Employment-based health benefits are the most common form of health insurance in the United States. In 2010, 58.7 percent of non-elderly individuals were covered by employment-based health plans, with 68.6 percent of working adults covered. However, the percentage of the population with employment-based health benefits has recently been in decline due to the 2007-2009 recession. The percentage of individuals under age 65 with employment-based health benefits fell from 62.4 percent in 2008 to 58.7 percent in 2010, and the percentage of workers with coverage through their own employers fell from 54.2 percent in 2007 to 51.5 percent in 2010, its lowest level since 1994. The Employee Benefit Research Institute (EBRI) recently published an Issue Brief to examine the state of employment-based health benefits among workers with respect to offer rates, coverage rates, and take-up rates. It also examines how the state of employment-based health benefits has changed since the mid-1990s, reasons why workers do not have employment-based health benefits from their own employers, and how these reasons have changed since the 1990s. The estimates presented in this paper can also serve as a baseline against which to measure the impact of the Affordable Care Act of 2010 (ACA) on employment-based health benefits in the future.

A paper recently released by the Center for Economic and Policy Research and Georgetown University uses data from the Current Population Surveys for 1980 through 2011 to review trends in health-insurance coverage rates for low-wage workers (defined as workers in the bottom fifth of the wage distribution in each survey year). In 2010, over 38 percent of low-wage workers lacked health insurance from any source, up from 16 percent in 1979. The biggest reason for the decline in coverage is the erosion of employer-provided health insurance, either through a worker's own employer or as a dependent on another family member's employer-provided policy. Over the last three decades, the role of public insurance in providing coverage for low-wage workers has increased, though not nearly enough to offset the declines in private insurance. In 2010, about 10 percent of low-wage workers had coverage through Medicaid, double the share in 1979. While a great deal of uncertainty still surrounds the Affordable Care Act (ACA) and its likely impact on employers and workers, reasonable estimates based on consensus projections suggest that the ACA will have a substantial positive effect on health-insurance coverage rates for low-wage workers. Even so, the ACA will likely leave an important share of low-wage workers, especially low-wage Latino, African American, and Asian workers, as well as many immigrant workers, without coverage. At the same time, if the ACA is blocked – in the courts or in Congress – there is every indication that coverage rates for low-wage workers will continue their long, steady decline.

In a new issue brief entitled "The Income Divide in Health Care: How the Affordable Care Act Will Help Restore Fairness to the U.S. Health System," The Commonwealth Fund Health Insurance Tracking Survey of U.S. adults finds nearly three of five adults in families earning less than 133 percent of the federal poverty level were uninsured for a time in 2011. Two of five were uninsured for one or more years. Low- and moderate-income adults who were uninsured during the year were much less likely to have a regular source of health care than people in the same income range who were insured all year. In addition, uninsured lower-income adults were more likely than insured adults in the same income group to cite factors other than medical emergencies as reasons for going to the emergency room. These included needing a prescription drug, not having a regular doctor, or saying that other places cost too much. The report suggests that the Affordable Care Act (ACA) will substantially narrow these inequities through a set of affordable coverage options.

Families USA's paper, "The Basic Health Option: Will It Work for Low-Income Consumers in Your State?" reviews the concept of the Basic Health Program (BHP), discusses some potential program pitfalls, and raises key issues that can influence the direction that a BHP might take in states with varying financial and political constraints. Some key challenges highlighted in the paper of the BHP include the provision of seamless coverage and provider payment rates.

A new study released by the National Bureau of Economic Research (NBER) compares care seeking behavior and health outcomes of individuals covered by insurance with those who are uniunsured, and found better self-reported physical and mental health among those with insurance. The study, "The Oregon Health Insurance Experiment: Evidence from the First Year," offered Oregon Medicaid on a randomly-assigned, lottery basis to an experimental group of uninsured individuals, while the control group received no coverage. Lower out of pocket medical costs were also noted among the group receiving coverage.