Small U.S. employers may be more likely to self-insure their health plans than they were before the major Affordable Care Act programs and rules came to life, but larger employers may be less likely to self-insure their health plans.
Paul Fronstin, an analyst at the Employee Benefit Research Institute (EBRI), has posted charts suggesting that possibility based on federal government survey data collected from 1996 through 2016. Fronstin included the charts in a report on trends at self-insured health plans.
A copy of the report is available here.
The percentage of all private-sector establishments that offer at least one self-insured health plan increased to 41% in 2016.
That’s up from 39% in 2015, and up from 37% in 2014, when most ACA benefits and underwriting rules for small health plans took effect.
The lowest self-insurance rate recorded since 1996 occured in 1999: In 1999, just 26.5% of employers self-insured their health plans.
But Fronstin found that recent self-insurance rate trends look much different for employers with 500 or more employees, employers with 100 to 499 employees, and employers with fewer than 100 employees.
For the smallest employers, self-insurance rates have bounced between about 12% and 14% in most years since 1996.
Since the ACA small-group rules rolled in, in January 2014, the small-group self-insurance rate moved from 13.4% in 2014, to 14.2% in 2015, to 17.4% in 2016.
For employers with 100 to 499 employees, the 1996 self-insurance rate was 35%.