Trends in Employer-based Health Insurance

Getting coverage from an employer-sponsored plan is still the single most common source of health insurance for Americans, but the number of firms making insurance available and the percent of people enrolling have declined over the last 15 years.  An analysis from the Kaiser Family Foundation examines trends in employers offering such insurance and employees enrolling in it.   (KFF Analysis)   In 2014, 66% of workers had an opportunity to get health insurance from their employer, compared to 71% in 1999.  Working less than 30 hours a week was strongly associated with not having access to a health plan; only 21% of these employees had access as opposed to 72% of those who worked more than 30 hours.  Unfortunately, and continuing the theme that those who need it most are most likely to lack access, lower-income employees have worse availability than high-income ones, with 78% of high-income households having access and only 30% of those below the federal poverty line.  Not everyone who is has a health plan available in the workplace takes up coverage, and even those who do don’t always enroll dependents.  The percent of the population under 65 who actually enroll in employment-based insurance has dropped from 67% in 1999 to 56% in 2014.  Partly this is due to aging of the population, but most is almost certainly attributable to the dramatic increase in the cost of health insurance, even when obtained through an employer.  One concern about the reform law was that it might result in fewer small employers offering health plans or in companies encouraging workers to get coverage on the exchanges.  This does not appear to be widespread at this point, with no change in the number of households covered by employer-sponsored health insurance from 2010 to 2014, but any effect may be muted by the fact that this time period was during a recovery from a fairly severe recession.  As with offer, take-up is influenced by income, with lower-income workers less likely to enroll.  This may in part reflect the availability of Medicaid to lower-income workers.  83% of high-income workers enroll compared to only 12% of those under the federal poverty line.  While high-income take-up rates have been fairly stable from 1999 to 2014, it has decreased significantly in that period for low-income ones.  The research does suggest some modest undermining of employer-based insurance as a primary source of health coverage over the last 15 years.