State-Level Trends in Employer-Sponsored Health Insurance

Recent analysis of ESI coverage provides a baseline to facilitate monitoring Affordable Care Act expansions of public and private coverage in 2014.

This study from the Robert Wood Johnson Foundation-funded State Health Access Data Assistance Center (SHADAC) found that health insurance coverage from employer-sponsored insurance (ESI) “eroded substantially” from 1999/2000 to 2010/2011 (study period).

"There is wide variation across states in the ESI measures analyzed here,” the authors conclude. “This variation points to the importance of monitoring and evaluating the impacts of the ACA on ESI at the state level.”

Key Findings

  • The percentage of nonelderly people with ESI declined 10.2 percentage points (PPs) from 69.7 percent to 59.5 percent over the study period while public coverage increased 3.1 PPs.

  • While most states saw “significant declines” in ESI coverage, the range was wide—from New Hampshire (73.8% coverage) to New Mexico (48.0% coverage).

  • ESI coverage varied by income. It fell less (2.8 PPs) for high-income groups (400% federal poverty level [FLP] or above) than for those with lower incomes (200 FPL or below) where the fall was 10.1 PPs.

  • Nationally, the percentage of private-sector firms offering ESI fell from 58.9 percent to 52.4 percent (although the percentage of workers eligible for coverage at firms that offered ESI held steady). The take-up rate also fell from 81.8 percent to 76.3 percent. Small firms offering coverage declined (67.7% to 56.3%) while at large firms it remained essentially unchanged.

  • Single-person premium costs doubled ($2,490 to $5,081); family premiums rose 125 percent ($6,415 to $14,447); employee contributions increased (17.5% to 20.8% of the total premium).

Recommended Reading

ESI Under Health Reform

The paper estimates how the ACA would affect ESI and employer costs, and finds that Overall ESI coverage under the ACA would not differ significantly from what coverage would be without reform.

Read more