Self-Insured Health Plans: Recent Trends by Firm Size, 1996‒2016

This Issue Brief examines 1996‒2016 trends in the availability of and enrollment in self-insured health plans among private-sector establishments offering health plans and their covered workers, with a particular focus on 2013 to 2016, so as to assess whether the Patient Protection and Affordable Care Act of 2010 (ACA) might have affected these trends. The data come from the Medical Expenditure Panel Survey Insurance Component (MEPS-IC). Here are the key findings: • The percentage of all private-sector establishments offering health plans at least one of which is self-insured has continued an increase that started in 2000. o In 2016, 40.7 percent of private-sector establishments reported that they self-insured at least one of their health plans, up from 39 percent in 2015. • Between 2013 and 2016, the percentages of small and midsized establishments offering at least one self-insured plan both increased. o For small establishments, the percentage increased from 13.3 percent to 17.4 percent (a 31 percent increase), with most of the increase occurring in 2016. o For midsized establishments, the percentage increased from 25.3 percent to 29.2 percent (a 15.4 percent increase). (In 2016, the percentage of midsized establishments offering a self-insured plan fell from 30.1 percent to 29.2 percent.) • Between 2013 and 2016, the self-insurance trend for large establishments continued to decline, falling from 83.9 percent to 78.5 percent. • Because many more employees work for large establishments, the increase in self-insurance among small establishments (and their workers) was not large enough to offset the decline among large establishments (and their workers), resulting in a decrease in the percentage of covered workers enrolled in self-insured plans. o Between 2015 and 2016, the percentage of enrollees in self-insured plans fell from 60 percent to 57.8 percent.