Percentage of Private-Sector Employers With at Least One Self-Insured Health Plan Has Decreased

The percentage of all private-sector establishments offering at least one self-insured health plan has reduced, except in firms with more than 1000 employees, according to research published by the Employee Benefit Research Institute (EBRI).

The researchers examined trends in the availability and enrollment of self-insured health plans among private-sector establishments from 2013 to 2018 using data from the Medical Expenditure Panel Survey-Insurance Component. This study period allowed the effects of the Affordable Care Act (ACA) to be evaluated.

The results revealed that in 2016, 40.7% of private-sector establishments reported that they self-insured at least one their health plans—an increase of 26.5% since 1999. In 2018, the percentage of private-sector establishments reporting that they self-insured at least one of their health plans decreased to 38.7%.

“The post-ACA changes in the availability of, and enrollment in, self-insured health plans among various sizes of private-sector establishments seem to be reversing course,” Paul Fronstin, director of the Health Research and Education Program, EBRI, said in a statement.

Furthermore, the study found that between 2013 and 2016 the percentages of small and medium-sized establishments offering at least one self-insured plan increased. Despite these increases, by 2018 the percentage of small establishments that self-insure at least one health plan had reduced back to the pre-ACA level of 13.2%.

“The availability of self-insured plans is now increasing among large establishments, has started to fall among small establishments, and might be stabilizing among medium-sized establishments,” Fronstin stated. “The data lead to more questions—why is the use of self-insured plans falling in small companies, and is the growing use of self-insured plans among large companies a new trend?”

For large establishments, self-insured plans experienced decline between 2013 and 2017, however a rebound began in 2018 since the percentage offering increased to 78.7%. Therefore, these firms with more than 1000 employees were the only establishments to increase.

Because the increase in self-insurance among large establishments was not large enough to offset the decline among small and medium-sized establishments, there was still an overall decrease in the percentage of covered worked on self-insured plans, according to the results.