Post-Affordable Care Act Trends in Health Coverage for Small Businesses

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Small employers are poised to make big health insurance coverage changes in the coming years.

The Issue

Interviews with stakeholders from Arkansas, Montana, New Mexico, Pennsylvania, and Vermont, and health coverage trends, suggest that 2017 may be marked by big changes in the small-group health insurance market.

Key Findings

  • Many of the ACA's small group market reforms are not yet fully realized, as a significant proportion of small-group employers remain in non-ACA-compliant plans.

  • Alternative coverage options for small-group employers, such as self-funding arrangements and group purchasing arrangements, may be gaining a foothold for future growth.

  • The year 2017 will be critical for the future of the small-group market.


Many small employers still offer their pre-ACA policies. Some of these plans are "grandfathered" and can continue if they are not significantly modified while others will be phased out over the next two years. Researchers say this may explain why many small businesses nationwide have not yet considered new options available to them since the ACA was implemented, but soon will.   

About the Center on Health Insurance Reforms

The Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute is a nonpartisan, expert team of faculty and staff dedicated to conducting research on the complex and developing relationship between state and federal oversight of health insurance markets.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. For more information specific to the Urban Institute’s Health Policy Center, its staff and its recent research, visit