Employer-Sponsored Insurance Remains Stable While Uninsurance Drops Under The ACA

Moderate conservatives   like Senators Susan Collins (R-Maine) and Joe Manchin (D-WVA)  assert  that the Affordable Care Act's definition of full time employment as 25 hours/week would drive large employers to cut workers hours rather than insure them.  Introducing her "Forty hours is full-time" bill Collins called on the Bangor Public library leader to claim they would have to cut hours or lay people off.  But it is the big picture not the press conference and photo-op that tells the story.  The Kaiser Family Foundation has the details - and the news is good.  Employer-sponsored health insurance is up, not down.  Of particular importance is the drop in the uninsured rate among low wage employees of small companies - which are not required to offer employer-sponsored insurance.  - gwc

Employer-Sponsored Insurance Remains Stable While Uninsurance Drops Under The ACA

by Adele Schartzer, et al.

Despite concerns that the changes introduced under the Affordable Care Act (ACA) would lead to a decline in employer-sponsored insurance (ESI) coverage, theavailable evidence continues to show no changes in ESI offer rates, take-up rates, or overall ESI coverage for workers under the ACA.

In earlier work, we reported that ESI offer rates, take-up rates, and ESI coverage held steady across income levels and firm sizes between June 2013 and September 2014, a period spanning the implementation of the ACA’s health insurance Marketplaces and Medicaid expansions that followed a long trend of declining ESI rates. An updated analysis shows those trends held through early 2015, after a full year of experience for employers and workers (Figure 1). Coverage, offer, and take-up rates were stable between June 2013 and March 2015 for workers in both small and large firms as well as for workers with higher and lower incomes. Employer-sponsored insurance coverage also remained unchanged among all nonelderly adults from June 2013 through March 2015.

Even as ESI rates have held steady for workers, the rate of uninsurance among nonelderly workers declined 5.9 percentage points between June 2013 and March 2015 (Figure 2) as new coverage options through the Marketplaces and Medicaid expansions became available under the ACA, dropping from 13.8 to 7.8 percent (data not shown). These parallel findings of steady ESI rates with decreasing uninsurance among workers suggest that the ACA coverage provisions are not displacing ESI but instead providing new coverage to previously uninsured workers.

As an example, the declines were particularly pronounced among lower-income workers at small firms, where there was a 15.6 percentage-point decline in uninsurance, dropping from 40.0 percent to 24.4 percent (data not shown). Before the ACA, small firms with predominately low-wage employees were much less likely to offer coverage than larger, higher-wage firms. Lower-income workers at large firms also experienced a significant decline in uninsurance (9.1 percentage points), though with 12.0 percent uninsurance in March 2015 these workers remain significantly more likely to have insurance coverage than lower-income workers at small firms (data not shown).

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