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Tracking Small-Firm Coverage, 1989-1996

January/February 1998
Health Affairs, vol.17, no.1 (January/February 1998): 167-171
Paul B. Ginsburg, Jon R. Gabel, Kelly A. Hunt

espite the fact that small employers are somewhat more willing to offer health insurance - up from 46 percent in 1989 to 49 percent in 1996 - employees in firms with fewer than 200 workers are increasingly unlikely to accept health insurance. The most important factor behind declining employee enrollment may be the sharp increase in the size of contributions required from workers. Related factors include declining real earnings for less skilled workers and the possibility that for those with the lowest expected use of medical care, purchasing medical care through employer-based insurance may be more expensive than paying for it directly. The combination of more small firms offering insurance and fewer enrolled employees in those firms results in a net decline in the proportion of workers who have employer-provided health insurance.

Free access to this article is available at the Health Affairs Web site.


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