Fewer Small Employers Offering Health Coverage; Large Employers Holding Steady

8 Pages Posted: 29 Jul 2016

See all articles by Paul Fronstin

Paul Fronstin

Employee Benefit Research Institute (EBRI)

Date Written: July 2016

Abstract

This paper examines the percentage of employers offering health insurance from 2008-2015 to better understand how health insurance offer rates have been affected by the Affordable Care Act of 2010 (ACA), the Great Recession of 2007-2009, and the subsequent economic recovery. The data come from the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC). Over 95 percent of employers with 100 or more employees offered health coverage before enactment of the ACA and continue to do so. More specifically, among employers with 1,000 or more employees, 98.9 percent offered health coverage in 2004 and 2005 and over 99 percent offered health coverage in each year from 2009 through 2015. Among employers with 100-999 employees, just over 94 percent offered health benefits in 2004-2006, while the percentages have ranged between 92.5 percent and 95.1 percent for 2012-2015. Offer rates among smaller employers have been falling since 2009: (a) for employers with fewer than 10 employees, from 35.6 percent in 2008 to 22.7 percent in 2015 (a 36 percent decrease), (b) for employers with 10-24 employees, from 66.1 percent in 2008 to 48.9 percent in 2015 (a 26 percent decline), and (c) for employers with 25-99 employees, from 81.3 percent in 2008 to 73.5 percent in 2015 (a 10 percent decline). There are several plausible reasons for the decline in health plan sponsorship among smaller employers, including rising health care costs; fear of rising health care costs; availability of non-group insurance in the public exchange; attitudes toward the ACA; the 2007-2009 recession; unemployment; and post-recession business and labor/employment softness and uncertainty. While health plan sponsorship hasn’t declined among larger employers, some have predicted that even these employers -- traditionally more committed to sponsoring health coverage for their workers -- will begin to move away from sponsorship at some point in the future. There’s no doubt that many larger employers have already made significant changes in the nature of their sponsorship, moving from defined benefit to defined contribution approaches that include more individual cost-sharing (both through employee premium or contributions and employee out-of-pocket expenses) and decision-making responsibilities; shifting to private health insurance exchanges; adopting wellness programs; and more generally supporting greater health consumer engagement.

Keywords: Employment-based benefits, Health care costs, Health care reform, Health insurance coverage, Recession

JEL Classification: I1, I18, J32

Suggested Citation

Fronstin, Paul, Fewer Small Employers Offering Health Coverage; Large Employers Holding Steady (July 2016). EBRI Notes, Vol. 37, No. 8 (July 2016), Available at SSRN: https://ssrn.com/abstract=2815660

Paul Fronstin (Contact Author)

Employee Benefit Research Institute (EBRI) ( email )

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