More Small and Mid-Sized Firms Using Self-Insured Health Plans

The share of both private-sector self-insured health plans and number of covered workers in self-insured health plans have increased among small and mid-sized firms since enactment of the Affordable Care Act (ACA) in 2010, according to new research from the Employee Benefit Research Institute (EBRI).

While the data does not demonstrate that ACA is conclusively the cause of the growth in self-insured plans, it “is consistent with the prediction that the ACA would cause more small and mid-sized employers to adopt self-insured plans,” says Paul Fronstin, director of EBRI’s Health Research and Education Program and author of the research report.

The research found the percentage of private-sector establishments offering health plans at least one of which is self-insured has increased from 28.5% in 1996 to 39% in 2015 (a 36.8% increase). Between 2013 and 2015, the percentages of establishments offering health plans with at least one self-insured plan has increased for mid-sized establishments from 25.3% to 30.1% (a 19% increase); for small establishments from 13.3% to 14.2% (a 7% increase); and has decreased from 83.9% to 80.4% for large establishments (a 4% decrease).

Similarly, the percentage of health-plan-covered workers enrolled in self-insured health plans has increased from 58.2% to 60% (a 3% increase) from 2013 to 2015. The largest increases in self-insured plan coverage among covered workers have occurred in establishments with 25 to 99 employees and with 100 to 999 employees.

The data comes from the Medical Expenditure Panel Survey Insurance Component (MEPS-IC), a survey of private-  and public-sector employers fielded by the U.S. Census Bureau for the Agency for Healthcare Research and Quality (AHRQ).