Employer-Sponsored Health and Retirement Benefits: Efforts to Control Employer Costs and the Implications for Workers
Released: 2007-04-30T00:00:00

Letter

Background

Many U.S. workers participate in employer-sponsored health benefit and retirement pension programs and the costs of these benefits in recent years have risen faster than wages. The designs of these benefit programs have changed over the course of the past several decades, and these changes have often been made in response to growing costs associated with providing the benefits. Millions of workers are not in traditional full- time, year-round work arrangements and some may legally be excluded from benefit plans that are offered to full-time workers. Employers are not required to offer health and retirement benefits to any workers, although when they are offered, federal laws provide some protections to workers related to their provision.

The U.S. System of Employer-Sponsored Health and Retirement Benefits

The U.S. system of employer-sponsored health and retirement benefits is financed by employers, individual worker contributions, and state and federal governments through foregone tax revenue. The degree to which individuals rely on employer-sponsored health care and retirement benefits depends on several factors, including age, income, employment status, and access. In addition to wages and other benefits, employers often provide workers with health and retirement benefits as a part of their total compensation. Employer-sponsored health benefits provide coverage to over 155 million individuals through coverage of active workers and their dependents. Employers may also provide health benefits to Medicare-eligible retirees and individuals who retire prior to their eligibility for Medicare (typically referred to as early retirees) and their dependents. Approximately 12 million retirees on Medicare and 3 million early retirees are covered under employer-sponsored health benefits.4, 5 About half of all private-sector workers participate in an employer-sponsored retirement plan according to the Bureau of Labor Statistics (BLS) National Compensation Surveys. The overall rate of worker participation in employer-sponsored retirement pension plans has not changed significantly in the last few decades.

Health and retirement benefits help employers attract and retain skilled workers; however, the costs of these benefits have accounted for an increasingly larger share of workers’ total compensation. During most of the period from 1991 until 2002, wages and benefits increased by about the same percentage, after which time real wages began to stagnate and real benefit costs continued to grow through 2005. Figure 1 shows the real growth in hourly expenses attributable to wages and benefits between 1991 and 2005.

Kaiser/Hewitt Surveys on Retiree Health Benefits, 2003-2005.

Employer-sponsored coverage for early retirees often mirrors coverage for current workers. Retiree coverage for Medicare-eligible retirees supplements benefits covered under Medicare and provides additional cost-sharing protections, such as limiting retiree out-of-pocket expenses, which traditional Medicare fee-for-service does not provide.

Evolution of Employer- Sponsored Health Benefits

The costs of health care and health-related benefits have been increasing for decades. Several factors help explain the rise in costs, including increasing demand for services, advances in expensive medical technology, and an aging population. The Kaiser Family Foundation and Health Research and Educational Trust (Kaiser/HRET) Annual Employer Health Benefits Surveys found that from 2001 to 2006 annual premium costs for single and family coverage rose by about 60 and 63 percent, respectively, and in each of those years premiums grew more than twice the rate of wages.

To contain rising health care costs, employers have made several changes to health benefits. For several decades, traditional fee-for-service plans were the predominant form of private health benefits sponsored by employers. These plans essentially reimbursed any providers for services covered by a plan based on providers’ actual costs with little or no incentives to control utilization. In the late 1980s employers increasingly looked to managed care plans, such as health maintenance organizations (HMO) and preferred provider organizations (PPO), as a way to contain these rising costs. HMOs and PPOs generally rely on providers to control service utilization and they provide financial incentives to encourage patients to use network providers who have agreed to accept fee discounts. Under an HMO, patients may be restricted to using only network providers, and they typically require that all specialty care be coordinated through a primary care physician. While enrollment in HMOs increased, some enrollees became resistant to the restrictions imposed by the plans and employers increasingly offered PPOs that offered more provider choice and flexibility. PPO enrollees face lower cost-sharing requirements when they receive care from network providers, but may choose non-network providers at a higher cost and do not typically need referrals to see a specialist. Despite these cost-control mechanisms, health care costs continued to rise.

While managed care relies primarily on health care providers to control rising costs, more recently employers have also looked to workers to assume greater responsibility for controlling these costs, such as by offering consumer-directed health plans (CDHP). CDHPs combine a high- deductible health plan with a tax-advantaged account that enrollees can use to pay for a portion of their health care expenses. Unused balances may accrue for future use, potentially giving employees an incentive to purchase health care more prudently. The higher deductibles generally result in lower health insurance premiums because the enrollee bears a greater share of the initial cost of care. Although not required to do so, CDHP insurance carriers typically provide enrollees with decision-support tools, such as Web-based information on costs of services and quality of providers, to help them become more actively involved in making health care purchasing decisions.

While not a new concept, employers often offer voluntary health and wellness programs in combination with CDHPs. These programs are intended to encourage enrollees to engage in healthy behaviors to help prevent certain chronic diseases and improve overall health. These benefits often include disease management programs in which individuals with certain high-risk conditions have access to a case manager to help them manage their disease; access to health advice lines; behavior modification programs such as smoking cessation; and health risk assessment programs to assess enrollees’ potential for health problems and suggest ways for participants to reduce their risk of disease. Health risk assessment programs can also provide employers with information about the overall health profile of their worker population that can be used to design targeted disease management and behavior modification programs.

While most employer-sponsored health benefit plans provide comprehensive coverage, employers may also offer health benefits through mini-medical plans. A mini-medical plan provides basic medical coverage combined with lower premium costs and a lower coverage cap than a comprehensive or major medical plan. Annual coverage limits typically include restrictions on the number of services covered, a low maximum dollar cap on spending, or both. For example, a mini-medical plan might cover no more than five doctor visits or no more than $200 per year for physician services. While these plans may include coverage for a wide range of hospital or specialty services, annual and lifetime coverage caps for mini-medical plans are far below those of comprehensive health insurance plans. For example, a mini-medical plan’s coverage cap might be set at $25,000 annually with a lifetime cap of $50,000, while many comprehensive health plans have no coverage caps or have lifetime caps in excess of $1,000,000.

Types of Employer- Provided Retirement Benefits

Employer-provided retirement plans can generally be characterized as either DB or DC plans. Under a traditional DB plan, an employer provides periodic payments to workers beginning at retirement, using a formula that considers a worker’s salary, age, and years of service. An employer is responsible for funding benefits in compliance with federal laws. To participate in employer-sponsored DB plans, workers must meet eligibility requirements; to receive any future benefits from the plans, workers must be vested. Vesting provisions specify when workers acquire the irrevocable right to pension benefits. Some employers offer hybrid DB plans that specify the current account balance as a dollar amount like a DC plan, but assume the financial risk to provide that amount, like a DB plan. For example, a common type of hybrid plan is a cash balance plan, which expresses benefits as an “account balance” based on hypothetical pay credits (percentage of salary or compensation) and hypothetical interest credits to employee accounts rather than predetermined payment amounts at retirement. Qualifying DB plans are federally insured by the PBGC. The agency provides retirement benefits to eligible workers in the event that their plans are terminated without sufficient assets to pay promised benefits. PBGC had an accumulated $19 billion deficit at the end of federal fiscal year 2006. The recently passed Pension Protection Act of 2006 (PPA) seeks to increase PBGC funding by requiring some plans to pay higher PBGC insurance premiums and to bolster the financial viability of private pension plans by requiring some employers to increase the funding of their plans.

Under DC plans, a worker’s benefits at retirement depend upon the accumulation of funds in a worker’s account, which may include employer and worker contributions, as well as the net investment returns on these contributions. Workers are generally responsible for managing their retirement assets. The common type of DC plan is the 401(k), which allows workers to choose to contribute a portion of their pre-tax compensation to the plan under section 401(k) of the Internal Revenue Code. To encourage participation in and contributions to such plans, employers may wholly or partially match worker contributions.

Individuals covered by employer retirement plans include: active workers who currently work for the employer and participate in separated vested workers—workers who previously worked for an employer and qualify for future DB pension benefits or retain a DC account with their former employer; designated individuals of qualified deceased workers or retirees; and retirees.

For the purpose of studying changes in employer-sponsored retirement plan participation, active workers are considered a better measure because they are part of the plans that employers are currently offering to workers. In contrast, a retired worker may receive benefits from an employer plan, even when the employer does not offer such a plan to current workers.

Workforce Restructuring

Millions of Americans are no longer in traditional work arrangements as full-time, year-round workers. Many workers are often characterized as contingent workers, which include a variety of categories such as agency temporary workers, contract company workers, day laborers, direct hire temps, independent contractors, on-call workers, self-employed, and part- time workers. Employers’ use of contingent workers, workers that are not full-time, year-round employees, has remained constant over the last decade at about 30 percent of the total workforce. Employers hire contingent workers to accommodate workload fluctuations, fill temporary absences, and screen workers for permanent positions, among other reasons. Workers take contingent jobs for a variety of reasons, both personal and financial. These reasons include workers’ preference for a flexible schedule due to school, family, or other obligations; need for additional income; inability to find a more permanent job; and hope that the position will lead to permanent employment. Figure 2 shows the composition of the contingent workforce as of February 2005.

Also, some workers are employed through alternative arrangements, such as with Professional Employer Organizations (PEO). PEOs usually operate as co-employers with traditional employers. According to the National Association of Professional Employer Organizations there are currently 2 to 3 million workers in such arrangements.

Key Legal Protections for Workers and Retirees

There are many federal laws that employers must adhere to if they provide health or retirement benefits to workers and retirees and if they consider options for reducing costs associated with providing employee benefits. For example, the Employee Retirement and Income Security Act, the Age Discrimination in Employment Act, the Health Insurance Portability and Accountability Act, and the Americans with Disabilities Act each contain important protections for some workers and worker benefits.

The Employee Retirement Income Security Act of 1974 (ERISA) governs employee pension and welfare plans, which includes health care benefits. Although ERISA does not require any employer to establish benefit plans, it does set certain minimum standards that most employers must satisfy to obtain tax advantages if they voluntarily elect to offer pension or health care benefits to their employees. ERISA requires that plan fiduciaries run the plan solely in the interest of participants and beneficiaries and for the exclusive purpose of providing benefits. Fiduciaries must act prudently and diligently and generally must diversify the plan’s investments in order to minimize the risk of large losses. ERISA requires employers to provide their employees with a summary plan document that contains important information about the benefit plan. They must also submit an annual report to the Secretary of Labor and plan participants that includes, among other things, a detailed financial statement, the number of employees enrolled in the plan, and the names and addresses of plan fiduciaries. Under ERISA, pension plans are generally subject to more extensive regulation than health benefit plans. For example, while ERISA has detailed participation and vesting requirements for pension plans, these rules do not apply to health plans. Furthermore, employers’ pension plans must meet non-discrimination testing requirements that seek to ensure that the plan design does not exceed certain limits in favoring highly compensated employees in participation and benefits over non-highly compensated employees. Although ERISA provides protections for much of the workforce, other laws permit employers to exclude some contingent workers, such as temporary, on-call, and part-time workers, from certain benefits plans.

The Age Discrimination in Employment Act of 1967 (ADEA) was enacted to promote the employment of older persons based on their ability rather than age, to prohibit arbitrary age discrimination in employment, and to help employers and workers find ways of meeting problems arising from the impact of age on employment. The ADEA, with some exceptions, prohibits employers, employment agencies, and labor organizations from discriminating against individuals over 40 on the basis of age. Specifically, employers may not refuse to hire an applicant or discharge an employee because of the individual’s age, and they may not otherwise discriminate against individuals with respect to compensation, terms, conditions, or privileges of employment because of their age. Furthermore, employers may not classify employees in a way that would deprive them of employment opportunities or otherwise affect their status as employees on the basis of age. However, the ADEA does identify some practices that employers may engage in without violating the general prohibition against discrimination. For example, under certain circumstances, an employer may reduce benefit levels for older workers to the extent necessary to achieve approximate equivalency in cost for older and younger workers. A benefit plan is considered to be in compliance with the ADEA if the actual amount of payment made, or cost incurred, on behalf of an older worker is equal to that made or incurred on behalf of a younger worker, even though the older worker may thereby receive a lesser amount of benefits or insurance coverage.

Among other things, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) prohibits employers and health insurance companies from discriminating against employees on the basis of their health status. Under HIPAA, an employer may not establish any employee eligibility or continued eligibility rules that are based on certain health-status-related factors, as applied either to the employee or his or her dependents. Health- status-related factors are defined broadly to include both physical and mental medical conditions, an individual’s past claims experience, receipt of health care, medical history, genetic information, disability, and evidence of insurability. This prohibition on discrimination does not require that an employer offer particular benefits, nor does it prevent an employer from using limits or restrictions on the amount, level, extent, or nature of the benefits for similarly situated employees.

Title I of the Americans with Disabilities Act of 1990 (ADA) prohibits discrimination in employment on the basis of disability. Specifically, employers with 15 more or employees are prohibited from discriminating against individuals with disabilities in regard to job application procedures, hiring, advancement, or discharge, compensation, job training, and other terms, conditions, and privileges of employment. To be protected by the ADA, a person must have a disability, as defined in the law, and be capable, with or without reasonable accommodation, of performing the essential functions of the position that he or she holds or desires. Reasonable accommodation may include, among other things, making existing facilities used by employees readily accessible to and usable by individuals with disabilities, as well as job restructuring, modified schedules, or the acquisition or modification of equipment or devices.

Recent Changes in Employer-Sponsored Health Benefits Prompted by Cost Concerns May Particularly Affect Lower-Wage and Less Healthy Workers

Many employers have changed employee health benefits in several ways to respond to rising costs while trying to continue to meet the demands of their workforce. As health care costs rise, the share of employers offering health benefits has fallen and employers have shifted responsibility for paying more health care costs to current workers and retirees. Employers have also begun offering new types of health plans to their workers, including CDHPs and mini-medical plans. Some of these changes may particularly affect low-wage or less healthy workers.

Fewer Small Employers Offered Health Benefits

In recent years, the share of employers offering health benefits has declined, due largely to a decrease in the share of small employers offering coverage, and the share of individuals covered by these benefits has also declined. While the share of large employers offering health benefits remained fairly constant between 2001 and 2006 at about 98 percent, the share of small employers (with 3-199 employees) offering them dropped from 68 percent to 60 percent (see table 1). Health policy experts from one organization we interviewed told us this decline is likely due to new employers choosing not to offer coverage rather than existing employers dropping coverage. Employer survey data show that in 2006, 74 percent of employers not offering health benefits cited high premiums as very important in their decision not to offer them. The percent of all workers covered by employer-sponsored health plans has also decreased in recent years, falling from about 73 percent in 2001 to about 70 percent in 2005.

Many Employers Changed the Design of Health Benefit Packages

Industry experts and survey data indicate that employers are changing health benefits packages in several ways.

Shifted More Responsibility for the Costs of Health Benefits to Workers

While the share of premiums borne by workers showed little variation for several years, employers recently shifted more responsibility for the costs of health benefits to workers by increasing deductibles, co-payments, and coinsurance. Many employers recently introduced deductibles for services where none previously existed. According to one survey, there were steady increases in the share of employers that required deductibles for PPO in-network care and HMO inpatient hospital services between 2001 and 2005—with total increases of 20 and 24 percentage points, respectively. Employers also recently increased annual deductible amounts. According to another survey, annual deductibles increased by 58 percent between 2001 and 2005 for workers enrolled in single PPO coverage from $204 to $323. Costs were also shifted to workers through increased co-payments and coinsurance at the point of care. Recent data shows that among workers enrolled in PPOs that required either co- payments or coinsurance, the co-payment amounts and coinsurance rates increased for many workers (see table 2).

Although employers continue to report cost-sharing increases, some benefits representatives have indicated that this trend may change due to employers’ concerns about workers’ willingness to absorb more costs. Employer survey data show that the share of employers that reported future plans to increase cost-sharing was 23 percent in 2003, but fell to 10 percent by 2005.

Introduced New Health Plan Options

Some employers are beginning to offer new health plan options to their workers, including CDHPs and mini-medical plans, either to control costs or to meet the needs of certain workers. For example, one employer survey found in 2006 that 7 percent of all firms offering health benefits offered CDHPs, up from 4 percent in 2005. This growth was largely due to an increase in the percent of employers offering HSA-qualified plans, which increased from 2 percent in 2005 to 6 percent in 2006. According to this same survey, among employers who offered HSA-qualified CHDPs in 2006, 37 percent did not make a contribution to workers’ HSA accounts.

While employer interest in offering CDHPs is increasing, some survey results suggest that enrollment is either holding steady or growing slightly, and overall enrollment remains low.36, 37 Surveys have found and benefits consultants told us that employers are offering CDHPs as a way to shift more of the cost and responsibility of health care to workers, while also encouraging them to become more actively engaged in their own health care decisions. According to consultants, employers hope that CDHP enrollees will decrease their use of unnecessary medical services, leading to immediate cost-savings, and also be encouraged to lead healthier lifestyles, potentially leading to long- term cost savings. Early evidence suggests that premiums are growing more slowly among CDHPs than among PPOs and HMOs.

The Kaiser Family Foundation has indicated that, among workers whose employers offer health benefits, enrollment in CHDPs held steady at 4 percent between 2005 and 2006. Mercer’s survey found that of workers who were eligible for their employers’ health plans, enrollment in CDHPs increased from 1 to 3 percent between 2005 and 2006.

Benefits consultants told us that enrollment in CHDPs is low when offered along side other more traditional health benefit options. However, most employers continue to offer multiple options, citing concern about workers’ reaction to the full-replacement of more traditional options. In 2006 we reported that, according to benefits consultants and insurance carrier representatives, there is growing interest among employers in fully replacing their traditional plans with CDHPs, and that one large employer we spoke with had done so. See GAO, Consumer-Directed Health Plans: Small but Growing Enrollment Fueled by Rising Cost of Health Care Coverage, GAO-06-514 (Washington, D.C.: Apr. 28, 2006). indicated that employers are offering mini-medical plans to meet the needs of low-wage workers who were previously ineligible for or could not afford more comprehensive health benefit options when offered. However, one insurance industry representative told us that a small number of employers have offered mini-medical plans as a replacement for previously offered comprehensive coverage.

Offered Health and Wellness Programs

Employers are increasingly offering health and wellness programs as well as financial incentives for workers to participate in them because they view them as a long-term strategy to control health costs. Table 3 summarizes the increasing prevalence of some of the most common health and wellness programs offered by large employers from 2001 through 2005. Some employers have also begun offering financial incentives for participation in these programs, often as cash bonuses or token rewards, and sometimes as discounts on premiums, co-payments, or deductibles. The share of large employers offering financial incentives increased from 7 percent in 2004 to 13 percent in 2005. Benefits consultants told us that offering these programs and incentives for participating in them has grown in recent years as employers believe they are a cost-effective way to help their workers avoid costly and preventable diseases.

Employers Continued to Offer Retiree Health Benefits, but Shifted More of the Costs to Retirees, and Some Employers Eliminated Health Benefits for Future Retirees

The extent to which employers offered health benefits to retired workers and the extent to which retired workers enrolled in these benefits has remained relatively steady for the last several years. One annual survey found that between 2001 and 2006 the share of employers with 200 or more workers offering retiree health benefits remained relatively steady, with about 35 percent offering retiree health benefits in 2006. Between 2001 and 2005, the share of the retired U.S. population covered by employer-sponsored health insurance also remained relatively steady, with about 37 percent covered by such plans in 2005.

Employers have shifted costs to retirees through higher cost-sharing and premium contributions. A Kaiser Family Foundation and Hewitt Associates (Kaiser/Hewitt) survey of private-sector employers with 1,000 or more workers that offer retiree health benefits found that in 2003, 2004, and 2005, many of these employers increased retirees’ coinsurance, co- payments, deductibles, and out-of-pocket spending limits (see table 4). In addition, data from the same survey indicated that in 2005, 42 percent of surveyed employers increased premium contributions for retirees age 65 or older at a rate that was higher than the reported increase in total premium costs, suggesting an increase in the share of premiums these retirees were required to pay. However, the survey researchers noted that this subgroup of employers tended to require retirees to contribute a lower share of premiums than other surveyed employers in that year.

Although few employers have terminated coverage for current retirees, many have done so for future retirees. The Kaiser/Hewitt survey found that among surveyed employers, 10, 8, and 12 percent dropped benefits for future retirees in 2003, 2004, and 2005, respectively. In contrast to employer-sponsored retirement plans, employer-sponsored health plans are not subject to ERISA’s vesting rules that require plans to establish employee rights in certain benefits based on years of service. Therefore, retirees are generally not protected against the termination of health benefits unless those benefits are found to have been vested, such as through explicit contractual language included in the plan documents by employers. Alternatively, employers may elect to include reservation of rights clauses in plan documents, which generally permit them to modify or terminate health benefits at any time. Terminations are more likely to affect new hires and workers who were hired after a specific date. Some experts believe the practice of terminating health benefits for future retirees will continue, and the Kaiser/Hewitt survey found that 10 percent of surveyed employers reported in 2006 that they are either very or somewhat likely to terminate retiree health benefits for future retirees in the next year. Some experts believe that this trend might be an indication that employers view these benefits as less important in attracting and retaining high-quality workers than offering health benefits for current workers.

Certain Recent Changes in Employer-Sponsored Health Benefits May Particularly Affect Low Income and Less Healthy Workers

Loss of health benefits and increased cost-shifting may particularly affect low-wage and less healthy workers. Decreasing rates of coverage among low-wage workers may be an indication that recent changes are disproportionately affecting these workers. A recent study found that, compared to their higher-wage counterparts, between 2001 and 2005, there were steeper declines in the percent of low-wage workers employed by firms that offered coverage and in the percent that enrolled in coverage when offered (see table 5). In addition, the Agency for Healthcare Research and Quality reported that between 2001 and 2004, enrollment among eligible workers employed by large retail firms—which often employ low-wage workers—fell, while enrollment among all employers held steady. Some experts believe that the recent drop in enrollment at the lowest income levels may be explained by the increasing cost of benefits to workers—such as higher premiums and increased cost-sharing requirements—which make them particularly difficult for low-wage workers to afford.

Similarly, experts are concerned that further cost-shifting of retiree health benefits may eventually lead some retirees—particularly those with lower retirement incomes—to drop this coverage, though the implications of this for some Medicare-eligible retirees might be mitigated by the recent introduction of Medicare Part D. Less healthy workers may be more affected by increased cost-shifting than others, because those who are high utilizers of health care may spend a greater share of their income on the care they receive, and if they are unable to afford it, they may forgo needed care.

CDHPs may appeal to some workers, but may not benefit certain low-wage workers or those with chronic illnesses who face higher out-of-pocket expenses under these plans. We have previously reported, and others have also found, that those enrolled in CDHPs tended to have higher incomes than enrollees in other plans. While lower premiums might make these plans more affordable for some and might encourage employers who previously did not offer health benefits to offer a CDHP, the increased financial risk associated with higher deductibles and cost-sharing may particularly affect low-income workers who may be less able to afford the upfront costs of care. Low-income workers enrolled in HSA-based plans may also be less likely to build their savings account balances because they have less disposable income and their tax benefit from making contributions would be small. This may be particularly true for those whose employers do not make contributions to their accounts. In addition, some early research indicates that CDHP enrollees may spend more of their annual incomes on health-related expenses than enrollees in other plan types. Those with high health care needs, such as those with a chronic illness, might be particularly affected by these plans as they may be more likely to use care and less able to accrue savings in their accounts from year to year. While some studies have found that CDHP enrollees were more likely to exhibit cost-conscious behavior than those in traditional insurance plans, one study found that they were also more likely to delay or skip needed medical care than were those with less cost- sharing, and this was more pronounced among those with low incomes. In addition, one study found that CDHP enrollees believed they did not have the information they needed to make wise decisions about the cost and quality of health care services. Workers whose employers only offer CDHPs would be particularly affected by these potential implications.

Mini-medical plans may benefit certain low-wage workers who would have no coverage in the absence of such a plan, but health policy experts and industry representatives we spoke to expressed several concerns about the adequacy of these plans. Proponents of mini-medical plans believe they will extend benefits to workers who were not previously insured either because they could not afford coverage or it was not offered to them. If enrolled in mini-medical plans, these workers may be more likely to obtain routine and preventive care, which may lead to better health outcomes and lower overall health expenditures. Representatives we spoke to from a health policy research organization, a benefits consulting firm, and a labor group generally agreed that these plans could provide access to some health coverage for individuals who were previously uninsured. However, they also expressed concern that the limitations of these plans may be too restrictive. For example, an annual coverage cap of $20,000 could be exceeded by a single hospitalization. In addition, there is concern that the limitations of these plans may not be clearly communicated to enrollees and that those who do not understand the coverage limitations may find themselves lacking coverage they need. In addition, some labor and consumer advocacy groups are concerned that mini-medical plans will lead to reduced benefits for some workers, such as those whose comprehensive benefits are fully replaced by mini-medical plans.

Some workers’ rights and consumer advocacy groups have expressed concerns about the privacy of workers’ health information gathered through wellness programs and that employers might use these programs to attract or retain the healthiest workers. The privacy rule issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) places limits on health plans’ use or disclosure of individually identifiable health information. However employers not acting as a health plan are not covered by the privacy rule. Concerning employers’ use of health information obtained through a wellness program, HIPAA generally protects individuals from discrimination related to health coverage and benefits based on health status factors, such as their medical condition or history. Regulations issued by DOL, the Department of Health and Human Services, and the Internal Revenue Service in 2006 provide that employers may establish wellness programs without violating the prohibition against discrimination, provided the programs meet certain guidelines. For example, if program rewards are given to participants who meet a health standard, such as achieving a cholesterol count below a set level, then a reasonable alternative standard must be made available to certain individuals, such as those who have a medical condition that makes it unreasonably difficult for them to meet the general standard.

The Ongoing Shift to Different Types of Employer-Sponsored Retirement Plans Continues to Affect Both Employers’ and Workers’ Roles in Retirement Planning

The trends in employer-sponsored pension benefits that have emerged over the last several decades have continued. Participation in DB plans continues to fall as employers continue to terminate existing plans or freeze benefits for active workers. Some employers choosing to retain their DB plans have converted them to hybrid plans that share characteristics of both DB and DC plans, a trend that may increase with the passage of the PPA. Conversely, participation in DC plans continues to rise as employers increase their offerings of these plans. In addition, some workers participate in both types of plans. Benefits experts stated that employers’ decisions regarding the retirement plans they offer reflect their attempts to control retirement benefit costs and make them more predictable. Employers’ decisions affect workers’ roles in retirement planning. With DC plans, workers assume the responsibilities and risks for managing their retirement accounts; however, a growing number of employers are attempting to increase participation rates and retirement savings in DC plans by automatically enrolling workers, escalating worker contributions and offering investment funds that require less worker management.

Participation in Traditional Defined Benefit Plans Decreased as Some Employers Terminated or Froze Plans, and Others Converted to Cash Balance Plans

DOL analysis of DB plans shows the number of active participants and number of plans has decreased over the past several decades and recent data show that the trend is continuing. The number of active participants in DB plans can be an important indicator of the long-term decline of the DB system. DOL analysis of Form 5500 data shows that the number of DB plans and the number of active participants in these plans have decreased since 1985 (see table 6).

More recently, data published in the National Compensation Survey shows that the percentage of private-sector workers with DB plans has remained steady around 20 percent between 2003 and 2006.

A number of active workers are participants in DB plans that have been “frozen.” Pension plans can be frozen in several ways. They can be closed to new entrants such that only those in the plan at a specific point in time continue to accrue benefits. Plans can be frozen for some, but not all participants, based on age, tenure, job classification, or location. Under a hard freeze, no participant accrues any additional benefits regardless of job tenure or compensation growth. Under a soft freeze benefits are generally not increased for additional tenure but are increased for compensation growth. Form 5500 data on DB plan freezes is available for only 2003 and shows that 9.4 percent of the single-employer DB pension plans insured by the PBGC were hard-frozen. Most of these plans were small plans with fewer than 100 participants, representing about 2.5 percent of all participants in PBGC-insured DB plans. Benefit consultants, benefits researchers, and others stated that employers will continue to freeze or terminate DB plans in response to financial distress, insufficient plan funding, and other considerations. Surveys also report that additional employers are either considering or planning to freeze or terminate their DB plans.

Some employers that have retained DB plans have converted them from traditional plans to hybrid plans, such as cash balance plans. Form 5500 annual reports show that cash balance plans (as a percentage of all DB plans) increased from 2.7 percent in 1999 to 4.9 percent in 2003. Active participants in cash balance plans increased from 15.7 percent of all active participants to 22.9 percent over the same period. Some consider cash balance plans controversial because of the effect they may have on pension benefits of workers of different ages and years of service. Some court decisions have found certain cash balance plans to be age discriminatory. This has created some uncertainty about the legality of cash balance plans and their design features that may have affected some employers’ decisions whether to convert to such plans. The PPA made changes intended to remove legal uncertainties, which may lead to additional conversions to cash balance plans.

Participation in Defined Contribution Plans Continues to Increase as More Employers Offer Plans

The number of DC plans and the number of active participants in such plans have increased over the past several decades, continuing established trends. DOL analysis of Form 5500 data shows that the number of DC plans and active participants have increased since 1985 (see table 7). While the number of participants continued to increase during a more recent 5- year period, the number of plans decreased, largely as a result of a drop in the number of reported plans in 2003.

DOL officials and industry publications stated that the decrease in DC plans does not necessarily reflect a decrease in the number of employers offering DC plans or the number of workers participating in DC plans. Employers often offer several types of plans, and employers can drop plan offerings while continuing to offer other types of plans. More recent data from the National Compensation Survey shows an increase in the percentage of private-sector workers with DC plans—increasing from 40 percent in 2003 to 43 percent in 2006.

Some Workers Participate in Both Defined Benefit and Defined Contribution Plans

Since the mid 1980s, a steady percentage of workers have participated in both DB and DC plans sponsored by their employers. Employers that offer a combination of a basic DB annuity and a DC plan can guarantee a certain minimum level of retirement benefits, while workers can choose the extent to which they participate in supplementary plans to increase their potential benefits upon retirement. Figure 3 shows the share of the private workforce that participated in some form of employer-sponsored retirement plan through 1999, including those that participated in both DB and DC plans.

The percentage of the private-sector workforce participating in both types of plans has generally remained at about 15 percent since the mid-1980s. Although DOL stopped conducting its analysis of dual participation with the 1999 Form 5500 filings, others who have analyzed the data continue to show similar levels of dual participation through 2005.

Employers’ Retirement Plan Decisions Reflect Their Preference for Retirement Benefit Cost Control and Predictability

While citing employer interest in obtaining greater control over benefit costs, benefits experts expressed various views on the relative costs associated with DB and DC plans. Several experts stated that companies can save money by changing from DB to DC plans; however, they added that it is difficult for employers to compare the relative costs of providing these plans because of the differences in the ways each type of plan is funded. Employers’ DB costs are based upon the amount of funding necessary to provide pension payments to current and future retirees and administrative costs, whereas DC costs are associated with employers’ current contributions and administrative costs. Nonetheless, several large companies that froze their DB plans and enhanced existing DC plans publicly stated that the actions would save their companies money.

Benefits experts also stated that employers are interested in making their benefits costs more predictable. According to the benefit consultants we interviewed, DB plan funding is subject to cost volatility from a variety of factors, including financial market conditions, investment performance, regulation, accounting requirements and changes in plan provisions. For example, DB plan funding requirements are affected by changes in interest rates and changes in the value of plan assets. In addition to interest rate and investment risks, employers are subject to legislative and accounting risk. For example, the PPA increases the required funding levels for DB plans and a new Financial Accounting Standards Board (FASB) rule requires companies to include pension obligations in their balance sheets, rather than reporting obligations in footnotes to a financial statement. Some benefits experts indicated that the rule could have a negative effect on companies’ financial statements. A survey of employers found that 82 percent of employers who froze or terminated their DB plans cited cost volatility as a significant factor. In contrast to DB plans, benefits consultants stated that employers prefer the predictability of DC plan contributions that are based on established contribution rates or are tied to company profitability. They stated that employers seldom change their employee contribution match rates, while profit sharing contributions vary with the company’s performance.

Despite their interest in greater benefit cost control and predictability, experts reported that many employers were not planning to make changes to their benefit plans. In fact, according to an employer survey, the majority of companies with DB plans do not expect to make changes to their plans. Likewise, experts stated that employers with DC plans have not generally made changes to the level of their DC plan contributions in recent years; however, contributions tied to profitability have resulted in some companies changing the amounts of annual contributions.

Employer Decisions May Affect Worker Roles in Retirement Planning

To further encourage worker participation and increased retirement savings, a growing number of employers offering DC plans are automatically enrolling workers and investing retirement assets on their behalf. Most DC plans require workers to affirmatively enroll and elect contribution levels, but a growing number of plans automatically enroll workers and escalate the amount of the worker’s contributions on a recurring basis. An employer survey found that 16.9 percent of responding companies reported that their plans offered automatic enrollment in 2005, up from 8.4 percent in 2003. The survey also found that automatic enrollment is more common in large plans than small plans—the survey indicated that in 2005, 34.3 percent of the largest plans (i.e., greater than 5,000 participants) offered automatic enrollment while only 3.5 percent of the smallest plans (i.e., less than 50 participants) offered the feature. Benefits experts stated that most individuals are passive in making investment decisions and that automatic enrollment features increase active participation. They stated that 40 to 60 percent of active workers participate in plans when they must affirmatively join the plan, while plans offering automatic enrollment can increase participation rates to 80 to 90 percent. Minority, low-wage, and younger workers may benefit more with automatic enrollment because they tend to participate less than other groups of workers. However, it is unclear whether workers will continue to participate after being automatically enrolled, since many report that they cannot afford to participate or do not want to tie up their money. Some experts are concerned that employers may choose low-risk default investments—which may provide inadequate returns—to avoid fiduciary liability that might be related to higher-risk investments. The PPA directed the Department of Labor to issue regulations providing employers with guidance on developing appropriate default investments and employers’ fiduciary responsibilities. Another technique employers are using in an attempt to increase workers’ retirement savings is automatically escalating workers’ 401(k) contributions. An employer survey found that, in 2003, only 1 percent of plans offered automatic escalation while 9 percent offered this feature in 2005.

Benefits experts are concerned about workers’ retirement investment performance because workers do not always choose appropriate investments. For example, experts stated that workers can be too aggressive or too conservative in their investment choices, resulting in lower plan balances for retirement. Therefore, some employers are offering different types of funds, such as life-cycle funds, to help workers manage their investments. An employer survey showed that, in 2004, 39.3 percent of participants offered life-cycle funds elected to invest some or all of their balances in these funds, up from 37.1 percent in 2003. Some employers also provide financial education and investment advice with the objective of helping workers invest more wisely. An employer survey indicated that over 47 percent of plans offered investment advice such as one-on-one counseling, Internet-based information and tools, and telephone hotlines. However, some experts stated that retirement studies have found that workers have little financial knowledge, despite the employer-provided courses and seminars. Other experts stated, however, that studies regarding the effectiveness of investment advice are inconclusive. Some employers choose not to offer investment advice due to concerns of fiduciary liability; however, the PPA provides additional protections for employers subject to certain conditions.

Employers’ decisions to increasingly choose DC plans over DB plans require workers to make several key decisions about their retirement planning. With DB plans, employers enroll all eligible workers and are responsible for funding and managing investments to provide them with pensions upon retirement. With DC plans, workers have generally been responsible to elect to participate, determine the amount of their contributions, and choose and manage their retirement. However, if workers participate in DC plans through employers’ automatic enrollment, automatic escalation, and default investments, then the workers’ role through retirement is more similar to that under a DB plan.

Workforce Restructuring Can Result in Different Benefit Arrangements for Workers and May Affect Employer Benefit Costs

Workforce restructuring through the use of contingent workers may affect workers’ benefits. Contingent workers are not offered and do not participate in employer-provided pension and health care benefits to the same extent as full-time workers. The use of contingent workers can reduce the costs associated with providing these benefits for employers; however, benefits experts presented mixed views on whether employers have been changing the composition of their workforces for this reason.

Fewer Contingent Workers Participate in Employer- Sponsored Benefit Plans, While Participation by Part-Time Workers Has Remained Stable

As we have previously reported, contingent workers do not participate in pension and health care benefits to the same extent as full-time workers. We consider contingent workers to include agency temporary workers, contract company workers, day laborers, direct hire temps, independent contractors, on-call workers, self-employed, and part-time workers; however, our analysis does not include self-employed or most independent contractors, because they do not have employers. Employers are permitted to exclude certain contingent workers from certain benefit plans, which may occur when employers think it is impractical or too costly to include them. Our analysis of BLS data shows that the proportion of contingent workers offered pension and health care benefits is much less than that for full-time workers (see fig. 4).

Also, significant differences exist in pension and health care participation rates between full-time and contingent workers. Our analysis of BLS data shows that in 2005, contingent workers’ participation in employer- provided pension and health care plans is significantly lower than that of full-time workers (see fig. 5). When considering whether workers participate in benefits from any source—such as a spouse or government- sponsored plan—percentages increase and the difference between full- time and contingent workers narrows. For example, the percentage of workers with health care from any source is 87 percent for full-time workers and 73 percent for contingent workers.

Our analysis of BLS data shows that pension and health care participation rates for part-time workers—the largest component of contingent workers—have remained relatively constant between 1999 and 2005 (see table 8).

Some types of contingent workers do not have a specific single employer, such as the self-employed and most independent contractors, so they do not receive employer-sponsored benefits. Such workers may be able to factor in costs for these benefits in their fees that they charge their clients. Because the self-employed and most independent contractors do not have employers, they are more likely to participate in other types of tax deferred retirement accounts (such as IRAs and Keogh plans). Our analysis found that in 2005, 45 percent of self-employed workers and 42 percent of independent contractors reported having such accounts, compared to 16 percent of full-time workers. Such workers may be able to deduct the amount paid for health insurance as an adjustment to income in determining their federal tax liability.

Employers’ Use of Contingent Workers Can Affect Benefit Costs, but the Extent to Which This Leads Employers to Use Contingent Workers Is Uncertain

We previously reported that employers’ retirement and health care benefit costs vary considerably between full-time and part-time workers. These differences in costs may be attributable to several factors, such as the extent to which employers offer benefits to full-time and part-time workers, worker participation in employer-sponsored benefit plans, and differences in the plans offered to each group (see table 9).

Some benefits experts reported that while some employers choosing to restructure their workforces may be affecting the total amount that they spend on benefits, the decision to restructure their workforces is made for other strategic reasons. These strategic reasons may be to more efficiently meet changing production and service needs in order to be competitive both domestically and internationally. For example, an employer may hire the number of full-time workers it knows it will need at all times and then supplement that worker base with contingent workers depending on production demands—instead of a continuous cycle of lay-offs and new hiring. Other benefit experts reported that employers are restructuring their workforces to reduce benefits costs by reducing their numbers of full-time workers. To reduce benefit costs, some employers are employing only a core of full-time workers in key positions to whom they provide benefits, while other work is outsourced or done by workers who are not included in the employers’ benefit plans.

Concluding Observations

The responsibilities of employers and workers in financing health and retirement benefits continue to evolve in an increasingly competitive global market. Employers have played a primary role in the financing of health benefits and retirement income for many workers for several decades; however, many are finding it increasingly challenging to provide these benefits. In responding to financial stresses, employers have changed the designs of both health and retirement benefits and shifted more of the cost, risk, and control to workers—reducing employers’ responsibilities while increasing workers’ responsibilities. These types of changes began with retirement benefits—with the shift from DB to DC plans—and were followed by similar changes to health benefits years later—such as through increased cost sharing and the more recent introduction of CDHPs. While DC plans have been widely adopted and their prevalence continues to grow, it is too early to tell if the shifting of health care costs and risks from employers to workers is sustainable or if CDHPs will take root in the same manner as DC plans.

Shifting some of the cost, risk, and control of health and retirement benefits from employers to workers, as well as the responsibility for managing them may help employers control their benefits costs and provide greater benefit choices for some workers, but such changes can also have other consequences. Workers participating in employer- sponsored benefits may not have or may perceive that they do not have sufficient financial resources, information, or knowledge to assume more of the costs and responsibility of these benefits. For example, a recent decline in health plan participation among lower-income workers may indicate that these workers are no longer able to afford the higher costs of these benefits. Similarly, although DC plans have grown in prevalence, recent employer changes to try to increase workers’ participation and workers’ investment returns—such as through automatically enrolling workers and offering life-cycle investment funds—may be an indication of growing concerns about workers’ ability to adequately prepare financially for retirement when they are responsible for their participation in and management of these plans. The challenges workers face in assuming greater cost, risk, and control of their health and retirement benefits can make it more difficult for low-wage earners to afford health care coverage and save for retirement. Although these challenges may weigh most heavily on the less wealthy and less healthy segments of the workforce, they affect a broad spectrum of the American workforce and could prove challenging to many.

Employers, individuals, and government share the responsibility of finding long-term solutions with the goal of ensuring that individuals of varying economic and health backgrounds are prepared for their health and retirement needs. For employers this will involve balancing their need to attract quality workers and maintain a workforce that is healthy and prepared for retirement, all within their fiscal constraints. This may mean that solutions will differ for employers depending on factors such as their size, industry, profitability, and competition for labor. For individuals, this will involve balancing their demand for health care coverage and retirement savings vehicles with their ability to pay for them. It is becoming increasingly important for individuals to become actively engaged in planning for their health and retirement, and their decisions on these matters will be shaped in part by their income levels and health status. For government, this will involve balancing the need to promote both a healthy population and a healthy economy within its own budget constraints while facing the challenges posed by an aging population.

Agency Comments

We provided a draft of this report to DOL. DOL did not provide written comments, but did provide technical comments, which we incorporated as appropriate.

As arranged with your office, unless you publicly announce the contents of this report earlier, we plan no further distribution until 30 days from the date of this report. At that time, we will send copies of this report to the Secretary of Labor, relevant congressional committees, and other interested parties. We will also make copies available to others upon request. In addition, this report will be available at no charge on GAO’s Web site at http://www.gao.gov.

If you or your staff have any questions concerning this report, please call Barbara D. Bovbjerg at (202) 512-7215 or John E. Dicken at (202) 512-7119. Contact points for our offices at Congressional Relations and Public Affairs may be found on the last page of this report. GAO staff who made major contributions to this report are listed in appendix II.

Appendix I: Description of Survey Data Used in Our Analysis

To measure trends in employer-sponsored benefits, we relied primarily on data from three private-sector surveys of employer-sponsored health benefits and two federal surveys that address workforce characteristics and benefits costs and participation rates.

Private Surveys of Employer-Sponsored Health Benefits

We relied on data from two annual surveys of employer-sponsored health benefit plans conducted by private entities, and one private-sector survey on retiree health benefits. For each of these surveys, we reviewed the survey instruments and discussed the data’s reliability with the sponsors’ researchers and determined that the data were sufficiently reliable for our purposes.

Kaiser Family Foundation and Health Research and Educational Trust Employer Health Benefits Annual Survey (Kaiser/HRET): Since 1999, Kaiser/HRET has surveyed a sample of employers each year through telephone interviews with human resource and benefits managers and published the results in its annual report—Employer Health Benefits. Kaiser/HRET selects a random sample from a Dun & Bradstreet list of private and public-sector employers with three or more employees, stratified by industry and employer size. It attempts to repeat interviews with some of the same employers that responded in prior years. For the most recently completed annual survey, conducted from January to May 2006, 2,122 employers completed the full survey, yielding a 48-percent response rate. By using statistical weights, Kaiser/HRET is able to project its results nationwide. Kaiser/HRET uses the following definitions for employer size: (1) small—3 to 199 employees—and (2) large—200 and more employees. In some cases, Kaiser/HRET reported information for additional categories of small and large employer sizes. We used the Kaiser/HRET surveys to report on the changes in employer-sponsored health benefits.

Mercer National Survey of Employer-Sponsored Health Plans: Since 1993, Mercer has surveyed a stratified random sample of employers each year through mail questionnaires and telephone interviews and published the results in its annual report—National Survey of Employer-Sponsored Health Plans. Mercer selects a random sample of private-sector employers from a Dun & Bradstreet database, stratified into eight categories, and randomly selects public-sector employers—state, county, and local governments—from the Census of Governments. The random sample of private-sector and government employers represents employers with 10 or more employees. Mercer conducts the survey by telephone for employers with from 10 to 499 employees and mails questionnaires to employers with 500 or more employees. Mercer’s 2005 database contains information from 2,122 employers who sponsor health plans, yielding a response rate of 21 percent. By using statistical weights, Mercer projects its results nationwide and for four geographic regions. The Mercer survey report contains information for large employers—500 or more employees— and for categories of large employers with certain numbers of employees as well as information for small employers (fewer than 500 employees). We used the Mercer surveys to report on the changes in employer-sponsored health benefits.

Kaiser/Hewitt Survey on Retiree Health Benefits: Since 2002, The Kaiser Family Foundation and Hewitt Associates have jointly conducted an annual survey—Survey on Retiree Health Benefits—that is based on a nonrandom sample of private-sector employers. Kaiser/Hewitt conducted its most recent survey online from June 2006 through October 2006 and obtained data from 333 large (1,000 or more employees) employers. These employers included about one-third of the Fortune 100 companies with the largest retiree health obligations in 2005. Because the sample is nonrandom, the survey results cannot be generalized to all large employers. We used the Kaiser/Hewitt surveys to report on the changes in employer-sponsored retiree health benefits.

Private Surveys of Employer-Sponsored Pension Plans

We reviewed several major 2005 industry surveys of pension plan sponsors including surveys by the Profit Sharing/401k Council of America (PSCA) and Hewitt Associates LLC. Since the survey response rates are low, the data are not generalizable. To assess reliability of the survey data, we contacted the authors of each survey and collected information on the methodology that was used to complete it, and determined that the data were sufficiently reliable for our purposes.

Profit Sharing/401k Council of America Survey of Profit Sharing and 401(k) Plans: PSCA’s 49th Annual Survey of Profit Sharing and 401(k) Plan reflects 2005 plan experiences of its members. PSCA’s survey results are based on responses from 1,106 plan sponsors that have profit-sharing plans, 401(k) plans, or a combination of both and represent 1 to 5,000-plus employees. The survey was mailed or faxed to respondents and conducted from March 2006 to May 2006. The survey provides a snapshot as of the end of 2005. The survey response rate was 21 percent. PSCA is a national, nonprofit association of 1,200 companies and their 6 million plan participants. According to PSCA, it represents the interests of its members to federal policymakers and offers assistance with profit sharing and 401(k) plan design, administration, investment, compliance, and communication.

Hewitt Associates LLC Pension Surveys: Hewitt Associates biennial survey results are reported in 2005 Trends and Experience in 401(k) Plans. The survey results are based on responses from 458 employers with 1,000 employees or more. Nineteen percent of the respondents represented Fortune 500 companies. The survey was conducted from mid-March through April 2005. The survey and a link to a Web site were e-mailed to respondents whose e-mail addresses were available so that they could complete the survey on the Web or on paper. The other surveys were mailed with a stamped and addressed envelope. The survey had a 9-percent response rate. Hewitt Associates is a human resource outsourcing and consulting firm. Hewitt also analyzed 401(k) savings and investment behavior, in its research report, How Well Are Employees Saving and Investing in 401(k) Plans, 2005. The analysis includes more than 2.5 million eligible workers and more than 1.6 million active participants across 107 large employers. Further, Hewitt reported survey findings in, Hot Topics in Retirement, 2006, from responses from 227 employers in October and November 2005. Human resource professionals were surveyed to learn their likely areas of focus and action over the next year regarding their defined contribution and defined benefit plans for active salaried workers.

Federal Surveys

The CPS is designed and administered jointly by the Bureau of the Census (Census) and BLS. It is a source of official government statistics on employment and employment-based benefits in the United States. The survey is based on a sample of the civilian, noninstitutionalized population of the United States. Using a multistage stratified sample design, about 60,000 households are selected on the basis of area of residence to be representative of the country as a whole and of individual states. A more complete description of the survey, including sample design, estimation, and other methodology, can be found in the CPS documentation prepared by Census and BLS. We used the Annual Social and Economic Supplement of the CPS to estimate the overall percent of the U.S. workers and retirees covered by employer-sponsored health benefits and the Contingent Worker Supplement to estimate the number of different types of contingent workers and their access and participation in employer provided health and retirement benefits.

The National Compensation Survey (NCS) is conducted by the U.S.

Bureau of Labor Statistics (BLS), U.S. Department of Labor. The estimates provided are for private nonagricultural industries. The NCS benefits survey obtains data on private-industry nonagricultural establishments and their workers. The survey provides data on access to and participation in selected benefits, such as employer health care and retirement benefits. We used the survey data to report increases in employer benefit expenses and to show workers’ participation in employer retirement plans.

Appendix II: GAO Contacts and Staff Acknowledgments

Acknowledgments

In addition to the contacts named above, Randy DiRosa, Assistant Director, and David Lehrer, Assistant Director; Joseph Applebaum; Gerardine Brennan; Laura Brogan; Richard Burkard; Susannah Compton; Sharon Hermes; John Larsen; Sheila McCoy; Daniel Meyer; Michaela M. Monaghan; Tovah Rom; Dayna Shah; and Eric Wenner made key contributions to this report.

Related GAO Products

Private Pensions: Changes Needed to Provide 401(k) Plan Participants and Labor Better Information on Fees. GAO-07-21. Washington, D.C.: November 16, 2006.

Consumer-Directed Health Plans: Early Enrollee Experiences with Health Savings Accounts and Eligible Health Plans. GAO-06-798. Washington, D.C.: August 9, 2006.

Employment Arrangements: Improved Outreach Could Help Ensure Proper Worker Classification. GAO-06-656. Washington, D.C.: July 11, 2006.

Employee Compensation: Employer Spending on Benefits Has Grown Faster Than Wages Due Largely to Rising Costs for Health Insurance and Retirement Benefits. GAO-06-285. Washington, D.C.: February 26, 2006.

Federal Workers Health Benefits Program: First-Year Experience with High-Deductible Health Plans and Health Savings Accounts. GAO-06-271. Washington, D.C.: January 31, 2006.

Private Pensions: Information on Cash Balance Pension Plans. GAO-06-42. Washington, D.C.: November 3, 2005.

Retiree Health Benefits: Options for Employment-Based Prescription Drug Benefits under the Medicare Modernization Act. GAO-05-205. Washington, D.C.: February 14, 2005.

Private Pensions: Implications of Conversions to Cash Balance Plans. GAO/HEHS-00-185. Washington, D.C.: Sept. 29, 2000.

Contingent Workers: Incomes and Benefits Lag behind Those of the Rest of the Workforce. GAO/HEHS-00-76. Washington, D.C.: June 30, 2000.