EBRI: How employer-sponsored coverage has evolved under the ACA

When the Affordable Care Act was passed, some feared its changes could lead many employers to drop health coverage altogether.

That's a trend, though, that hasn't materialized, according to a new analysis from the Employee Benefit Research Institute (EBRI). Instead, the researchers found that the percentage of workers eligible for benefits increased by 5% between 2014 and 2022.

The study shows that in 2017, the percentage of private sector employees offering benefits grew for the first time in a decade. Just over half (56.4%) of private employers offered health benefits in 2008, and that declined to 45.3% in 2016.

However, by 2020, the number grew again to 51.1%, according to the report.

Paul Fronstin, director of health benefits research at EBRI, said in a press release that how large and medium-sized employers respond to economic changes in the future is a trend to watch, as the COVID-19 pandemic did not deter them.

“It is highly unlikely that larger and medium-sized employers will conclude that offering their own health plan is not crucial to the attraction and retention of workers," he said. "However, when the next business slowdown takes hold, it will be interesting to see if fewer larger and medium-sized employers continue to offer health coverage."

The analysis is based on data from the Medical Expenditure Panel Survey's Insurance Component, which is a survey of both public and private employers conducted by the Agency for Healthcare Research and Quality.

As of 2022, 81% of private sector workers qualify for health coverage, and that has consistently trended upward since 2014, according to the report.

In addition, the percentage of employers with 1,000 or more workers that offer health insurance has been consistently around 99%. And 97% of employers with between 100 and 999 workers offer coverage, according to the report.

Among smaller employers, the trends are more variable. Just 24.9% of employers with 10 or fewer employees offered benefits in 2022, and 53.6% of those with 10 to 24 workers offered benefits.

Most (80.1%) of employers with 25 to 99 workers offered benefits in 2022, according to the report.

Fronstin also said that potential policy changes, including tax exclusion updates and additional individual plans, could drive employers to think differently about coverage.

"It’s also possible that certain public policy changes, if adopted, may drive some employers—large and small alike—away from offering health benefits and cause some workers to care less about whether they get health coverage from their employer," he said.