<P> Workers who receive employer - sponsored health insurance tend to be paid less in cash wages than they would be without the benefit, because of the cost of insurance premiums to the employer and the value of the benefit to the worker . The value to workers is generally greater than the wage reduction because of economies of scale, a reduction in adverse selection pressures on the insurance pool (premiums are lower when all employees participate rather than just the sickest), and reduced income taxes . Disadvantages to workers include disruptions related to changing jobs, the regressive tax effect (high - income workers benefit far more from the tax exemption for premiums than low - income workers), and increased spending on healthcare . </P> <P> Costs for employer - paid health insurance are rising rapidly: between 2001 and 2007, premiums for family coverage have increased 78%, while wages have risen 19% and inflation has risen 17%, according to a 2007 study by the Kaiser Family Foundation . Employer costs have risen noticeably per hour worked, and vary significantly . In particular, average employer costs for health benefits vary by firm size and occupation . The cost per hour of health benefits is generally higher for workers in higher - wage occupations, but represent a smaller percentage of payroll . The percentage of total compensation devoted to health benefits has been rising since the 1960s . Average premiums, including both the employer and employee portions, were $4,704 for single coverage and $12,680 for family coverage in 2008 . </P> <P> However, in a 2007 analysis, the Employee Benefit Research Institute concluded that the availability of employment - based health benefits for active workers in the US is stable . The "take - up rate," or percentage of eligible workers participating in employer - sponsored plans, has fallen somewhat, but not sharply . EBRI interviewed employers for the study, and found that others might follow if a major employer discontinued health benefits . Effective by January 1, 2014, the Patient Protection and Affordable Care Act will impose a $2000 per employee tax penalty on employers with over 50 employees who do not offer health insurance to their full - time workers . (In 2008, over 95% of employers with at least 50 employees offered health insurance .) On the other hand, public policy changes could also result in a reduction in employer support for employment - based health benefits . </P> <P> Although much more likely to offer retiree health benefits than small firms, the percentage of large firms offering these benefits fell from 66% in 1988 to 34% in 2002 . </P>

Do all business have to offer health insurance