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.