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date: 18 October 2019

Abstract and Keywords

This article examines the complexities of employer-sponsored health insurance in the United States, along with its history and future prospects. It begins with an overview of the economic and legal factors that account for employers’ dominant position in the private health insurance market. It then considers a number of public policy problems that arise when insurance premiums are sheltered from income tax, such as the bias toward “first-dollar” coverage, which in turn causes higher medical spending. Finally, the article discusses future prospects for employment-based coverage, with emphasis on the provisions of the Patient Protection and Affordable Care Act (ACA) and its mandated benefits, but also considering insurance exchanges and defined contributions, health reimbursement and savings accounts, preemption and self-insurance under the Employee Retirement Income Security Act (ERISA), and managed care liability.

Keywords: health insurance, insurance premiums, employment-based coverage, Patient Protection and Affordable Care Act, insurance exchanges, defined contributions, health savings accounts, self-insurance, managed care liability

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