Health benefits in 2005: premium increases slow down, coverage continues to erode.

This paper reports findings on the state of job-based health insurance in spring 2005 and how it has changed during recent years. Premiums rose 9.2 percent, the first year of single-digit increases since 2000. The percentage of firms offering health benefits has fallen from 69 percent in 2000 to 60 percent in 2005. Cost sharing did not grow appreciably in the past year. Enrollment in preferred provider organizations (PPOs) grew from 55 percent in 2004 to 61 percent in 2005, while enrollment in health maintenance organizations (HMOs) fell from 25 percent to 21 percent of the total.

What high-deductible plans look like: findings from a national survey of employers, 2005.

This paper documents the availability, enrollment, premiums, and cost sharing for high-deductible health plans that are offered with a health reimbursement arrangement (HRA) or are health savings account (HSA)-qualified plans. Almost 4 percent of employers that offer health benefits offer one of these arrangements in 2005, covering about 2.4 million workers. Deductibles, as expected, are relatively high, averaging dollar 1,870 for single coverage and dollar 3,686 for family coverage in high-deductible health plans with an HRA and dollar 1,901 for single coverage and dollar 4,070 for family coverage in HSA-qualified high-deductible health plans. One in three employers offering a high-deductible health plan that is HSA-qualified do not contribute to HSAs established by their workers.

Self-insurance in times of growing and retreating managed care.

This paper examines trends in self-insurance and in the content of self-insured plans from 1993 to 2001. The percentage of employees enrolled in self-insured plans fell during these years. Much of the decrease was attributable to the decline of indemnity insurance and the rise of HMO and point-of-service plan enrollment. If the product mix had remained constant throughout these years, self-insured enrollment would have grown between 1993 and 1996 and then declined to its current 50 percent level. As a result of the Health Insurance Portability and Accountability Act (HIPAA), the use of preexisting condition clauses declined dramatically in self-insured plans. Self-insured and purchased plans cost similar amounts and provide similar benefits. Cost sharing is somewhat lower in self-insured PPO plans. During periods of rapid inflation, premiums increase more slowly for self-insured than for fully insured plans.

Job-based health benefits in 2002: some important trends.

Based on a national survey of 2,014 randomly selected public and private firms with three or more workers, this paper reports changes in employer-based health insurance from spring 2001 to spring 2002. The cost of health insurance rose 12.7 percent, the highest rate of growth since 1990. Employee contributions for health insurance rose in 2002, from $30 to $38 for single coverage and from $150 to $174 for family coverage. Deductibles and copayments rose also, and employers adopted formularies and three-tier cost-sharing formulas to control prescription drug expenses. PPO and HMO enrollment rose, while the percentage of small employers offering health benefits fell. Because increasing claims expenses rather than the underwriting cycle are the major driver of rising premiums, double-digit growth appears likely to continue.

Health benefits in 2003: premiums reach thirteen-year high as employers adopt new forms of cost sharing.

This paper reports changes in job-based health insurance from spring 2002 to spring 2003. The cost of health insurance rose 13.9 percent, the highest rate of increase since 1990. Employers required larger contributions from employees for the monthly cost of health insurance. Separate copayments and deductibles for hospital services have become commonplace, and provider networks have broadened. There was no change in the percentage of employers offering health plans to their workers. Employers indicate little confidence in any future strategies for controlling health care costs.

Design of mental health benefits: still unequal after all these years.

This paper examines recent trends in the design and organization of coverage for mental health care using data from a Henry J. Kaiser Family Foundation and Health Research and Educational Trust (KFF/HRET) national employer survey. Legislation and changes in the delivery of mental health services have altered how mental health insurance is bought and sold. However, our findings reveal that mental health coverage is still typically not offered at a level equivalent to coverage for other medical conditions. We attempt to synthesize these data with prior research as a foundation for informed debates.

Health benefits in 2004: four years of double-digit premium increases take their toll on coverage.

This paper reports changes in employer-based insurance during the past year and since 2001. From spring 2003 to spring 2004, premiums increased 11.2 percent (compared with 13.9 percent last year). Since 2000, premiums have increased 59 percent. Since 2001, employee contributions have grown by 57 percent for single coverage and 49 percent for family coverage, and the percentage of workers covered by their own employer's health plan has fallen from 65 percent in 2001 to 61 percent in 2004. The worst of the current round of premium inflation appears to be over, but employers plan to increase employee cost sharing next year [corrected]

Employer-sponsored health insurance in New York: findings from the 2003 Commonwealth Fund/HRET survey.

A 2003 Commonwealth Fund/Health Research and Educational Trust survey of 576 New York State firms found that, in order to manage rising health costs, employers are increasing the share of the insurance premium that employees pay, delaying the start of benefits, and increasing cost-sharing at the point of service. This has enabled employers to preserve health benefits, but has raised costs for workers and their families. On average, workers' contributions for family coverage rose 54 percent, from $1,392 per year in 2001 to $2,148 per year in 2003. During that time period, fewer workers selected family coverage. Employers are receptive to a wide range of approaches to make coverage more available and affordable for their employees, but they have limited familiarity with public programs that could cover their lower-wage workers, such as Healthy New York, Family Health Plus, or Child Health Plus.

Hydroxypropyl methylcellulose substituent analysis and rheological properties.

The methyl and hydroxypropyl substituents in hydroxypropyl methylcellulose (HPMC) affect the resulting gel properties. These substituents in five HPMC gels were characterized using Fourier transform infrared spectroscopy (FT-IR), Raman spectroscopy, small-amplitude oscillatory shear measurements, and differential scanning calorimetry (DSC). In FT-IR spectra, the most intense peak appeared at 1053 cm(-1), denoting the presence of the glucose ring. The ratio of peak intensities at 1452 cm(-1), which represents -C-H absorptions, and at 1053 cm(-1) (I1452/I1053) and percent methylation from gas chromatography exhibited a linear association (r(2)=0.6296). The broadening of the Raman spectra indicated that the relative crystallinity of HPMC decreases with increasing hydroxypropyl contents. DSC showed no linear relationship between the percent hydroxypropylation in HPMC and the percentage of free water in an HPMC gel. Small-amplitude oscillatory shear measurements revealed that the formation of an entanglements networks and/or weak gel depends on substituent contents.

Comparison of FTIR spectra between Huanglongbing (citrus greening) and other citrus maladies.

Fourier transform infrared (FTIR) spectroscopy has the ability to quickly identify the presence of specific carbohydrates in plant materials. The presence of the disease huanglongbing (HLB) in the leaves of infected citrus plants has a distinctive spectrum that can be used to distinguish an infected plant from a healthy plant. However, many citrus diseases display similar visible symptoms and are of concern to citrus growers. In this study several citrus diseases (citrus leaf rugose virus, citrus tristeza virus, citrus psorosis virus, and Xanthomonas axonopodis ) and nutrient deficiencies (iron, copper, zinc, manganese, and magnesium) were compared with HLB using FTIR spectroscopy to determine if the spectra alone can be used to identify plants that are infected with HLB instead of another disease. The results indicate that the spectra of some diseases and deficiencies more closely resemble those of apparently healthy plants and some share the carbohydrate transformation that has been seen in the spectra of HLB-infected plants.

Detection of citrus Huanglongbing by Fourier transform infrared-attenuated total reflection spectroscopy.

Citrus Huanglongbing (HLB, also known as citrus greening disease) was discovered in Florida in 2005 and is spreading rapidly amongst the citrus growing regions of the state. Detection via visual symptoms of the disease is not a long-term viable option. New techniques are being developed to test for the disease in its earlier presymptomatic stages. Fourier transform infrared-attenuated total reflection (FT-IR-ATR) spectroscopy is a candidate for rapid, inexpensive, early detection of the disease. The mid-infrared region of the spectrum reveals dramatic changes that take place in the infected leaves when compared to healthy non-infected leaves. The carbohydrates that give rise to peaks in the 900-1180 cm(-1) range are reliable in distinguishing leaves from infected plants versus non-infected plants. A model based on chemometrics was developed using the spectra from 179 plants of known disease status. This model then correctly predicted the status of >95% of the plants tested.

Health benefits in 2008: premiums moderately higher, while enrollment in consumer-directed plans rises in small firms.

Our annual Employer Health Benefits Survey contains findings from interviews with 1,927 public and private employers surveyed during the first five months of 2008. Average annual premiums in 2008 are $4,704 for single coverage and $12,680 for family coverage. These amounts are about 5 percent higher than premiums were last year. Enrollment in high-deductible health plans with a savings option increased to 8 percent of covered workers, up from 5 percent in 2007. Deductibles in preferred provider organizations, the plan type with the largest enrollment, increased from 2007 levels. This paper also provides new insights into firms' offering wellness programs and retiree health benefits.

Health benefits in 2007: premium increases fall to an eight-year low, while offer rates and enrollment remain stable.

This paper reports findings from a survey of 1,997 public and private employers with three or more workers, conducted during the first five months of 2007. Premiums increased 6.1 percent from spring 2006 to spring 2007--the lowest rate of increase since 1999. Enrollment in different types of health plans did not change significantly, and high-deductible health plans with a savings option did not experience major growth in enrollment. Despite the comparatively modest increase in premiums during a period of strong economic growth, the percentage of workers obtaining coverage from their employer remained statistically unchanged.

Generosity and adjusted premiums in job-based insurance: Hawaii is up, Wyoming is down.

This paper reports national and state findings on the generosity or actuarial value of U.S. employer-based plans and adjusted premiums in 2002. The basis for our calculations is simulated bill paying for a large standardized population. After adjusting for the quality of benefits, we find from regression analysis that adjusted premiums are 18 percent higher in the nation's smallest firms than in firms with 1,000 or more workers. They are 25 percent higher in indemnity plans and 18 percent higher in preferred provider organizations than in health maintenance organizations. The generosity of coverage increased from 1997 to 2002.

Health benefits in 2006: premium increases moderate, enrollment in consumer-directed health plans remains modest.

Based on a survey of 2,122 randomly selected public and private employers, this paper reports on the state of employer-sponsored health insurance in spring 2006, including recent changes. Premiums increased 7.7 percent from spring 2005 to spring 2006 and have risen 68 percent since 2001. About 4 percent of workers are enrolled in high-deductible health plans with savings options. The percentage of workers covered by their own employer did not statistically change from 2005 to 2006.