EBRI Issue Brief

Self-Insured Health Plans Since the ACA: Trends Remain Unclear

Aug 25, 2022
by Paul Fronstin

Summary

What has happened to the availability of and enrollment in self-insured health plans since passage of the Patient Protection and Affordable Care Act of 2010 (ACA)? Using data from the Medical Expenditure Panel Survey - Insurance Component (MEPS-IC), this paper examines trends in offerings and utilization, with a particular focus on 2013 to 2021.

Key findings:

• The percentage of private-sector establishments offering health plans increased through 2016 but has since ebbed and flowed with no discernible trend.
• Between 2013 and 2016, the percentages of small and medium-sized establishments offering at least one self-insured plan both increased — but they have bounced up and down since.
• Between 2013 and 2017, the self-insurance trend for large establishments declined. A rebound started in 2018, but the rebound did not hold in 2020.
• Overall, the percentage of workers in self-insured plans has been bouncing around between 58 percent and 60 percent since 2013.
• Self-insurance varied substantially by state.  Overall, the percentage of private-sector enrollees in self-insured plans ranged from 33.6 percent in Hawaii to 75.5 percent in Nebraska.