In the United States today, employer health care is not mandatory on the employer's part. Even after the recent reforms enacted by Congress, no private sector employer, large or small, is required by law to provide a health care plan to its employees. Still, many employers choose to make health insurance available to their employees, with some or most of the cost assumed by the employers.

Employer health care undeniably adds to the cost of doing business. However, there are many reasons for an employer to offer some sort of health care plan for employees, even in the face of rising health care costs. It is a matter of common sense that healthy employees will be more productive on the job because they are far less likely to call in sick. Moreover, offering a health care plan will increase job satisfaction among employees and make it easier for employers to retain their best workers. Many employers spend years, and large sums of money, to train their workforce, and these expenses will have been wasted if the employees leave because no employer health care was made available.

If an industry is unionized, it is most likely that employer health care will be required as part of the union contract. For non-unionized industries, the decision on whether to provide employer health care is left up to the individual employers. In either case, the type of employer health care that is offered will vary, sometimes dramatically, from company to company. Although it is not commonplace, some employers offer health care plans at no cost to their employees. More often, employers require their workers to contribute a percentage of the premium costs through a payroll deduction. Some employers, but not all, offer a health care plan to both full-time and part-time employees. Many employers offer a choice of plans, for example, a traditional 80-20 indemnity plan versus an HMO, while a few employers are self-insured. Self-insured employers cover the costs of employees' medical care themselves, rather than purchasing a group plan from an insurance company. Finally, most employers offering a health care plan allow an employee's spouse and minor children to be enrolled, although many employers require an additional employee contribution for such dependent coverage.

Although employer health care is not mandatory in the United States, it is the primary source of health care coverage for many working Americans and their families. As the new health care reform law goes into effect, making it a requirement for individuals to demonstrate proof of being insured, the pressure will only mount for more employers throughout the country to offer at least some basic health care plan to their employees.