Shocking Truth About Health Insurance in the US: What You Need to Know Now about coverage, eligibility and staff participation?

Employers are the primary source of health insurance in the United States, providing health care coverage to nearly 153 million nonelderly people. Most workers are offered health insurance at work, and most workers who are offered coverage accept it. Workers may not get health insurance from their employer for several reasons: their employer may not offer coverage, they may not be eligible for benefits offered by their company, they may choose coverage from another source (such as through their spouse's employer), or they may simply refuse to be offered coverage by their company. In 2023, 59% of workers at companies offering health benefits will be insured by their company, which is the same as last year, five years ago, and ten years ago.

FREEDOM TO RECEIVE

Even in companies that offer health benefits, some workers may not be eligible for the program. For example, many companies do not offer coverage to part-time or temporary workers. Among workers at firms offering health benefits in 2023, 79% are eligible to participate in the benefits offered by their firm, which is similar to last year, five years ago, and ten years ago for large firms. For small firms, the percentage willing to participate in benefits offered by their firm (82%) differs from last year (79%), but is similar to the percentages of five and ten years ago. [ Figures 3.1 and 3.2 ].

• Eligibility varies considerably by firm wage level. Workers in firms with a relatively large share of low-wage workers (where at least 35% of workers earn $31,000 per year or less) have lower average eligibility rates than workers in firms with a smaller share of low-wage workers (65% vs. 81%) [ Figure 3.6 ].
• Workers in firms with a relatively large share of highly compensated workers (where at least 35% earn $72,000 per year or more) have a higher average compliance rate than workers in firms with a smaller share of highly compensated workers (86% vs. 74%) [ Figure 3.6 ].
• The level of coverage also depends on the age of the labor force. Firms with a relatively small share of younger workers (where less than 35% of workers are 26 years old or younger) have higher average compliance rates than firms with a larger share of younger workers (81% vs. 66%). Firms with a relatively large share of older workers (where more than 35% of workers are age 50 or older) have a higher average compliance rate than firms with a smaller share of older workers (85% vs. 74%) [ Figure 3.6 ].
• Compliance rates vary considerably for workers in different industries. The average rate is particularly low for retail trade workers (54%) [ Figure 3.3 ].

UTILIZATION RATE

• Seventy-five percent of eligible workers accept insurance when offered it, which is consistent with last year [ Figure 3.7 ].
  • The average rate of insurance acceptance by workers in small firms is lower than that of workers in large firms (71% vs. 76%) [ Figure 3.8 ].
  • The likelihood that a worker will accept a firm's offer of insurance coverage depends on the firm's wage level. Firms with a relatively large share of low-wage workers have a lower average rate of insurance acceptance than firms with a smaller share of low-wage workers (66% vs. 76%) [ Figure 3.7 ].
  • Firms with a relatively large share of high-wage workers have a higher average acceptance rate than firms with a smaller share of high-wage workers (78% vs. 72%) [ Figure 3.7 ].
  • The likelihood that a worker will accept a firm's offer of coverage also depends on the age distribution of the labor force. Firms with a relatively high proportion of young workers have a lower average offer acceptance rate than firms with a lower proportion of young workers (69% vs. 75%) [ Figure 3.7 ].
  • Workers in private for-profit firms have lower (73%) and higher (87%) average program participation rates than workers in other types of firms [ Figure 3.7 ].
  • Eligible workers in firms with some union workers have a higher average participation rate (82%) than eligible workers in firms without union workers (71%) [ Figure 3.7 ].
• The average percentage of workers eligible for benefits across firms also varies by industry, with the lowest rates of benefit receipt among retail and service workers [ Figure 3.3 ].
• The share of eligible workers in offering firms (75%) is similar to the share in 2018 (76%) but lower than the share in 2013 (80%) [ Figure 3.1 ].

COVRAGE

• In 2023, the percentage of employees at companies offering health benefits covered by their company's health plan will be 59%, the same as last year [ Figure 3.1 ] and [ Figure 3.2 ].

  Coverage rates at firms offering health benefits in 2023 are similar for small and large firms. These figures are similar to those of last year for both small and large firms [ Figure 3.1 ] and [ Figure 3.3 ].

• The level of coverage of employees in companies offering health benefits varies considerably by industry. The average coverage rate is particularly low in retail (36%) [ Figure 3.3 ].
• The level of coverage also depends on the wage level in the firm. Among workers in firms that offer health benefits, workers in firms with a relatively large share of low-wage workers are less likely to be covered by health insurance than those in firms with a smaller share of low-wage workers (42% vs. 61%). The pattern is similar for firms with a relatively large share of high-wage workers: workers in these firms are more likely to be covered by their employer's health benefits than those in firms with a smaller share of high-wage workers (67% vs. 53%) [ Figure 3.9 ].
• The age distribution of workers is also associated with differences in coverage rates. Among workers in firms offering health benefits, those in firms with a relatively small share of younger workers are more likely to be covered by their firm than those in firms with a larger share of younger workers (61% vs. 46%). Similarly, workers in firms offering health care with a relatively large share of older workers are more likely to be covered by their firm than workers in firms with a smaller share of older workers (65% vs. 55%) [ Figure 3.9 ].
• Workers in firms offering health benefits are more likely to be covered by health insurance than workers in non-unionized firms [ Figure 3.9 ].
• Among workers in firms that offer health benefits, workers in firms that offer health benefits are more likely to have health care services covered by their own firm than workers in other types of firms [ Figure 3.9 ].
• Among workers at all firms, including those that do and do not offer health benefits, 53% are covered by health benefits offered by their employer, which is similar to last year (54%), five years ago (53%), and ten years ago (56%) [ Figure 3.10 ].