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New postings and analysis from Health Affairs, the leading journal of health policy. Health Affairs publishes new research each week online at For more information, contact Chris Fleming at 301-347-3944.

November-December Health Affairs Asks: "Will Employer Coverage Endure?"

A study led by Yale professor Patricia Seliger Keenan warns of the "graying" of group health insurance. Keenan and Harvard coauthors David Cutler and Michael Chernew find that the population with employer-based coverage is becoming older and wealthier at a rate greater than the population overall. The authors report that older, more affluent people in working families are more likely to keep their employer-based coverage as premiums rise, while others increasingly get public coverage or go without altogether. These trends, they warn, make it harder for health insurers to pool risks, since fewer younger people with lower health care costs are included in the pool.

Keenan's article is one of many in the November-December issue of Health Affairs, released November 14 and supported by the California HealthCare Foundation, that address questions related to employer-sponsored health coverage.

Print editions of Health Affairs may be ordered for $35 each from Health Affairs' Customer Service at 301-347-3900 or online at

Americans Value Choice, Expanded Coverage, But Don't Want To Pay

A new national survey gauging Americans' attitudes toward the financing and provision of health insurance shows that consumers want more coverage and choice but don't want to pay higher insurance costs, and that the uninsured are more likely to reject policies that mandate the purchase of health insurance. In work supported by the California HealthCare Foundation, researchers from NORC at the University of Chicago report that almost nine in ten Americans say health insurance premiums should not vary by health status, but more than one in four Americans are comfortable with charging obese people higher premiums.

On The Health Affairs Blog: Mark Smith Deconstructs "Insurance"

New on the blog: California HealthCare Foundation President Mark Smith, MD, provides a thought-provoking discussion of the meaning of "insurance." He notes: "When you ask people why they want health insurance, they will give you one of four answers. ... (1) What if I'm hit by a bus?; (2) I need to be covered for my preventive services; (3) I can't afford to go to the doctor, or to get my medicine; and (4) I've got a chronic disease, for which I can't afford to pay over time. ... Those are the reasons why people want health insurance. Please note: Only the first of those is "insurance," in the sense in which anyone would understand that term - that is to say, protection of financial assets against the rare, unpredictable, catastrophic event."


Health Affairs, published by Project HOPE, is the leading journal of health policy. The nonpartisan, peer-reviewed journal appears bimonthly in print, with additional online-only papers published weekly as Health Affairs Web Exclusives at The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. The abstracts of all articles are free. The Nov/Dec 2006 issue was supported by the California HealthCare Foundation. Web Exclusives are supported in part by a grant from the Commonwealth Fund.


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