Employers in both the private and public sectors are the dominant source of health
insurance for nonelderly individuals in the Untied States, providing coverage for nearly
two-thirds of this under-age-65 population in 1998. But for more than a decade the
proportion of nonelderly Americans without health insurance has been steadily creeping up.
Today, some 44 million people in the United States—18.4 percent of those under 65—do not
have insurance coverage to pay for their health care.
It is widely recognized that people without health insurance still receive health care.
The uninsured are not staying out of the health care system; rather, they are receiving
higher-cost medical care (through emergency room visits), and they are forcing others to
pay for their health care.
Increasingly, the uninsured are being viewed as a challenge to and criticism of the
employment-based health care system in this country—not just because the ranks of the
uninsured are growing but also because roughly 85 percent of the 44 million uninsured
Americans are in a family with a working adult. As a result, many critics see the
employment-based health insurance system as a failure, and are calling for it to be
replaced with an individual-based system or universal-coverage government mandate.
Should employers be concerned about the uninsured population? Are there adverse
consequences to driving employers out of the health care delivery system? Is there a link
between health insurance and the health of the population, productivity, and economic
output? What are the private and public sectors doing to increase access to health
Policymakers, leading thinkers on benefits, employers, and labor representatives
examined these questions during the May 3, 2000, policy forum on "The Economic Costs
of the Uninsured," sponsored by Employee Benefit Research Institute Education and
Research Fund (EBRI-ERF). The papers contained in this book, based on the policy forum's
proceedings, explore those questions, and illustrate some innovative private- and
The Economic Cost of the Uninsured: Implications for Business and Government
provides an in-depth look at current thinking on the uninsured and how new thinking is
forcing a new look at the business and social costs resulting from the growing ranks of