This paper examines trends in the availability of and enrollment in self-insured health plans among private-sector establishments offering health plans and their covered workers, with a particular focus on 2013 to 2018, so as to assess whether the Patient Protection and Affordable Care Act of 2010 (ACA) might have affected these trends and more recent trends. The data come from the Medical Expenditure Panel Survey – Insurance Component (MEPS-IC).

Key findings:

  • The percentage of all private-sector establishments offering health plans, at least one of which is self-insured, increased through 2016 but has fallen since.
    • In 2016, 40.7 percent of private-sector establishments reported that they self-insured at least one of their health plans, up from 26.5 percent in 1999.
    • By 2018, the percentage of private-sector establishments reporting that they self-insured at least one of their health plans fell to 38.7 percent.
  • Between 2013 and 2016, the percentages of small and medium-sized establishments offering at least one self-insured plan both increased.
    • For small establishments, the percentage increased from 13.3 percent to 17.4 percent (a 31 percent increase), with most of the increase occurring in 2016.
    • For medium-sized establishments, the percentage increased from 25.3 percent to 29.2 percent (a 15.4 percent increase).
    • By 2018, the percentage of small establishments self-insuring at least one health plan fell back to a pre-ACA level of 13.2 percent. The percentage of medium-sized establishments offering a self-insured plan fell to 29 percent.
  • Between 2013 and 2017, the self-insurance trend for large establishments continued to decline, falling from 83.9 percent to 75.9 percent. A rebound may have started in 2018, as the percentage offering a self-insured plan increased to 78.7 percent.
  • Despite the fact that many more employees work for large establishments, the increase in self-insurance among large establishments was not large enough to offset the decline among small and medium-sized establishments, resulting in a decrease in the percentage of covered workers enrolled in self-insured plans.
    • Between 2017 and 2018, the percentage of enrollees fell from 59.4 percent to 58.7 percent.
    • The percentage of workers in self-insured plans fell in every establishment size except for those in firms with 1,000 or more employees.
  • Self-insurance varied substantially by state. Overall, the percentage of establishments offering at least one self-insured plan ranged from 24.3 percent in Massachusetts to 52.6 percent in North Carolina. The percentage of private-sector enrollees in self-insured plans varied from 31.4 percent in Hawaii to 72.7 percent in North Carolina.

Source: Employee Benefit Research Institute