost of health care in America gradually became focused on just financing and coverage of health insurance. The ever-rising cost of health insurance affects different employers and workers in different ways--with small employers and low-wage workers being the most disadvantaged. Small employers, if they offer health benefits at all, pay proportionately more than large employers for the same health coverage. While large employers tend to express continued commitment to health benefits, small employers see themselves strongly disadvantaged by the current system. Consultants report many employers privately want to drop benefits to control costs, but realize there are risks to doing so and none wants to be first. Employers express strong interest in wellness and disease management programs as a way to control costs, even though some experts say there is no evidence these work. Consumer-driven health plans are expected to continue their slow rate of growth.

Download or read book The Impact of Hours of Work on Employment Based Health Benefits written by Paul Fronstin and published by . This book was released on 2006 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This paper examines changes in the distribution of workers by hours of work and the resulting impact on employment-based health benefits. The percentage of workers in the labor force employed either full time or part time tends to vary with the strength of the economy, and for various other reasons. In 2004, 17.5 percent of workers ages 18-64 were employed part time, up from 16.3 percent in 2000. The movement of workers from full-time status to part-time status has significant implications for their health benefits: In 2004, 18.6 percent of workers employed part time were covered by employment-based health benefits through their own employer in 2004, compared with 61.5 percent of full-time workers. As a result, any shift of workers from full-time to part-time status will likely lead to fewer workers with employment-based health benefits unless they obtain them from another source, such as a working spouse.

Download or read book The Impact of the 2007 2009 Recession on Workers Health Coverage written by Paul Fronstin and published by . This book was released on 2011 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This paper examines changes in employment-based health insurance coverage among workers; the analysis uses data from 2008 and 2009 that were collected in the March 2009 and March 2010 Current Population Survey following the 2007-2009 recession. The 2007-2009 recession has taken its toll on the percentage of the population with employment-based health coverage. While, since 2000, there has been a slow erosion in the percentage of individuals under age 65 with employment-based health coverage, 2009 was the first year in which the percentage fell below 60 percent, and marked the largest one-year decline in coverage. The percentage of workers with coverage through their own job fell from 53.2 percent in 2008 to 52 percent in 2009, a 2.4 percent decline in the likelihood that a worker has coverage through his or her own job. The percentage of workers with coverage as a dependent fell from 17 percent in 2008 to 16.3 percent in 2009, a 4.5 percent drop in the likelihood that a worker has coverage as a dependent. These declines occurred as the unemployment rate increased from an average of 5.8 percent in 2008 to 9.3 percent in 2009 (and reached a high of 10.1 percent during 2009). The decline in the percentage of workers with coverage from their own job affected workers in private-sector firms of all sizes. Among public-sector workers, the decline from 73.4 percent to 73 percent was not statistically significant. Workers in all private-sector industries experienced a statistically significant decline in coverage between 2008 and 2009. Full-time workers experienced a decline in coverage that was statistically significant while part-time workers did not. Among full-time workers, those employed full year experienced a statistically significant decline in coverage from their own job. Those employed full time but for only part of the year did not experience a statistically significant change in coverage. Among part-time workers, those employed full year experienced a statistically significant increase in the likelihood of having coverage in their own name, as did part-time workers employed for only part of the year. The decline in the percentage of workers with coverage through their own job was limited to workers with lower annual earnings. Statistically significant declines were not found among any group of workers with annual earnings of at least $40,000. Workers of all races experienced statistically significant declines in coverage between 2008 and 2009. Both men and women experienced a statistically significant decline in the percentage with health coverage through their own job. The movement of workers from the manufacturing industry to the service sector continued between 2008 and 2009. The percentage of workers employed on a full-time basis decreased while the percentage working part-time increased. While there was an overall decline in the percentage of full-time workers, that decline was limited to workers employed full year. The percentage of workers employed on a full-time, part-year basis increased between 2008 and 2009. The distribution of workers by annual earnings shifted from middle-income workers to lower-income workers between 2008 and 2009.

Download or read book The Impact of the Macroeconomy on Health Insurance Coverage written by John Cawley and published by . This book was released on 2011 with total page 37 pages. Available in PDF, EPUB and Kindle. Book excerpt: This paper investigates the impact of the macroeconomy on the health insurance coverage of Americans. We examine panel data from the Survey of Income and Program Participation (SIPP) for 2004-2010, a period that includes the Great Recession of 2007-09. We find that a one percentage point increase in the state unemployment rate is associated with a 1.67 percentage point (2.12%) reduction in the probability that men have health insurance; this effect is strongest among college-educated, white, and older (50-64 year old) men. For women and children, the unemployment rate was not significantly correlated with the probability of health insurance coverage through any source. When one examines the source of coverage, it becomes apparent that a one percentage point increase in the unemployment rate is associated with a 1.37 percentage point (4.69%) higher probability that a child is covered by public health insurance. Based on the point estimates in this paper, we estimate that 9.3 million adult Americans, the vast majority of whom were men, lost health insurance due to a higher unemployment rate alone during the 2007-09 recession. This is roughly nine times more than lost health insurance during the previous (2001) recession. We conclude with a discussion of how components of recent health care reform may influence these relationships in the future.

Download or read book The Great Recession written by David B. Grusky and published by Russell Sage Foundation. This book was released on 2011-10-01 with total page 342 pages. Available in PDF, EPUB and Kindle. Book excerpt: Officially over in 2009, the Great Recession is now generally acknowledged to be the most devastating global economic crisis since the Great Depression. As a result of the crisis, the United States lost more than 7.5 million jobs, and the unemployment rate doubled—peaking at more than 10 percent. The collapse of the housing market and subsequent equity market fluctuations delivered a one-two punch that destroyed trillions of dollars in personal wealth and made many Americans far less financially secure. Still reeling from these early shocks, the U.S. economy will undoubtedly take years to recover. Less clear, however, are the social effects of such economic hardship on a U.S. population accustomed to long periods of prosperity. How are Americans responding to these hard times? The Great Recession is the first authoritative assessment of how the aftershocks of the recession are affecting individuals and families, jobs, earnings and poverty, political and social attitudes, lifestyle and consumption practices, and charitable giving. Focused on individual-level effects rather than institutional causes, The Great Recession turns to leading experts to examine whether the economic aftermath caused by the recession is transforming how Americans live their lives, what they believe in, and the institutions they rely on. Contributors Michael Hout, Asaf Levanon, and Erin Cumberworth show how job loss during the recession—the worst since the 1980s—hit less-educated workers, men, immigrants, and factory and construction workers the hardest. Millions of lost industrial jobs are likely never to be recovered and where new jobs are appearing, they tend to be either high-skill positions or low-wage employment—offering few opportunities for the middle-class. Edward Wolff, Lindsay Owens, and Esra Burak examine the effects of the recession on housing and wealth for the very poor and the very rich. They find that while the richest Americans experienced the greatest absolute wealth loss, their resources enabled them to weather the crisis better than the young families, African Americans, and the middle class, who experienced the most disproportionate loss—including mortgage delinquencies, home foreclosures, and personal bankruptcies. Lane Kenworthy and Lindsay Owens ask whether this recession is producing enduring shifts in public opinion akin to those that followed the Great Depression. Surprisingly, they find no evidence of recession-induced attitude changes toward corporations, the government, perceptions of social justice, or policies aimed at aiding the poor. Similarly, Philip Morgan, Erin Cumberworth, and Christopher Wimer find no major recession effects on marriage, divorce, or cohabitation rates. They do find a decline in fertility rates, as well as increasing numbers of adult children returning home to the family nest—evidence that suggests deep pessimism about recovery. This protracted slump—marked by steep unemployment, profound destruction of wealth, and sluggish consumer activity—will likely continue for years to come, and more pronounced effects may surface down the road. The contributors note that, to date, this crisis has not yet generated broad shifts in lifestyle and attitudes. But by clarifying how the recession’s early impacts have—and have not—influenced our current economic and social landscape, The Great Recession establishes an important benchmark against which to measure future change.

Download or read book Employment based Health Insurance written by United States. General Accounting Office and published by . This book was released on 1997 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Protecting the U S Population s Health Against Potential Economic Recessions and High Unemployment and the Endemic Inflation of Health Care Costs written by Fritz Dufour and published by Fritz Dufour. This book was released on 2019-12-15 with total page 307 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book has three main parts: (1) the challenges of the U.S. health care system; (2) the impacts of economic recessions and high unemployment on the U.S. population’s health; and (3) recommendations or a look into what might improve the health care system. Part I, through a dissection of the challenges faced by the U.S. health care system, exposes the particularities and the vulnerabilities of the system. It shows the role played by businesses and employment in the U.S. population’s health and describes major challenges of the health care system such as astronomical health care costs, the average family health spending – which is exceedingly high, wasteful spending, death due to inaccessibility to health care, and the hardships that medical costs created for more than half of Americans. Part II is an analysis as to why do economic recessions have health implications. That analysis is done by considering the health implications of economic recessions both at the micro and macroeconomic levels and by considering the societal costs of uninsurance or inaccessibility to health care due to economic recessions and high unemployment. Part III primarily focuses on what can make the system better, that is more efficient and more cost-effective. Ironically, as Part III argues, there are a myriad of feasible recommendations that are waiting to be fully explored, agreed upon, adopted and implemented nationwide: · Design labor and fiscal policies aimed at preventing economic recessions and high unemployment o Blend labor and fiscal policies into structural reforms · Create job security and take other steps that guarantee health care security during financial hardship · Improve health outcomes through nationwide permanent supportive housing to combat chronic homelessness during economic recessions and high unemployment · Prioritize the use of more cost-effective medical technologies o Promote telemedicine to reduce costs and improve accessibility to health care · Eliminate health disparities thanks to the democratization of health care · Promote health literacy and the valorization of communities · Design policies or procedures that 1) promote health care costs reduction and efficiency through affordable insurance coverage and 2) eliminate Wasteful spending: o Extend drug coverage and implement cost-effective pricing policies o Extend coverage of more medical procedures and implement cost-effective policies On the other hand, Part III also sells the idea of a thorough and bold revolution in our health care system, which would make health care a right of citizenship. It does so by analyzing the political, social, ethical, and economic aspects of the issue. Furthermore, it argues that the relationship between universal health care and economics justifies the notion of “health care as a right of citizenship.”

Download or read book Tracking Health Insurance Coverage by Month written by Paul Fronstin and published by . This book was released on 2013 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Prior research has shown that both the offer rate (the percentage of workers offered health benefits) and the take-up rate have both been declining. However, there is still a strong link between health benefits and employment. As a result, employment-based health benefits remain the most common form of health insurance for nonpoor and nonelderly individuals in the United States. In 2011, 58.4 percent of nonelderly individuals (under age 65) were covered by an employment-based, health-benefits plan, including 68.3 percent of workers, 34.7 percent of nonworking adults, and 54.7 percent of children. This analysis examines the recent state of employment-based health benefits, updating prior research by the Employee Benefit Research Institute (EBRI) that examined trends in coverage on a monthly basis over the time period of December 1995 to July 2011. This paper extends the analysis to March 2012. Examining these data on a monthly basis allows more accurate identification of changes in trends and can also more clearly indicate the effects of recession and employment on changes in coverage. Trends in offer rates and reasons for being uninsured among uninsured workers are also examined. Between December 2007 and August 2009, the percentage of workers with coverage in their own names fell from 60.4 percent to 55.9 percent. After August 2009, there appeared to be the beginning of a recovery in the percentage of workers with employment-based coverage, and by December 2009, 56.6 percent of workers had employment-based coverage. However, by October 2011, the coverage had slipped back to 54.7 percent. Most uninsured workers reported that they did not have coverage because of cost: 70-90 percent over the December 1995-March 2012 period. The percentage of uninsured workers reporting that they were not offered employment-based health benefits was roughly 40 percent from the mid-1990s through 2003, but has been falling since, reaching 22.4 percent by the end of 2011. The PDF for the above title, published in the July 2013 issue of EBRI Notes, also contains the fulltext of another July 2013 EBRI Notes article abstracted on SSRN: “Decisions, Decisions: Choices That Affect Retirement Income Adequacy -- EBRI's 72nd Policy Forum”

Download or read book Employment Based Health Benefits written by Paul Fronstin and published by . This book was released on 2003 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This Issue Brief discusses recent trends in and the future of employment-based health insurance benefits. The paper explores recent trends in the percentage of the population with and without health benefits, the make-up of the benefits package, and retiree health benefits. The paper finds that despite rising health insurance costs, employers increasingly have been offering health benefits to workers, and the percentage covered by employment-based health benefits has been increasing. Also, while health insurance cost inflation has been increasing, the proportion of the premium paid by employees has not been increasing, and the benefits package has been improving. Retiree health benefits, however, have seen changes in which retirees are asked to pay a greater share of the cost of coverage. The paper also examines the drivers of these trends, such as health benefit cost increases and labor market conditions and discusses the outlook for health benefits, in light of the slowing economy, the enduring problem of uninsurance, impending public policy changes, and the emergence of defined contribution health benefits. The document has 2 tables and 23 charts.

Download or read book Employment Based Health Benefits and Taxation written by Paul Fronstin and published by . This book was released on 2011 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This paper examines the implications of changing the tax treatment of employment-based health coverage. It discusses the current tax treatment of health coverage and various proposals to change the tax treatment of health coverage. The implications of changing the tax treatment are also discussed in the context of health reform. The tax preference associated with employment-based health coverage is the largest tax expenditure in the U.S. budget, accounting for $1.1 trillion in foregone tax revenue during 2012-2016. In contrast, retirement plans account for about $700 billion in foregone tax revenue and the mortgage interest deduction accounts for about $600 billion. This makes the tax treatment of health coverage an almost inescapable target. President Obama's bipartisan National Commission on Fiscal Responsibility and Reform proposed changes that would achieve $4 trillion in deficit reduction by 2020 and reduce the debt to 30 percent of GDP by 2040. As part of the proposal, the commission would reduce the preferential tax treatment of employment-based health benefits as it applies to workers, first by capping, then freezing, phasing down, and ultimately eliminating them. The Commission does not recommend any changes to the employer deduction as a business expense. The Affordable Care Act changes the playing field in that workers will no longer need to rely on their employer to obtain health coverage. Workers will benefit from a number of insurance market reforms, such as guaranteed issue, modified community rating, subsidies, and increased choice of health plan. If the favorable tax treatment of workers' health benefits is eliminated, they would face an increase in taxes and some would question the value of keeping the coverage. Lowest-income workers would find the new health exchanges more advantageous than employment-based health benefits, while high-income workers likely would not. For example: For single coverage among policyholders regardless of age at 150 percent of the federal poverty level (FPL) in 2014 would save an average of about $800 by moving from employment-based coverage to a health insurance exchange; workers at 200 percent of FPL would come out about even between employment-based coverage and the insurance exchange; and those above 250 percent of FPL would have to pay more for coverage in the exchange than employment-based coverage if their employer did not give them any portion of the employer share of the premium. The number of workers who might prefer an insurance exchange over employment-based coverage depends upon not only the relative premium in each option and income levels, but the number of workers by income. About 41 percent of workers are in families with income between 133 percent and 400 percent of the federal poverty level, accounting for 65 million workers. Even if only a fraction of these workers preferred an insurance exchange over employment-based coverage, it would send a clear message to employers that millions of workers no longer valued the benefit. If employers found that workers no longer valued the coverage, they might stop offering health coverage. Predicting how this might play out by firm size, industry, worker earnings, geographic region, among other things, is highly uncertain.