As the legislation to reform the nation s health-care coverage continues to take shape, it has drawn more attention to the relationship between the working and the insured.

A heavy payroll loss and a spike in the unemployment rate helped expose Americans dependence on their jobs for health care. Nearly 60% of the population receives health coverage through their employer, according to the latest Census Bureau data from 2007. And as the recession has roiled the job market (roughly 7.2 million people have lost their jobs since December 2007, according to the Labor Department), so has it underscored the link between employment status and health insurance. Millions have lost their employer-sponsored coverage since the downturn began, and fewer companies are providing coverage or the same level of coverage to the workers they retain.

A study by Hewitt Associates conducted in April found that 13% of employers surveyed had increased the premiums employees pay for insurance since late 2008, while 32% reported considering an increase and 19% said were weighing cutbacks to medical benefits.

Many individuals are staying with their jobs primarily for the health benefits a phenomenon known as job-lock. These workers who might be their family s sole source of coverage or who might have a pre-existing medical condition are reluctant to switch jobs or strike out on their own because they don t want to risk giving up the security of a health plan.

So what might a new health-care system mean for these different types of workers?

For starters, the White House s proposed health care reform legislation would seek to weaken the bond between medical coverage and employment status.

Supporters of President Obama s plan say the overhaul could make coverage generally more affordable and easier to get. However, the legislation is still a moving target, and many details have yet to be worked out by Congress. (They re set to resume legislative wrangling when they return from recess on Sept. 8.)

Here s a look at how the current proposals may change health insurance for different groups of workers.

Employees who get laid off

Laid-off workers who cannot participate in a spouse s health plan now have three options when they lose their subsidized employer-sponsored insurance. They can continue with the coverage they received from their employer for 18 months through Cobra (for which they pay the full premium), buy an individual plan in the open market, or go without coverage.

A new health-care system would change those options. First, any person regardless of their employment status would be able to shop for coverage on the health insurance exchange, a feature of two proposals now on the table. The exchange would offer a menu of private and public (government-sponsored) plans.

There are two advantages of such an exchange, says Karen Davenport, the director of health policy at the Center for American Progress, a left-leaning think tank based in Washington. Insurers would not be permitted to deny coverage based on a pre-existing condition or on someone s health status. And consumers would get a better deal on the exchange than they would shopping for an individual plan on today s open market because they would be buying into a larger pool and benefiting from economies of scale, Davenport says.

Under the two versions of the legislation, individuals and families with annual income up to 400% of the poverty level (or four times $22,000, for a family of four) would receive scalable subsidies to help them buy coverage through the exchange.

Roughly 25% of workers with employer-based insurance are less likely to switch jobs than those who lack work-based insurance are, according to a 1994 study conducted by Brigitte Madrian, a professor of public policy at the Harvard Kennedy School. (Other studies suggest that number is overstated, including a 1993 report by Douglas Holtz-Eakin, a former director of the Congressional Budget Office.)

The proposed legislation should mitigate insurance-related anxiety for workers tethered to their jobs because of the robust benefits package. In the bills proposed by House Democrats and the Senate HELP (Health, Education, Labor and Pensions) committee, all except for the smallest employers would be required to provide coverage or else pay a penalty (the House bill would impose a fine of 8% of the employer s payroll).

It should get rid of a lot of the job lock, says Chris Conover, a research scholar at Duke University s Center for Health Policy. It should also increase job mobility. Under an employer mandate, companies with a minimum number of employees would be required to offer health insurance to their staffs.

Workers would also gain leverage in knowing that if they end up at a company that doesn t offer coverage (or satisfactory coverage), they would have the option to buy affordable insurance through the exchange, says Conover.

Employees who are happy with their rich benefits package

One possible feature of the Senate Finance draft that s picked up some momentum in Congress is an excise tax on very rich insurance plans. The plan would impose a 20%-35% tax on insurance plans with premiums above $25,000 for a family per year as a way to help fund the overhaul. (If your health plan is valued at $35,000 -- $10,000 over the threshold you might be on the hook for $3,500 in taxes.)

This provision would have a disproportionate impact on high-salaried employees, says Brad Herring, a professor of health policy and management at Johns Hopkins University s Bloomberg School of Public Health. However, there are cases in which workers with more modest salaries are given rich insurance packages, like union workers and some state and local employees. If employees who would be subject to this tax ask their employer for a less expensive plan, they may get compensated for that sacrifice in the form of a higher salary, Herring says. (Of course, they would have to pay income taxes on that higher salary whereas their previous insurance package would have been excluded from taxes.)