Why Employers will Continue to Provide Health Insurance

The Impact of the Affordable Care Act


An issue brief funded by the Robert Wood Johnson Foundation as part of its Quick Strike Series considers how employers might react to provisions of the Affordable Care Act (ACA) and offers an analysis of factors that are likely to influence their decisions to drop or retain employer-sponsored insurance (ESI).

The Urban Institute authors state that the ACA will leave ESI largely intact, but that decisions to continue or drop ESI will come down to whether employers and their employees stand to benefit more from ESI or coverage available through state insurance exchanges.

The authors contend:

  • Better-paid workers remain better off with ESI.
  • Employers will likely only drop coverage if most workers would benefit from switching to the exchange.
  • Employers are unlikely to drop coverage due to complexities in assessing employees' preferences.
  • Employers are unlikely to make decisions to encourage some employees to drop coverage and not others.

The brief examines the ACA's coverage provisions, current tax subsidies and workforce characteristics to identify: (1) which option provides the best scenario for attracting and retaining a skilled, loyal workforce; (2) how employee demographics will influence employers' decisions on offering coverage; and (3) what eliminating ESI will mean in terms of true costs associated with employer penalties and as increased employee compensation.