As the administration and Congress continue to move toward comprehensive health reform, the role and future of the current employer-based insurance system is a crucial point of discussion. Employers, both large and small, as well as their workers are dissatisfied with the current employer-based health insurance system and are generally supportive of the concept of reform. As with every aspect of reform, however, the devil is in the details. The ability to address employer concerns and maintain their cooperation will be a major factor in the health reform debate. Employers identify four critical challenges that can be met through health care reform: (1) Obtaining greater value through the use of health information technology; (2) Creating more affordable insurance options for individuals through a more competitive private market and replacing the current state-by-state market with multi-state markets; (3) Engaging Americans to take an active role in the health care through an individual mandate as well as encouragement to participate in prevention, wellness and chronic care programs; and (4) Offering assistance to the uninsured and low-income workers to enable them to meet the obligation to be insured and financing this support through savings gleaned from a more efficient health care system. Although a lack of data about how firms and their workers are likely to respond to specific reforms precludes simple predictions of the degree to which reform will impact employers and their employees, impact is nonetheless likely in a number of areas, particularly those related to monitoring and enforcement of individual or employer mandates, premium subsidies, delivery system reform and care coordination, and performance-based measurement and payment systems.
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