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January 24, 2019
David Burda
Economics Policy System Dynamics

The Immovable Force That Is Employer-Sponsored Health Insurance

Death, taxes and employer-sponsored health insurance. We know the first two are certainties in life, and new research again confirms the assurance of the third.

Researchers from the School of Public Health at the University of Minnesota wanted to know whether provisions in the Patient Protection and Affordable Care Act prompted private employers to drop health benefits for workers. And the answer to that question is a resounding no, according to the researchers’ findings published in the International Journal of Health Economics and Management.

As you well know, the ACA created state health insurance exchanges through which individuals can buy private health coverage if it’s not available from their employers or another source. The ACA also gave states the option to expand their Medicaid programs through which low-income workers could obtain health benefits if their employers decided to drop their coverage.

Using data from something called the Medical Expenditure Panel Survey-Insurance Component from the U.S. Agency for Healthcare Research and Quality, the researchers looked specifically at whether private employers in Medicaid expansion states  dumped low-income workers on to their state’s Medicaid rolls.

The study pool consisted of 141,900 private companies with 100 or more full- and part-time employees each. The study period was 2010 through 2015, which the researchers broke into two segments: pre-ACA (2010-2013) and post-ACA (2015-2015).

Comparing the post-ACA period with the pre-ACA period, the researchers found that:

  • 44 percent of employers offered health benefits, down from 49 percent
  • 80 percent of workers were eligible for health benefits, down from 81 percent
  • 74 percent of workers signed up for health benefits, down from 75 percent

The researchers said the slight drops from the pre-ACA period to the post-ACA period were statistically insignificant, and they found “little or no casual effect of the ACA Medicaid expansion” on any of those outcomes.

The study adds to previous research that found that the ACA has had no impact on employer-sponsored health insurance and that employers continue to offer health benefits to workers at historic levels.

Released in 2016, a survey of nearly 28,000 businesses by the Centers for Disease Control and Prevention and the AHRQ found “no significant changes” in employer-sponsored health insurance between 2014 and 2015.

Also released in 2016, a report from the Urban Institute and the Robert Wood Johnson Foundation said the percentage of workers with employer-sponsored health insurance rose to 72.1 percent by March of that year from 70.8 percent in June 2013.

CMS itself projects little change in employer-sponsored health insurance through 2026, when the agency says 180.3 million people will have coverage through their employers, up almost 3 percent from 175.4 million today.

It’s clear that employer-sponsored health insurance has staying power, and it has that power because it helps companies attract and retain workers to be competitive. And let’s not forget the tax advantages.

Given that employer-sponsored health insurance isn’t going anywhere, it’s time for employers to use that muscle for more than hiring the right people and getting a tax break. It’s time to use that muscle to demand safer, more effective care at more affordable prices for employees.

About the Author

David Burda

David Burda began covering healthcare in 1983 and hasn’t stopped since. Dave writes this monthly column “Burda on Healthcare,” contributes weekly blog posts, manages our weekly newsletter 4sight Friday, and hosts our weekly Roundup podcast. Dave believes that healthcare is a business like any other business, and customers — patients — are king. If you do what’s right for patients, good business results will follow.

Dave’s personnel experiences with the healthcare system both as a patient and family caregiver have shaped his point of view. It’s also been shaped by covering the industry for 40 years as a reporter and editor. He worked at Modern Healthcare for 25 years, the last 11 as editor.

Prior to Modern Healthcare, he did stints at the American Medical Record Association (now AHIMA) and the American Hospital Association. After Modern Healthcare, he wrote a monthly column for Twin Cities Business explaining healthcare trends to a business audience, and he developed and executed content marketing plans for leading healthcare corporations as the editorial director for healthcare strategies at MSP Communications.

When he’s not reading and writing about healthcare, Dave spends his time riding the trails of DuPage County, IL, on his bike, tending his vegetable garden and daydreaming about being a lobster fisherman in Maine. He lives in Wheaton, IL, with his lovely wife of 40 years and his three children, none of whom want to be journalists or lobster fishermen.

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