Only one in four working Americans say they would be "very likely to continue" their health insurance coverage through COBRA if they lost their jobs, and cost appears to be the main reason, according to findings from the "2002 Workplace Health Insurance Survey," recently published by The Commonwealth Fund, a private foundation in Washington, D.C., that supports independent research on health and social issues.

According to the survey, just one-fourth (23 percent) of workers with employer-sponsored health insurance say they would be very likely to continue coverage if they became unemployed. However, those percentages double when workers are asked if they would take COBRA coverage with a premium subsidy, an option that has been debated by Congress for some groups of displaced workers.

Three out of five (59 percent) of those polled say they would be very likely to enroll in COBRA with a subsidy that would reduce premium share to $50 a month for individuals and $150 a month for families, an amount roughly equal to a 75 percent subsidy for the average group employer rate. The national unemployment rate was 4.9 percent just prior to the 9/11 terrorist attacks. In 2003, the average unemployment rate was 5.8 percent, but as high as 7.7 percent in Alaska, which had the highest unemployment rate in the nation.

According to the consumer health organization Families USA, the national average cost of employer-provided family coverage under COBRA, plus a 2 percent administrative fee, is $7,194 per year, or $600 per month. Additionally, the national average monthly unemployment benefit is approximately $939 and the cost of continuation of coverage under COBRA for a family (600 per month) would constitute almost two-thirds, or 64 percent, of the families' average monthly unemployment benefit, leaving only 36 percent of the unemployment benefit to cover mortgage or rent, food, utilities, car payments, gas, and clothing.

No confidence?

The study also finds that while workers support job-based health insurance, they are worried about its future. According to the survey, more than two in five (43 percent) working-age adults favor employer-based coverage, while only one in five (22 percent) favor individually purchased health insurance. However, the poll shows that confidence in the future of the employer-based system is eroding. Only three in five workers with employer-sponsored health insurance say they are "very confident" that their employer will continue to offer health insurance benefits in the future.

Even lower percentages were confident in their ability to get high-quality health care in the future: Fewer than half of all employees, and only three out of ten with low incomes, say they feel certain they will be able to get high-quality health care in the future.

"The survey signals storm warnings for the job-based system of health insurance coverage, especially as both unemployment and health care costs are rising," says Karen Davis, president of The Commonwealth Fund. "Working Americans prefer this system but they have concerns about whether coverage will be there for them in the future."