(Bloomberg View) — The next big shift is coming in U.S. health care, and Republicans are doing their best to speed it up. What's not clear is how carefully they've thought through the consequences.
A defining feature of U.S. health care policy is that most Americans get insurance through their employers. That has frustrated liberals' attempts to rally voters behind the modest reforms of the Patient Protection and Affordable Care Act (PPACA) – Obamacare — let alone the single-payer model that works so well in most developed countries. Average people have no incentive to support changes that might jeopardize their situation.
But judging by the trend of the past few years, Americans with job-based coverage could soon become a minority.
See also: Employers applaud employer mandate bill.
Look at the percentage of Americans younger than 65 with health insurance provided by their employer. (Almost everyone 65 and older is covered by Medicare.) There has been a gradual but steady decline, from 59.2 percent in 2009 to 57.1 percent in 2013.
The shift away from employer-based insurance has been pronounced for most age groups. Among those 55 to 64, for example, the share with employer-based coverage fell almost four percentage points from 2009 to 2013. There's one exception: young adults, who benefited from an Obamacare provision that forces insurers to keep children on their parents' plan until age 26.
Other parts of Obamacare will accelerate the trend. The Congressional Budget Office estimates that in 2018, 8 million fewer people will have employer-based coverage than would have without the law. If 8 million fewer people 64 or younger had been covered by their employer in 2013, the share of non-elderly Americans with job-based health insurance would have been 54.1 percent.
