The document analyzes trends in employer-sponsored health insurance (ESI) in the United States and Minnesota after the Affordable Care Act. It finds that while the percentage of U.S. workers offered and eligible for ESI dropped slightly from 2013-2014, Minnesota saw no significant changes. Both saw minimal increases in workers taking up ESI. Individual premiums significantly increased every year in the U.S. and 2013-2014 in Minnesota. Enrollment in high-deductible plans rose each year in the U.S. and 2013-2014 in Minnesota. The concerns over reduced ESI due to the ACA appear overstated while rising individual costs remain a policy issue.

1. CHANGING TRENDS IN EMPLOYER-
SPONSORED INSURANCE AFTER THE
AFFORDABLE CARE ACT
Carrie Suplick Benton
State Health Access Data Assistance Center (SHADAC)
University of Minnesota, School of Public Health
Minnesota HSR Conference
March 1, 2016

2. 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”

3. Agenda:
• Background & policy relevance
• Research questions
• Findings in employer-sponsored insurance
(ESI)
• Conclusions and policy implications

4. Study Methodology:
• Timeframe: 2010 – 2014, 1 year estimates
• Source: Medical Expenditure Panel Survey –
Insurance Component (MEPS–IC), tabular
data

5. 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 = < 50
all firms
Offer
Eligibility
Take-up
Source: Proportions of figure derived from 2012/2013 Medical Expenditure
Panel Survey-Insurance Component as analyzed by SHADAC.

6. Health Insurance is Dominated by ESI
Source: SHADAC analysis of the American Community Survey (ACS) Public Use Microdata Sample (PUMS) files. 2014.
51%
6%
12%
15% 16%
59%
7%
12%
15%
6%
0%
10%
20%
30%
40%
50%
60%
70%
Employer Individual Medicaid/CHIP Medicare Uninsured
Health Insurance Coverage, by Type
2014
United States
Minnesota

7. 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.

8. 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?

9. ESI Findings:
Minimal changes excluding premiums and
health plan type

10. 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.

11. 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.
87% 85%* 85% 85% 83%*
84% 84% 85% 85%
82%
20%
40%
60%
80%
100%
2010 2011 2012 2013 2014
Trends in Workers Offered ESI
Minnesota
United States

12. 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.

13. 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.
78%
78%
78%
78% 75%*
75%
80%
76% 75%
75%
20%
40%
60%
80%
100%
2010 2011 2012 2013 2014
Trends in Workers Eligible for ESI
Minnesota
United States

14. 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.

15. Workers’ Take-Up of ESI Changes
Minimally
80% 79%
74% 73%
75%77% 76%
76% 75%* 77%*
0%
20%
40%
60%
80%
100%
2010 2011 2012 2013 2014
Trends in Workers Taking-Up ESI
Minnesota
United 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.

16. 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.

17. Individual Premiums Increase
$1,023 $1,085 $1,212 $1,234 $1,219*
$3,941
$4,341 $4,126 $4,040
$4,613
$0
$2,000
$4,000
$6,000
2010 2011 2012 2013 2014
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.

18. 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.

19. Trends in High Deductible Health
Plans
21%
25%*
34%*
30%*
35%*25%
32%
36%
31%
45%*
0%
20%
40%
60%
80%
100%
2010 2011 2012 2013 2014
Workers in High-Deductible Plans
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.

20. 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.