By NextBestFitJob lock: people stay in jobs to keep insurance
About 178.6 million people get coverage through work. Leaving a job, starting a business, retiring early, or cutting hours can mean losing insurance.
Evidence
- 178.6M people in employer-sponsored insurance (2024).Sources: CMS Office of the Actuary (2025)
Who's affected
- People whose job, income, or home changes: Would-be founders, early retirees, and caregivers stay in jobs to keep insurance.
- Employers: Benefits help employers keep workers who would otherwise leave.
- Health insurers, brokers, and their shareholders: Insurers and brokers sell group coverage through employers.
Under your mix of paths
- The WWII-era tax exclusion for employer premiums
- No portable coverage outside employment
Related costs
Open questions
- Should employers have any role in providing health coverage?
Solution paths (2)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
Replace employer-sponsored insurance with public or individually chosen coverage so leaving a job never ends coverage.
- +Job lock: people stay in jobs to keep insurance
- −Transition disruption: jobs, companies, and familiar coverage
- −Limits choice or applies one rule to every setting
Employers contribute to an individual plan the worker owns (an ICHRA-style account), so coverage moves with the person.
- +Job lock: people stay in jobs to keep insurance
- −Concentrates costly patients in some plans
- −Solves only part of the problem
Also addressed by paths for other problems
Coverage no longer depends on having or keeping a job.
Mandatory plans accepting all applicants provide coverage beyond reliance on a particular employer.
A public plan available to anyone offers coverage outside employer insurance.