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The Health and Wealth of a Nation

Employer-Based Health insurance and the Affordable Care Act

Nan L. Maxwell

Publication Year: 2012

In this timely new book, Nan L. Maxwell examines the behavior of firms with respect to their provision of health care prior to ACA deliberations and uses those behaviors to forecast changes in employer-sponsored health insurance (ESI) once the ACA is fully implemented. Her analysis focuses on potential changes in the ESI offer due to implementation of the ACA concerning access and quality.

Published by: W.E. Upjohn Institute

Title page

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Copyright page

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pp. v-viii

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pp. ix-xi

The Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, provided the first major health care reform in 45 years. The so-called Affordable Care Act (ACA) was enacted to provide high-quality, affordable health care for all Americans. Once all of its provisions become effective, circa 2014, the goal is to ensure that all U.S. ...

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1 - Health Care Coverage in the United States

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pp. 1-34

One of the major social policy issues of the first decade of the twenty-first century was access to quality health care. Only 4 percent of the population in 2009 said the health care system worked well and did not need to be changed, whereas 14 percent said the system needed a complete overhaul (Blakely 2010). Consider that about 41 percent of Americans in 2006 were very worried about having to pay ...

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2 - Employer-Sponsored Health Insurance

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pp. 35-56

Many of the problems in health care access and coverage can, arguably, be traced to the century-old marriage between health care access and employment—an arrangement that is uniquely American.1 At the turn of the twentieth century, a time that was prior to this marriage, the problems in health care were quite different from the ones that were present 100 years later, at the turn of the twenty-first century. ...

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3 - Benchmarking Change: Employer-Sponsored Insurance before the ACA

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pp. 57-75

The ACA was designed to increase the percentage of individuals with access to health care, to increase the quality of health care, and to control health care costs, as Chapter 1 discussed. Achieving these goals would reduce the discrepancies in coverage that existed in the prereform period. To help achieve its goals, the ACA kept ESI as the ...

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4 - How Large Firms Might Respond to the ACA

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pp. 77-101

The ACA has the potential to increase a firm’s expenditures on ESI, as the popular press was quick to point out with respect to premium increases (e.g., Adamy 2010). Analyses presented in Chapter 3 suggest that costs will increase for at least the 55.4 percent of large firms that do not meet the legislation’s requirements for covering workers and so must either expand their coverage to meet these requirements or ...

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5 - How Small Firms Might Respons to the ACA

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pp. 103-125

Small firms are less likely than large firms to offer ESI, to make a lower-quality offer, and to pay increased premiums for a given level of coverage. In 2009, only about 34 percent of firms with fewer than 10 employees offered ESI, compared to 99 percent of firms with 10,000 or more workers (McMorrow, Blumberg, and Buettgens 2011). ...

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6 - Health Policy and Firm Behavior

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pp. 127-145

The lack of universal access to high-quality, affordable health care that had periodically commanded center stage in public policy discussions over the past three decades culminated in the passage of the Patient Protection and Affordable Care Act (ACA), as amended by the Health Care and Education Reconciliation Act of 2010. Discussions and debate about health care reform may have even intensified after its ...

Appendix A: The California Health and Employment Surveys

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pp. 147-155

Appendix B: Factor Analysis

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pp. 157-169

Appendix C: Defining Empirical Constructs

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pp. 171-175


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pp. 177-191

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pp. 193

Nan L. Maxwell is a senior researcher in the Oakland, California, office of Mathematica Policy Research. She was formerly a professor and chair of the Department of Economics and the executive director of the Human Investment Research and Education (HIRE) Center at California State University, East Bay. Her research expertise focuses on the areas of improving employment and educational opportunities for disadvantaged workers ...


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pp. 195-201

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About the Institute

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pp. 203

The W.E. Upjohn Institute for Employment Research is a nonprofit research organization devoted to finding and promoting solutions to employment-related problems at the national, state, and local levels. It is an activity of the W.E. Upjohn Unemployment Trustee Corporation, which was established in 1932 to administer a fund set aside by Dr. W.E. Upjohn, founder of The Upjohn ...

E-ISBN-13: 9780880994262
E-ISBN-10: 0880994266
Print-ISBN-13: 9780880994231
Print-ISBN-10: 0880994231

Page Count: 203
Publication Year: 2012

Edition: First