Decline in Self-Insured Health Plan Enrollment Masks Growth Among Small Companies

Between 2015 and 2016, the percentage of enrollees in self-insured health plans fell from 60% to 57.8%, according to an analysis from the Employee Benefit Research Institute (EBRI), using data from the Medical Expenditure Panel Survey Insurance Component (MEPS-IC).

However, the percentage of all private-sector establishments offering health plans at least one of which is self-insured has continued a growth trend that started in 2000, EBRI notes. In 2016, 40.7% of private-sector establishments reported that they self-insured at least one of their health plans, up from 39% in 2015.

The increase has been ongoing among small and mid-sized employers. The analysis shows that between 2013 and 2016, for small establishments, the percentage increased from 13.3% to 17.4% (a 31% increase), with most of the increase occurring in 2016. For mid-sized establishments, the percentage increased from 25.3% to 29.2% (a 15.4% increase).

In 2016, EBRI found the largest increases in self-insured plan coverage among covered workers occurred in establishments with 25 to 99 employees and with 100 to 999 employees. Passage of the Affordable Care Act (ACA) sparked a movement to self-insurance.

EBRI notes that the decrease in self-insured plan enrollment is due to a decrease in self-insurance for large employers. “Because many more employees work for large establishments, the increase in self-insurance among small establishments (and their workers) was not large enough to offset the decline among large establishments (and their workers),” the institute said in an Issue Brief.

Between 2013 and 2016, the self-insurance trend for large establishments fell from 83.9% to 78.5%.