CHANGING TRENDS IN EMPLOYER-SPONSORED INSURANCE BEFORE AND SINCE THE GREAT RECESSION

Colin Planalp, MPA

State Health Access Data Assistance Center (SHADAC)

University of Minnesota, School of Public Health

Minnesota HSR Conference

March 3, 20153/6/2015

Acknowledgments

Co-authors:• Julie Sonier, Minnesota Management and Budget

(work conducted while at SHADAC)

• Brett Fried, SHADAC

“State-level Trends in Employer-sponsored Health Insurance: A State-by-state Analysis”• www.shadac.org/ESIreport2015

Supported by a grant from the Robert Wood Johnson Foundation

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Background

Concerns voiced about ACA effects on ESI

What were trends before implementation of ACA?

• Decline in ESI since early 2000s

• But did those trends change more recently?

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-New York Times, Oct. 8, 2014

Research questions

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Has ESI changed since the Great Recession?

1. Did ESI trends differ pre- and post-recession?

2. How did trends vary by worker and employer types?

3. What were the drivers of worker ESI trends pre- and post-recession?

Study timeline

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Early 2000s -decline of ESI begins

2014 -Full ACA implementation

2007-2009 -Recession

2004/2005 2012/20132008/2009

Study timeline

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Early 2000s -decline of ESI begins

2014 -Full ACA implementation

2007-2009 -Recession

Pre-recession Post-recession

Data source

Medical Expenditure Panel Survey-Insurance Component (MEPS-IC)• National survey of private and public employers about

ESI offers, eligibility, enrollment, cost, plan characteristics

• Sponsored by the Agency for Healthcare Research and Quality

Our analysis:• Focused on private-sector employers

• Uses 2-year averages to improve precision of estimates

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Findings:Employer offers of ESI

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Employers offering ESI

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55.7%

42.7%

95.9%

55.7%

42.1%

96.4%

50.0%

35.0%

95.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Total employers Small employers Large employers

2004/2005 2008/2009 2012/2013

Significant increase Significant decrease at 95% confidence level

Factors in worker ESI:

Offer, Eligibility, and Take-up

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Factors in worker ESI coverage

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Offer

Eligibility

Take-up

1. Does a worker’s firm offercoverage?

2. Does the worker meet eligibilityfor coverage?

3. Does the worker take up that coverage?

Worker Offer, Eligibility and Take-up

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86.8%

78.5% 79.7%

87.7%

78.8% 77.8%

84.8%

77.8%75.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Offer Eligible Take-up

2004/2005 2008/2009 2012/2013

Significant increase Significant decrease at 95% confidence level

Trends by worker, employer type

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Part-time workers begin with lower offer, eligibility and take-up

• Take-up: PT saw greater post-recession drop (6.8 point drop vs. 2.1 point drop)

Workers in small firms begin with lower offer

• Offer: Small firm saw greater post-recession drop (7.6 point drop vs. 0.8 point drop)

Drivers of workers’

ESI coverage rates

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Drivers of Workers’ ESI coverage

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Pre-recession period

(2004/2005 to 2008/2009)

Post-recession period

(2008/2009 to 2012/2013)

Offer Eligibility Take-up Offer Eligibility Take-up

Total

Part-time

Full-time

Small firms

Large firms

Number of dots shows relative impact (e.g., one dot is smallest impact, three dots is largest impact).

Color of dots shows direction of impact (e.g., green has positive effect on ESI coverage, red has negative effect on ESI coverage).

Drivers of Workers’ ESI coverage

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Pre-recession period

(2004/2005 to 2008/2009)

Post-recession period

(2008/2009 to 2012/2013)

Offer Eligibility Take-up Offer Eligibility Take-up

Total

Part-time

Full-time

Small firms

Large firms

Number of dots shows relative impact (e.g., one dot is smallest impact, three dots is largest impact).

Color of dots shows direction of impact (e.g., green has positive effect on ESI coverage, red has negative effect on ESI coverage).

Drivers of Workers’ ESI coverage

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Pre-recession period

(2004/2005 to 2008/2009)

Post-recession period

(2008/2009 to 2012/2013)

Offer Eligibility Take-up Offer Eligibility Take-up

Total

Part-time

Full-time

Small firms

Large firms

Number of dots shows relative impact (e.g., one dot is smallest impact, three dots is largest impact).

Color of dots shows direction of impact (e.g., green has positive effect on ESI coverage, red has negative effect on ESI coverage).

ESI in Minnesota

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Minnesota: Employers offering ESI

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54.0% 55.7%54.5% 55.7%

49.6% 50.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Minnesota U.S.

2004/2005 2008/2009 2012/2013

Significant increase Significant decrease at 95% confidence level

Minnesota: Worker Offer

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88.7% 86.8%87.7% 87.7%84.9% 84.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Minnesota U.S.

2004/2005 2008/2009 2012/2013

Significant increase Significant decrease at 95% confidence level

Minnesota: Worker Eligibility

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76.8% 78.5%78.6% 78.8%75.4%

77.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Minnesota U.S.

2004/2005 2008/2009 2012/2013

Significant increase Significant decrease at 95% confidence level

Minnesota: Worker Take-up

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79.3% 79.7%78.1% 77.8%73.6% 75.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Minnesota U.S.

2004/2005 2008/2009 2012/2013

Significant increase Significant decrease at 95% confidence level

Conclusions

ESI trends have changed since Great Recession• Pre-recession period — relative stability in ESI

• Post-recession — consistent declines in ESI

Drivers of worker ESI coverage have changed• Pre-recession period — Take-up was primary driver

• Post-recession — Offer was primary driver

Policy implications• When assessing impact of ACA,

need to consider other factors’ effects on ESI

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COLIN PLANALP, MPARESEARCH FELLOWCPLANALP@UMN.EDU

State Health Access Data Assistance Center (SHADAC)

University of Minnesota, Minneapolis

www.SHADAC.org

3/6/2015