The success of health care reform may come down to how we frame that pivotal decision This Issue Brief uses previously unpublished data to examine variations by industry in employer contributions to workers’ health insurance. It finds substantial variation in industry spending on health insurance premiums, with much of this variation driven simply by the share of workers covered by ESI plans in each industry.  Besides providing a rich set of data on health spending by detailed industry, this brief also uses a set of examples to demonstrate how employer and employee decisions are made in the context of “play-or-pay” mandates that are the centerpiece of most of today’s reform proposals.