Most Americans with health insurance have coverage through employer health plans. The increase in managed care (including HMOs, PPOs, and POS plans) has been dramatic, rising from 27% in 1988 to 93% in 2001. PPOs’ dominance has continued to increase, reaching 48% of covered workers in 2001. HMO enrollment decreased to 23% in 2001, its lowest point since 1993. Conventional fee-for-service enrollment has declined from 73% of total enrollment in 1988 to 7% in 2001.
While nearly all (99%) of large employers offered health benefits in 2001, only about two-thirds (65%) of small firms did so. Even among these small firms – all those under 200 workers – the larger the firm, the more likely it offered coverage in 2001. The share of small firms offering coverage decreased somewhat from 2000 to 2001 but overall has increased from 59% to 65% since 1996. The proportion of large firms providing health benefits has remained close to 100% over this period.