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
Jan 24, 2017
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.