ABSTRACT
This chapter provides a brief overview of declining employment-based coverage, and examines changes that have occurred as a result of the passage of the affordable care act (ACA) under the Barack Obama administration, and reform efforts to overturn the ACA by the Donald Trump administration. The decline of employment-based insurance has had a dramatic effect on insurance coverage in the US Workers who did not receive employment-based insurance and did not purchase it on their own cited cost as the primary reason for lack of insurance. A central factor in the enactment of the ACA was the need to address declining coverage; the ACA was designed to impact employment-based health insurance plans. The ACA employs multiple strategies to expand coverage in the private sector, including incentives, mandates, penalties for noncompliance, and required changes in benefits.
