Private Insurance

Most Americans who have health coverage are enrolled in private health plans. The majority get this coverage through their employer, but some have to buy coverage on their own in the individual market.

Unfortunately, there are serious (and growing) problems with private insurance. Prices are spiraling upwards, leading employers to raise the share paid by workers, cut back on benefits, or drop coverage altogether. Those who don't have coverage through their jobs often find that buying insurance in the individual market is expensive, and many have trouble finding anyone willing to sell them a policy at all. As people lose coverage at work and find that they cannot afford to buy a policy on their own, more and more Americans become uninsured.

This section of our Web site keeps you up-to-date on what's happening in the private health insurance arena. "The Facts" helps you follow the latest trends in the private market, "Bad Ideas" shows you why some proposals move us in the wrong direction, and "Good Ideas" highlights positive approaches.

The Latest

From Families USA:

Your Medical Bills: A Consumer's Guide to Coping with Medical Debt covers steps for paying your medical bills, understanding your rights, and other information you need to know if you are struggling with medical debt. The guide also includes links to many useful online resources. | Fact Sheet | State Protections (November 2009)

Senate Amendment on Wellness Program Surcharges Jeopardizes Access to Affordable Coverage and Care describes the concerns with an amendment under consideration in the Senate health reform bill that would allow employers and insurers to charge heath insurance enrollees larger surcharges for failing to meet "wellness" plan goals than are currently allowed. (October 2009)

Help for Small Businesses discusses how small businesses face a disadvantage when it comes to providing health insurance and how health reform will help remedy this situation. | Comparing the Small Business Tax Credit Provisions in the House, Senate HELP Committee, and Senate Finance Committee Bills (October 2009)

Health Coverage in the States: How Will Health Reform Help? analyzes how the House health reform bill, America's Affordable Health Choices Act of 2009, would address many of the gaps and problems in the health care systems of specific states. (September-October 2009)

The Essential Benefits Package in the House Health Reform Bill (H.R. 3200) examines the proposed benefits package for the plans in the exchange, discusses the benefits committee and its responsibilities, and outlines issues that advocates should monitor as health reform moves forward. (September 2009)

Bridging the Gap: How Health Reform Will Help 55-to 64-Year-Olds discusses how the health reform legislation currently before Congress will make insurance more available and affordable for 55- to 64-year-olds and provide coverage stability for this age group. (September 2009)

From the Center for American Progress:

Insurers’ Black Box: Now-Secret Claims Denial Rates Could Tell Consumers a Lot about Their Insurance Company discusses the dramatic variation in denial rates among insurance companies in California—the only state that requires such data to be made public. The denial rates suggest insurers may be putting profits ahead of patients’ best interests. The brief argues that health reform proposals must require insurers to release their denial rates to help educate consumers. (October 2009)

From the Commonwealth Fund:

Aiming Higher: Results from a State Scorecard on Health System Performance, 2009 finds rising health care costs are making coverage less affordable across the country. The report projects that these costs are also likely to widen gaps in access based on income, insurance status, or race/ethnicity. These nationwide problems underscore the need for comprehensive national reform to expand and improve the quality of coverage. (October 2009)

Out of Options: Why So Many Workers in Small Businesses Lack Affordable Health Insurance, and How Health Care Reform Can Help examines why small businesses often have more difficulty offering their employees health insurance, as well as how the economic downturn has intensified the problem. The brief also outlines how measures in the health reform proposals, such as the creation of an exchange and tax credits for small businesses, could help small businesses and their employees gain access to affordable, comprehensive coverage. (September 2009)

From Health Affairs

Massachusetts Health Reform: Employer Coverage from Employees’ Perspective reveals that concerns about employers dropping coverage or scaling back benefits under Massachusetts’s 2006 health reform law have not been realized. In fact, the quality of and access to job-based coverage has actually increased. Now lawmakers are working to make premiums and out-of-pocket costs more affordable for smaller firms. (October 2009) Subscription Required

From Health and Human Services (HHS)

Insurance at Risk: Small Business Employees Risk Losing Coverage discusses how small businesses and their employees will significantly benefit from health reform. Many small businesses currently struggle to provide the health coverage they and their employees need. (October 2009)

From the Kaiser Commission on Medicaid and the Uninsured:

Changes in Health Insurance Coverage, 2007-2008: Early Impact of the Recession indicates that the sharp decrease in coverage over this time period (1.5 million newly uninsured adults) was largely due to declines in job-based insurance. Coverage through public programs has bridged some of this gap, but increases in coverage for children were substantially larger than for adults. (October 2009)

From the Kaiser Family Foundation:

Americans’ Satisfaction with Insurance Coverage provides deeper insight into the tracking polls that have found that Americans positively rate their own health insurance. The data reveal that significant portions of those who rate their insurance positively say they still face problems paying their medical bills or are dissatisfied with certain aspects of their coverage, which casts some doubt on the accuracy of this type of poll. (September 2009)

In Pursuit of Affordable Health Care: On the Ground Lessons from Families in Massachusetts details how the state’s health reform legislation has achieved near-universal coverage (94.7 percent) by combining a foundation of public coverage with greater access to private insurance through employers. While some budgetary challenges remain, the program has been largely successful, including a marked increase in job-based coverage. (September 2009)

Individuals with Special Needs and Health Reform: Adequacy of Health Insurance Coverage examines the health care needs and medical expenses of three individuals who require extensive acute and long-term care to discover how reform proposals can best serve those with special health needs. It concludes that a comprehensive benefits package, limits on out-of-pocket expenses, subsidies, and strong Medicaid programs are essential to ensuring that people with special needs are fully supported under health reform. (September 2009)

From the Kaiser Family Foundation and Health Research and Educational Trust:

Employer Health Benefits 2009 Annual Survey provides a detailed look at trends in job-based health coverage, including changes in premiums, employee contributions, and cost-sharing. The survey also includes new questions about onsite health clinics, whether employers offer financial incentives to employees for completing health risk assessments, and the impact of the economic downturn. (September 2009)

From the Robert Wood Johnson Foundation:

Assuring Health Coverage for Rural People through Health Reform compares health insurance trends of rural and urban residents. Rural workers tend to have less job-based coverage and pay more than urban workers for similar plans. Several provisions in the current health reform proposals, such as providing subsidies to purchase insurance and expanding Medicaid, would significantly benefit rural consumers. (October 2009)

Health Reform in Massachusetts: An Update on Insurance Coverage and Support for Reform as of Fall 2008 provides an update of the impact on working-age adults, the primary target of reform policies, as well as an update on public support for health reform. The state has achieved its goal of near universal health coverage, and residents continue to show strong support for health reform, despite the rising costs of the program. (September 2009)

The Cost of Failure to Enact Health Reform examines the repercussions of not passing health reform in three scenarios—worst, intermediate, and best case—each based on different projected growth rates in income and health care costs. This state-by-state analysis shows that without reform, the percent of uninsured individuals will increase, job-based coverage will continue to deteriorate, spending on public programs will expand, and out-of-pocket costs could increase by more than 35 percent. (September 2009)

From the Urban Institute:

Variation in Insurance Coverage across Congressional Districts: New Estimates from 2008 reveals which districts face the greatest deficiencies in private coverage and where public coverage has been able to close some of these gaps. Rates of private coverage are lowest in districts that have higher poverty rates, and despite above-average rates of public coverage in these areas, lack of insurance continues to be a serious problem. (October 2009)

[Return to top]