Self-Insurance Changes Appear to Be Leveling Off

Since the passage of the Patient Protection and Affordable Care Act of 2010, there has been much speculation that an increasing number of small and medium-sized employers would convert their health plans from fully insured to self-insured arrangements. Small and medium-sized employers were already less likely to offer health benefits because of affordability issues, and when they were offered, they were much less likely than larger employers to self-insure. In a review from 1996–2024, this Fact Fact examines the number and size of firms implementing self-insured health plans.