The Employee Retirement Income Security Act of 1974 (ERISA) provided the legal framework for the uniform provision of benefits by employers doing business in the United States. This uniformity allows multistate companies to “self-insure” health plans, and the passage of the Affordable Care Act of 2010 (ACA) created speculation about increased adoption of self-insured plans among small and medium-sized employers. This Fast Fact, drawing from a recent EBRI report, examines trends in self-insurance offerings from 2010 to 2023.