CHANGING TRENDS IN EMPLOYER- SPONSORED INSURANCE AFTER THE AFFORDABLE CARE ACT
Carrie Suplick BentonState Health Access Data Assistance Center (SHADAC)
University of Minnesota, School of Public Health
Minnesota HSR ConferenceMarch 1, 2016
Acknowledgements:
• Co-Authors: • Elizabeth Lukanen, SHADAC• Brett Fried, SHADAC• Natalie Schwehr, SHADAC
• 2016 full report coming soon at: http://www.shadac.org/“State-level Trends in Employer-Sponsored Health Insurance: A State-by-state Analysis”
Agenda:
• Background & policy relevance
• Research questions
• Findings in employer-sponsored insurance (ESI)
• Conclusions and policy implications
Study Methodology:
• Timeframe: 2010 – 2014, 1 year estimates
• Source: Medical Expenditure Panel Survey – Insurance Component (MEPS–IC), tabular data
Defining the Insurance Components of ESI:• Offer: % of workers that are offered coverage
• Eligibility: % of workers who have an offer who are eligible for coverage
• Take-Up: % of eligible workers eligible who enroll in coverage
• Firm size comparison:small firms = < 50all firms
Take-up
Source: Proportions of figure derived from 2012/2013 Medical Expenditure Panel Survey-Insurance Component as analyzed by SHADAC.
Health Insurance is Dominated by ESI
Source: SHADAC analysis of the American Community Survey (ACS) Public Use Microdata Sample (PUMS) files. 2014.
Employer Individual Medicaid/CHIP Medicare Uninsured0%
10%
20%
30%
40%
50%
60%
70%
51%
6%12%
15% 16%
59%
7%12%
15%
6%
Health Insurance Coverage, by Type2014
United States
Minnesota
ESI Predictions Prior to ACA Implementation:
• Many varied predictions including dramatic decreases and increases in ESI.
• Congressional Budget Office and the Joint Committee on Taxation estimated in 2012 a range of 20 million ESI loss to a 3 million ESI gain.
Source: Congressional Budget Office. (2012, March). CBO & JCT’s estimates of the effects of the Affordable Care Act on the number of people obtaining employment-based health insurance.
Research Questions:
• How has ESI changed during the ACA time frame (2010 – 2014)?
• How has ESI affected Minnesotan’s compared to the U.S.?
• How has ESI changed by firm size?
ESI Findings: Minimal changes excluding premiums and health plan type
Workers’ Offer Findings:
• U.S. workers given an offer significantly dropped 2 percentage points from 2013 to 2014.
• Minnesota workers experienced no significant changes in offer.
• Minimal offer differences between Minnesota and the U.S.
Source: SHADAC analysis of the MEPS – IC, tabular data, 2010 – 2014.
Workers’ Offer Changes Minimally
Source: SHADAC analysis of the MEPS – IC tabular data 2010 – 2014.Note: *’s denote statistically significant differences between years within geography at the 95% confidence level.
2010 2011 2012 2013 201420%
40%
60%
80%
100%
87%* 85%* 85%* 85%* 83%*
84% 84% 85% 85%82%
Trends in Workers Offered ESI
United StatesMinnesota
Workers’ Eligibility Findings
• U.S. ESI eligible workers significantly dropped by 3 percentage points from 2013 to 2014.
• Minnesota saw no significant changes in ESI eligible workers.
Source: SHADAC analysis of the MEPS – IC tabular data 2010 – 2014.Note: *’s denote statistically significant differences between years within geography at the 95% confidence level.
Worker’s Eligibility Changes Minimally
Source: SHADAC analysis of the MEPS – IC tabular data 2010 – 2014.Note: * denotes statistical significance between consecutive years within geography.
2010 2011 2012 2013 201420%
40%
60%
80%
100%
78%
78%
78% 78% 75%
75%
80%
76% 75%75%
Trends in Workers Eligible for ESI
United StatesMinnesota
Workers’ Take-Up Findings
• Within the U.S., workers significantly increased their take-up of ESI from 2012 – 2013 and 2013 – 2014.
• Minnesota workers did not significantly change their take-up of ESI during any time period between 2010 – 2014.
Workers’ Take-Up of ESI Changes Minimally
2010 2011 2012 2013 20140%
20%
40%
60%
80%
100%
80% 79%
74% 73% 75%77% 76%
76% 75% 77%
Trends in Workers Taking-Up ESI
United States
Minnesota
Source: SHADAC analysis of the MEPS – IC tabular data 2010 – 2014.Note: * denotes statistically significant differences between consecutive years at the 95% confidence level.
Individual Premium Findings
• U.S. individual premiums have significantly increased every year between 2010 – 2014.
• Minnesota individual premiums did not significantly change between 2010 – 2013, but did significantly increase between 2013 – 2014.
• To illustrate the magnitude of change between 2010 – 2014, individual premiums significantly increased 17% in the U.S. and 18% in Minnesota.
Individual Premiums Increase
2010 2011 2012 2013 2014$0
$2,000
$4,000
$6,000
$1,023 $1,085 $1,212 $1,234 $1,219
$3,941 $4,341 $4,126 $4,040
$4,613
Trends in Individual Premium Contributions Minnesota
Employee Contributions Employer Contributions
$4,964$5,426 $5,338 $5,274
$5,832*
Source: SHADAC analysis of the MEPS – IC tabular data 2010 – 2014.Note: * denotes statistically significant differences between consecutive years at the 95% confidence level.
Health Insurance Plan Findings• U.S. workers significantly increased
enrollment in high-deductible plans every year except 2010.
• Minnesota workers only saw a significant increase in high-deductible plans from 2013 – 2014.
Source: SHADAC analysis of the MEPS – IC tabular data 2010 – 2014.
Trends in High Deductible Health Plans
2010 2011 2012 2013 20140%
20%
40%
60%
80%
100%
21%*25%*
34%*30%*
35%*25%32%
36%31%
45%
Workers in High-Deductible Plans
MinnesotaUnited States
Source: SHADAC analysis of the MEPS – IC tabular data 2010 – 2014.Note: * denotes statistically significant differences between consecutive years at the 95% confidence level.
Concluding Policy Implications
• The concerns over the ACA dramatically reducing ESI offer and eligibility seem to be over-stated.
• The long-term increasing premium cost trends for individuals and families continues to be a policy concern.
• The employee shift to high-deductible plans will need to be evaluated to determine possible cost savings and impacts and concerns over unmet health needs.
