The Employer Public Possibility: A Instrument for Bettering Affordability by way of Various Well being Protection

  

Introduction and abstract

As the most important supply of protection, employer-sponsored insurance coverage (ESI) has lengthy been the spine of america’ medical insurance system.¹ By leveraging preferential tax remedy, bigger danger swimming pools, and administrative efficiencies, employers traditionally have been capable of present complete protection to their workers at a relatively decrease value than related choices within the nongroup market.² Nevertheless, rising well being care costs are eroding the worth of ESI, leaving employers and workers to bear the brunt of rising prices.

Medical inflation usually outpaces inflation of different services.³ These larger costs increase insurance coverage prices, in the end rising ESI premiums and deductibles.⁴ Because the early 2000s, premiums have recurrently grown sooner than inflation.⁵ Accordingly, in 2023, the typical annual ESI premium was $8,435 for single protection and $23,968 for household protection.⁶ Households with incomes under 200 % of the federal poverty stage spend a considerably higher share of their incomes on well being premiums and out-of-pocket bills than do higher-income households with ESI.⁷

Accordingly, in 2023, the typical annual ESI premium was $8,435 for single protection and $23,968 for household protection.
KFF, "Employer Well being Advantages: 2023 Annual Survey" (2023).

Employer efforts to brace in opposition to rising insurance coverage expenditures are presenting important affordability and entry challenges for employees. Ways reminiscent of shifting prices to workers by way of larger deductibles, copayments, and out-of-pocket limits or incentivizing high-deductible well being plans (HDHPs) contributed to just about one-third of working adults being thought-about underinsured (missing entry to reasonably priced well being care, whether or not attributable to excessive out-of-pocket prices or deductibles) in 2022.⁸ In 2023, amongst adults with ESI, 43 % reported problem affording well being care prices and 29 % reported forgoing well being care or pharmaceuticals attributable to value.⁹ And there seems to be no finish in sight: A 2023 KFF survey discovered that 23 % of employers intend to additional improve employees’ contributions within the subsequent two years.¹⁰

Lowering prices and enhancing ESI affordability is a precedence for the enterprise neighborhood.

Lowering prices and enhancing ESI affordability is a precedence for the enterprise neighborhood: A 2021 KFF and Purchasers Enterprise Group on Well being survey discovered that 87 % of enterprise leaders believed the price of worker well being advantages “will change into unsustainable within the subsequent 5 to 10 years.”¹¹ Employers are looking for coverage intervention: The identical survey discovered that 85 % of enterprise leaders “imagine that there'll must be higher authorities roles in offering protection and containing prices.”¹² In response, policymakers are exploring a wide range of legislative and regulatory choices. On the federal stage, coverage choices into consideration embody rising transparency, addressing consolidation, enhancing entry to complete plans, and reforming the prescription drug market.¹³

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An answer to enhance ESI affordability that coverage researchers, together with on the Middle for American Progress, have beforehand proposed and that's deserving of additional exploration is an employer public possibility: a government-sponsored medical insurance plan that employers might select to supply to their workers as a substitute for current non-public medical insurance choices.¹⁴ This report first offers an outline of public possibility reform typically, highlighting three distinct fashions—basic, buy-in, and public-private partnership—and their value discount and containment mechanisms, contemplating how these reforms could apply to the ESI market. The report concludes with coverage ideas and design suggestions for implementation of an efficient employer public possibility, together with employer eligibility, employer and worker alternative, advantages and ranges of protection, price setting, community adequacy, and financing.

Public possibility frameworks

Whereas the time period “public possibility” has been utilized in varied contexts and included in a wide range of coverage proposals at each the state and federal ranges, for the aim of this report, public possibility refers to a government-regulated well being plan that goals to enhance protection and produce down prices by way of improved competitors.¹⁵

Normal traits of public possibility plans embody:

• Enrollment accessible to all.
• Competitors alongside current individual-market non-public plans.
• Authorities-set reimbursement charges.
• Revenue-based monetary help accessible to those that want it.¹⁶

There are a selection of public possibility fashions that may be tailor-made to fulfill particular affordability targets and goals if tailored for employers. Frequent public possibility fashions embody: basic government-sponsored and -administered medical insurance, buy-ins to public packages, and a government-contracted public-private partnership.

‘Traditional’ public possibility

The basic employer public possibility could be an entirely government-backed plan that straight competed with non-public medical insurance plans.¹⁷ The federal government would set up, administer, and handle the employer public possibility, controlling eligibility, advantages, value sharing, premium setting, and supplier fee charges.¹⁸ The federal government would additionally bear the monetary danger of the employer public possibility. The federal government might finance this system by way of enrollee premiums and price sharing, state or federal revenues, or a mixture of every.¹⁹

Many proposals of this sort (whether or not associated to employers or typically) are reform packages that embody a public possibility plus different modifications to affordability and eligibility with the objective of attaining common protection. Medicare Additional, a 2018 CAP proposal for a basic public possibility, was designed to attain common well being protection in america by way of institution of a public possibility managed by the federal authorities.²⁰ The nationwide Medicare Additional program “could be accessible to all Individuals, no matter earnings, well being standing, age, or insurance coverage standing.”²¹ Supplier charges in this system could be capped at a proportion of Medicare charges, and monetary help could be extra beneficiant than the unique Reasonably priced Care Act (ACA) subsidy ranges.

Purchase-in

A buy-in employer public possibility mannequin would permit employers to purchase into an current public plan or program reminiscent of Medicare, Medicaid, a state worker well being plan, or a plan that mirrors these current plans. Prices could be lowered by leveraging the present buying energy and administrative methods to barter extra favorable charges with suppliers and insurers.²²

Below a buy-in mannequin on the state stage, employers might have the flexibility to purchase into the state’s worker well being plan or the state’s Medicaid plan. On the federal stage, employers would wish to purchase into Medicare. A 2021 buy-in proposal by students Allison Hoffman, Howell Jackson, and Amy Monahan recommends providing massive employers—these with 70 % of their workforce enrolled in ESI—the choice of providing a Medicare-based plan to their workers.²³ Reimbursement charges could be set by the federal government initially at a proportion of Medicare, and to make sure enrollees had entry to a broad supplier community, participation within the public possibility could be tied to Medicare participation.²⁴

Below a buy-in proposal such because the CAP-proposed Medicare Additional, the place an employer would need to sponsor participation in a plan, particular person employers “would have the choice to sponsor Medicare Additional and workers would have the choice to decide on Medicare Additional over their employer protection.” In response to CAP’s 2018 report, “Medicare Additional would strengthen, streamline, and combine Medicaid protection with assured high quality right into a nationwide program.”²⁵

Public-private partnership

Below a public-private partnership employer public possibility mannequin, the federal government would contract with or require a personal entity, reminiscent of a well being insurer, to manage a public possibility on its behalf. The federal government would set necessities and affordability parts together with premiums and supplier fee charges, and the non-public accomplice would bear the monetary danger for protection.²⁶

A public-private partnership mannequin public possibility accessible within the employer group market would profit employers by enhancing plan alternative and competitors whereas doubtlessly producing value reductions attributable to premiums and reimbursement charges being set by the state or federal authorities.

Public possibility in motion: Federal progress and state particular person market experiences

Latest legislative proposals for a normal federal public possibility embody the Medicare for America Act of 2019, the Shopper Well being Choices and Insurance coverage Competitors Enhancement (CHOICE) Act, the Public Possibility Deficit Discount Act, the Medicare-X Alternative Act of 2021, and the Select Medicare Act of 2021²⁷. Usually, federal public possibility proposals have stalled, largely attributable to important trade opposition.²⁸ Nevertheless, state policymakers throughout the nation are in varied levels of exploration and implementation of public possibility reform to assist their state ACA marketplaces obtain affordability targets. A number of states—together with Maine, New Jersey, Minnesota, and Maryland—have launched laws or carried out research on public possibility plans.²⁹ So far, Washington, Nevada, and Colorado have all adopted market public option-style packages, with Washington’s and Colorado’s plans opening for enrollment in 2021 and 2023, respectively.³⁰ Though these public possibility reforms are solely accessible within the particular person market, they nonetheless can function a blueprint for future public possibility reform for the employer market, providing insights and classes discovered.

Purchase-in public possibility

So far, no state has carried out a buy-in public possibility for its particular person market. New Mexico has explored adopting a Medicaid buy-in for a number of years,³¹ contemplating a focused Medicaid buy-in program operated by a managed care group at Medicaid supplier reimbursement charges that will be provided outdoors the person market. A feasibility evaluation and analysis urged that this system might cut back particular person market premiums by 15 % to twenty-eight %, with a projected whole enrollment of seven,000 to 16,000 folks.³² A number of states provide a buy-in program for the Youngsters’s Well being Insurance coverage Program (CHIP), allowing households whose earnings exceeds eligibility thresholds to purchase public protection for his or her kids.³³

Traditional public possibility

So far, a basic public possibility has not been carried out on the state or federal ranges. There have, nevertheless, been a number of proposals to ascertain a basic public possibility. For instance, the Medicare for America Act of 2019 sought to exchange current well being packages, together with the marketplaces, Medicare, and Medicaid/CHIP, with a federal public program accessible to all U.S. residents.³⁴

Public-private partnership public possibility

Washington’s, Colorado’s, and Nevada’s market public option-style plans are just like this mannequin, with the state authorities contracting with non-public carriers to supply state-backed and controlled plans within the particular person market.³⁵ The experiences in Washington and Colorado have demonstrated some progress in enhancing affordability: In each states, 2024 price will increase for public possibility plans are decrease than will increase for nonpublic possibility plans.³⁶

How public possibility reform may benefit employers

An employer public possibility might assist decrease insurance coverage prices and enhance affordability by regulating reimbursement charges and enhancing competitors.

Regulating supplier reimbursement charges

Central to employer public possibility value containment is the federal government’s capacity to find out reimbursement charges for suppliers, together with docs and hospitals.³⁷ Via authorities price setting, a public possibility can lower supplier fee charges.³⁸ Supplier charges are a big driver of premium price will increase—regulating them might enhance the affordability of employer-sponsored insurance coverage by decreasing premiums and decreasing employer premium contributions and price sharing.³⁹

Bettering competitors

Implementation of an employer public possibility would introduce further competitors into the market. Elevated competitors amongst insurers, notably in much less aggressive markets, could end in lowered prices for all clients.⁴⁰ An employer public possibility might immediate non-public plans contracting with employers to decrease their premiums, increase high quality, or cut back value sharing to compete with the general public possibility.⁴¹

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Design issues for a public possibility different to ESI

Whether or not pursued by way of a basic, buy-in, or public-private partnership mannequin, when designing an employer public possibility that's able to successfully decreasing costs and enhancing ESI affordability, policymakers ought to rigorously take into account the design parts. These particulars shall be important in figuring out whether or not some companies will be persuaded to forgo their present non-public protection in favor of a public different, which shall be important to long-term viability of an employer public possibility. Lengthy-term public possibility viability is necessary for guaranteeing the continued presence of a public competitor to non-public protection that may maintain exerting downward stress on insurance coverage premiums and well being care prices throughout the employer market. The design issues explored under have differing implications for self-insured versus totally insured employers. The suggestions that comply with provide a framework for employer eligibility, employer and worker alternative, advantages and ranges of protection, price setting, and community adequacy. Among the parts have been tailored from CAP’s Medicare Additional for All proposal, and others have been impressed by implementation expertise from state-level market public possibility reforms.

Whether or not pursued by way of a basic, buy-in, or public-private partnership mannequin, when designing an employer public possibility that's able to successfully decreasing costs and enhancing ESI affordability, policymakers ought to rigorously take into account the design parts.

Employer participation must be voluntary

Participation in an employer public possibility must be voluntary. Regardless of current affordability challenges, 6 in 10 employees with ESI reported being “extraordinarily or very glad with well being advantages” in 2021.⁴² Voluntary participation would additional preempt further criticism that the reform is a authorities overreach or pointless disruptor of market forces, a cost that has been levied in opposition to well being reform proposals such because the ACA and that has contributed to the derailment of earlier well being reform efforts.⁴³

All employers must be eligible to take part

No matter mannequin sort, an employer public possibility must be accessible to employers in each the small and huge group markets, in addition to to employers that self-insure. The ESI market has seen important premium will increase over the previous decade which have affected corporations of all sizes.⁴⁴ Whereas there are arguments to be made in favor of incentivizing massive employers to enroll early in a public possibility’s implementation as a proof of idea and to rapidly set up a big danger pool, that section of the market shouldn't be policymakers’ unique focus.⁴⁵ Smaller companies are at the moment the least more likely to provide insurance coverage protection to their workers, most frequently citing value as a barrier; small companies would have the ability to leverage a extra reasonably priced public choice to develop their advantages packages, thereby boosting their recruitment and retention potential.⁴⁶

Employers ought to retain the choice to self-insure or totally insure

An employer public possibility ought to preserve the present ESI framework that enables employers to decide on their plan funding. At present, employers have two choices when contracting with non-public insurers: 1) to completely insure their danger pool, buying a plan the place an insurance coverage firm takes on the chance of insuring enrollees; or 2) to self-insure, which ends up in the employer bearing the chance and contracting with the service for administrative providers solely.⁴⁷ An employer’s plan funding resolution is influenced by a wide range of elements, together with agency dimension, worker composition, and danger tolerance.⁴⁸ Sustaining the flexibleness for employers to make these buying determinations inside an relevant public possibility mannequin (basic or public-private partnership) is necessary to rising the attractiveness of this system amongst employers. With an employer public possibility, the federal government would bear the chance for totally insured employers. For self-insured employers, the general public possibility would perform as a third-party administrator.

The employer public possibility must be the employer’s unique supply of medical insurance

Whereas all employers ought to have the ability to select whether or not to take part within the public possibility, people who do decide to take part ought to make it the unique insurance coverage profit provided to maximise value financial savings. If an employer chooses to supply the general public possibility as its medical insurance profit, the employer shouldn't be permitted to supply complete non-public plan alternate options.⁴⁹ If employers had been permitted to supply each the employer public possibility and personal plans, they could attempt to enhance the chance pool for the non-public plan and decrease their prices by partaking in antagonistic choice—encouraging older or sicker workers to enroll within the employer public possibility. This will particularly be the case for self-insured employers, who assume the protection danger for his or her employees.⁵⁰ Whereas exclusivity limits an employer’s capacity to supply workers a variety of plan choices, the excessive worth and lowered value of the employer public possibility ought to make it a sexy alternative. To alleviate considerations concerning the lack of aggressive benefit, employers must be permitted to supply supplemental plans that embody further advantages and act as secondary, complementary protection to the employer public possibility.⁵¹

The employer public possibility ought to embody a number of tiers of plan generosity to protect employer and worker alternative

In 2023, 53 % of employees had been provided well being advantages of various plan designs and actuarial values by their employer.⁵² In step with this pattern, an employer public possibility ought to current employers with protection choices at totally different tiers of actuarial worth. This may tackle considerations that the exclusivity requirement would end in employers holding full energy to make medical insurance choices for his or her workers. Staff would have the ability to evaluate their well being care wants, examine the tier choices, and make the perfect choice for themselves and their households. In distinction to cases when workers should examine plans with totally different value constructions and protection charges, offering a number of tiers underneath the general public possibility would permit workers to make less complicated calculations of dangers and bills.

In a public-private partnership or basic public possibility mannequin, plans ought to mirror the ACA’s tiering system of metallic ranges.⁵³ To keep up consistency with the present common actuarial worth of ESI protection (83.5 % in 2019), the bottom plan an employer chooses to supply must be akin to a market gold plan.⁵⁴ For added flexibility, employers ought to develop their providing to incorporate bronze, silver, or platinum plans, with the plans protecting 60 %, 70 %, and 90 % of prices for lined advantages, respectively. To enhance affordability and provide additional cost-sharing reduction for employees, the general public possibility must be designed to incorporate employer subsidies for silver plans, just like silver loading within the market.⁵⁵

The employer public possibility ought to provide complete advantages on par with non-public protection

Below the ACA, insurance coverage are typically required to cowl 10 classes of important well being advantages.⁵⁶ An employer public possibility would cowl these providers at least normal to make the plan corresponding to accessible non-public plans. Along with the baseline protection classes mandated by the ACA, the general public possibility might embody medical machine, dental, imaginative and prescient, and listening to providers. Within the absence of protection for these further providers, employers must be permitted to supply supplemental plans akin to people who some employers at the moment provide, reminiscent of standalone dental and imaginative and prescient protection.

The employer public possibility ought to have government-set charges

For max effectiveness, the federal government ought to set employer public possibility costs administratively relatively than by way of negotiations. Charges must be pegged to Medicare, making use of a multiplier of the Medicare Elements A and B price schedule.⁵⁷ Some earlier congressional proposals for a public possibility based mostly on Medicare charges, together with the Retaining Well being Insurance coverage Reasonably priced Act of 2019, additionally tied reimbursement to the Medicare Elements A and B price schedule and granted the secretary of well being and human providers the discretion to extend funds for varied suppliers and care settings, carrying ahead current fee changes for important entry hospitals, sole neighborhood hospitals, and rural emergency hospitals, in addition to geographic changes for doctor funds.⁵⁸

In response to City Institute estimates, a public possibility accessible within the nongroup and employer markets with supplier charges set at Medicare charges, plus 10 % for professionals and 25 % for hospitals, might cut back premiums by 12 % to twenty-eight % for taking part employers.⁵⁹ This discovering is supported by a Brookings Establishment evaluation exhibiting {that a} public possibility with charges set nearer to Medicare charges would produce a higher downward power on costs within the non-public insurance coverage market.⁶⁰

In the end, the quantity of market disruption attributable to introducing an employer public possibility could be decided by the general public possibility’s reimbursement charges. As such, constructing in flexibility for presidency officers to regulate fee charges as much as a specified multiplier of Medicare charges could be important to clean implementation.⁶¹ The secretary of well being and human providers would use their discretion to advance the targets of stability, affordability, downward market stress on negotiations for personal plans, and stability within the supplier market.⁶²

The employer public possibility ought to have an satisfactory supplier community

An satisfactory supplier community is important for an employer public possibility plan as a result of it ensures entry to care. And not using a enough community, the plan’s capacity to supply reasonably priced, high-quality well being care to a broad inhabitants is compromised. Public possibility design should take into account community necessities or incentives to facilitate the event of satisfactory supplier networks.

If an employer public possibility had been carried out on the federal stage, probably the most logical course could be to tie participation in Medicare to participation within the public possibility. Conventional Medicare’s community would supply a robust basis nationwide for the general public possibility: 89 % of nonpediatric physicians accepted Medicare sufferers in 2019.⁶³ For suppliers that usually don't contract with Medicare, reminiscent of psychological well being practitioners, or which are briefly provide, the employer public possibility ought to go away room to barter larger fee charges.⁶⁴

State experiences: Supplier participation in individual-market public possibility reform

On the state stage, policymakers have instruments to enhance supplier participation in a public possibility community. After experiencing points with hospitals refusing to affix public possibility networks, Washington state started requiring that sure hospitals contract with a minimum of one public possibility plan.⁶⁵

State lawmakers might take into account concentrating on higher participation by sure varieties of amenities, hospitals, or doctor specialties by passing laws to revoke tax-exempt standing for nonparticipating entities. In most states, when an entity qualifies for tax-exempt standing underneath 501(c)(3) of the Inner Income Code, the entity can be granted tax-exempt standing by the state by which it operates.⁶⁶ As a result of nonprofit amenities are meant to serve their communities, states might take into account creating a further requirement that well being care entities take part within the public possibility to be able to be granted tax-exempt standing. Florida and New Mexico have taken related approaches by tying state tax exemption for nonprofit hospitals to participation in Medicaid; New Mexico takes this additional by additionally requiring participation in Medicare and “county indigent care packages.”⁶⁷

Another choice is to tie participation within the state’s worker well being plan to participation within the public possibility. In Nevada, for instance, all suppliers that take part in Medicaid or the state worker plan or that present care to injured employees receiving employees compensation should be a part of a minimum of one public possibility community.⁶⁸

Financing an employer public possibility

By sustaining funding by way of employer-employee contributions and danger spreading, an employer public possibility might cut back the necessity to increase income from different sources. Along with the associated fee containment energy of value setting described above, an employer public possibility plan administered by the federal government would have the ability to provide protection for an actuarially honest premium. In contrast to with the non-public insurance coverage trade, a basic or buy-in public possibility plan wouldn't have a revenue incentive and premiums could be based mostly on anticipated value of claims plus value of administration.

The employer public possibility ought to seize present contributions from employers by way of maintenance-of-effort and minimal contribution necessities

When an employer gives medical insurance to its workers, the premium for that plan is usually divided between the employer and the worker. On common, employers contribute about 80 % for particular person protection and practically 70 % for household protection.⁶⁹

Just like partaking with non-public insurers to buy protection for his or her employees, employers ought to leverage the employer public possibility with the expectation of contributing to the premium prices of their workers. In line with CAP’s Medicare Additional for All proposal, an employer public possibility plan ought to, at a minimal, require a upkeep of effort by employers, with a baseline premium sharing association of 70/30 for every enrollee.⁷⁰ Employers that at the moment contribute a better proportion towards premiums ought to nonetheless have the option and inspired to take action as a part of their compensation packages. For instance, employers looking for to place collectively a aggressive advantages package deal could select to fund premiums at 80 % for his or her base plan, thereby rising the contribution to different plan choices as nicely. Whereas this may increasingly seem to be a disincentive for employers who at the moment pay a smaller proportion of premiums to enroll within the public possibility, their elevated proportion of premium contributions must be offset by decrease total public possibility premiums achieved by price setting.

Further advantages of an employer public possibility

Along with offering entry to different, extra reasonably priced protection for employees, an employer public possibility can construct on the protection positive factors of the Reasonably priced Care Act and enhance well being fairness—specifically, if an employer public possibility had been to exist alongside a public possibility within the nongroup market.

An employer public possibility presents a chance to construct on the ACA’s success in advancing affordability within the particular person market. The ACA’s Small Enterprise Well being Choices Program (SHOP) was established to permit small companies (these with as much as 100 workers) to entry reasonably priced protection for his or her workers, together with subsidizing protection for companies with fewer than 26 workers.⁷¹ Nevertheless, utilization and enrollment has been low attributable to delays within the rollout of key options in addition to the low worth and complexity of the small-business tax credit score.⁷² The employer public possibility would substitute SHOP. A companion particular person public possibility, operating alongside the employer public possibility, would assist cut back reliance on costly COBRA protection and permit people a smoother transition into the parallel market plan within the occasion of job loss. If a public possibility existed in each the employer and particular person markets, it might assist cut back gaps in protection and allow employees to keep up their sources of care and lined remedies.

An employer public possibility might additionally advance well being fairness by enhancing affordability and entry to complete protection.

An employer public possibility might additionally advance well being fairness by enhancing affordability and entry to complete protection. Decrease-income employees are much less more likely to enroll in ESI protection attributable to value, reporting premiums as an affordability barrier.⁷³ By regulating supplier fee charges, a public possibility plan can move on financial savings to lower-income employees by way of decrease premiums, deductibles, and different types of value sharing.⁷⁴ As well as, the excellent plan design of an employer public possibility can higher meet the well being wants of a various workforce. The rise in high-deductible well being plan enrollment amongst employees—from 20 % in 2013 to 29 % in 2023⁷⁵—could also be additional compromising entry to care, notably for folks of coloration, by shifting prices onto workers. HDHPs’ value containment impacts have been attributed to a discount in well being care utilization, together with preventive care.⁷⁶ A 2017 JAMA research discovered an affiliation between HDHPs and cost-related limitations to most cancers care, with Black sufferers being extra considerably affected.⁷⁷ A latest McKinsey survey discovered that greater than 30 % of Black, Hispanic and Latino, and LGTBQ+ workers, in addition to workers underneath age 40, had thought-about switching employers for higher well being advantages in 2021.⁷⁸ A thoughtfully designed public possibility could make nice strides towards well being fairness and reasonably priced protection for all employees.

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Conclusion

The continuous progress of well being care prices over latest many years has elevated the associated fee and compromised the affordability of employer-sponsored insurance coverage. Earlier reforms reminiscent of important well being advantages and medical loss ratio necessities have helped enhance the worth of employer protection; nevertheless, further coverage intervention is required to deal with prices additional.⁷⁹ There are lots of alternatives for federal coverage motion to deal with rising well being care costs that may assist alleviate a few of that stress.⁸⁰ One strategy deserving of further consideration is to design and implement an employer public possibility. There are a selection of how to strategy employer public possibility reform, particularly by way of a buy-in that leverages an current authorities program; a basic public possibility that establishes a brand new authorities plan to compete with non-public protection choices; or a public-private partnership that splits plan design and administration between the federal government and a personal entity. Whatever the chosen mannequin, policymakers contemplating an employer public possibility should replicate on a wide range of elements—together with employer eligibility, employer and worker alternative, advantages and ranges of protection, price setting, and community adequacy—to make sure continued entry to high-quality and reasonably priced employer-sponsored insurance coverage.

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