Chairman Good, Ranking Member DeSaulnier, and Members of the subcommittee, I am Paul Fronstin, Director of Health Benefits Research at the Employee Benefit Research Institute (EBRI). I am pleased to appear before you today to testify on ERISA’s 50th Anniversary: The Value of Employer-Sponsored Health Benefits. Established in 1978, EBRI is committed exclusively to data dissemination, policy research, and education on financial security and employee benefits. Consistent with our mission, EBRI does not lobby or advocate specific policy recommendations: The mission is to provide objective and reliable research and information. All of EBRI’s research is available on the internet at www.ebri.org.
Employers’ commitment to worker health established its roots many years ago. Early examples of employment-based health programs include the mining, lumbering, and railroad industries during the late 1800s (Institute of Medicine, 1993). Employers in these industries provided company doctors funded by deductions from workers’ wages. Employers had a practical interest in providing health services to injured or ill workers, who often worked in remote geographic regions.
It was during World War II that employers began to offer more formal health coverage. Because the National War Labor Board (NWLB) froze wages, employers sought ways to get around the wage controls to attract scarce workers (Helms, 2008). In 1943, the NWLB ruled that employer contributions to insurance did not count as wages and thus did not increase taxable income, and they were not subject to the wage freeze. As a result, health insurance became an attractive means to recruit and retain workers. Employers began to offer health coverage to their workers to be competitive in the labor market, and the number of persons with employment-based health coverage started to increase. By the end of the war, health insurance coverage in the United States had tripled (Weir, Orloff, and Skopol, 1988).
It has also been suggested that the tax-preferred status of employment-based health coverage led to the rise in its prevalence and comprehensiveness (Gabel, 1999) and that the tax-exempt status of health coverage has encouraged employers to offer it and to provide more comprehensive coverage than they otherwise would have (Sheils and Haught, 2004).
Employers today offer health coverage because of their belief that offering it has a positive impact on the overall success of the business. And it can be argued that the Employee Retirement Income Security Act of 1974’s (ERISA’s) pre-emption of state law has created an environment of national uniform standards for employee benefit plans, thus giving employers the regulatory means to continue to offer health benefits as they do today.
There were questions as to whether employers had reached a tipping point with health benefits in 2007 (Fronstin, 2007). At the time, there were numerous references to the “death” of employment-based health benefits. Not long after, the Patient Protection and Affordable Care Act of 2010 (ACA) was passed, and similar debate ensued on whether employers would stop offering coverage. There were also contrary views at the time.
In this testimony, I examine trends in the availability of employment-based health coverage. I also examine employer sponsorship of coverage and employee eligibility for coverage, as well as other questions.
Figure 9 Overall Satisfaction With Current Health Insurance Plan, 1998 –2023 Figure 5 Figure 7 Extremely or Very Satisfied Some Figure what Sa3 tisfied Not Too or Not At All Satisfied Percentage of Private-Sector Establishments That Offer Health Cha As ifor Incre n top p hi irma ro as p s vi os e te d n de s itng from G dimony oo t o he dg , 9 a ro 2 Ra , lt.7 up I h nk e b p xco e ie a ng ne rce mi ve fi M ne ra nt ts eg mb t t a e o re nd , 9 e nd he 5 r wo .6 s a De li tul n p h S e d a tirce he ns ul like ni ura nt ae lva y . rnce ,S cl i la a ios mi nd b p ie lla urch iltM y ry le y, wa of m atb t s e he ch e e mp d rs p ti lhe n e of oyme rce tihe r the nt co nt i a nd mp sg ub -b e ivi e a co of t d sie t ua mmi or e dmp ls he ma tto lta oye elrke td eh e , rs tt co Ie ta rmi wi e ve m nd tra ne h Psg a tu eo.l I Appendix: Figures Testimo Percent ny ag to e of th Priv e Ho ate-Secto use r C Wo orkers Elig mmitte ibe le fo or Healt n Educ h Insu atio rance, n a by nd the 70% Percentage of Private-Sector Establishments That Offer Health Insurance, by Establishment Size, 1996 –2023 a Fro b ne 1l,0 e s x o 0 s ns tome 0 e st x tior n, e ap mi wha more s Di .n re et ct e l e mp e or smp s of lg oye le oye H ne r ee ro a ss lp tus h ons offe .B P e or ri ne lang sn h fisi tp he s p of urch Re altco sh ea ve a b srch e era n de g ia fi n ett s ta the he nd incre iEm nd emp aivi p se lld oye oye dua from le e ma B ele ig rke 9 ne i6 b.7 fi itlt i t ap y Re ve efor rce s ra ea g co nt rch e ve a to n I ra ns 9 ag 7 ct te .6 iua t, ut a pri s e e a rce we l nt ll . Establishment Size, 1996 –2013 Insurance, 1996 –2023 Workforce on behalf of the Employee Benefit Research Fewer Than 10 Employees 10 –24 Employees 25 –99 Employees 100 –999 Employees 1,000 or More Employees 61% Figure 1 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 va (E asB lue ot RI he ). of r I7 qa 6 ue m pse p trce ilons eant s. e d (F tro o ns aptp in, eaH r a bg ee fore n, e you t al.,t o 2d 0a2y 1) to . testify on ERISA’s 50th Anniversary: The 59% 60% 57% 57% 70% W Coo nc rke lusi r El on ig ibility for Health Benefits Percentage of Persons Under Age 65 With Employment-Based Institute 55% 55% 55% Value of Employer-Sponsored Health Benefits. Established in 1978, EBRI is committed 53% 53% Health Coverage, 1970 –2022 97.6% Several 96.7% factors may explain the slightly lower AV typically seen in the individual market. First, Employment-Based Health Benefits System Most Common Source of 100% 51% 51% 51% 51% 51% 90% 50% 50% 50% exclusively to data dissemination, policy research, and education on financial security and 49% 49% 49% 49% 49% T De he sp co itemmi thet me ove nt ra lof l de emp cline loye in rs the to p wo erce rke nt r ahe gea lof th swa ma sl lie ni r te ia mp lly ld oye rive rsn offe by p rira ngct he ica all tne h e co dve s. ra The ge , 59.3% 48% 50% 60% 58.4% NHIS CPS Annual Premium Changes consumers may have more choices in the individual market than would typically be offered by 46.0% 58.3% 5746% .2% 95.6% Health Coverage 56.3% 56.4% 56.2% employee bene 55.2fi %ts. Consistent with our 55.8mi % ssion, EBRI does not lobby or advocate specific t forma he pelirce z92.7% atnt ion agof e of hewo alth rke co rs ve era mp ge loye duri d ng by Wo priva rldt e Wa -ser ct II or , fac emp ilitla oye tedr sb who y wa g we e re co nt eliro gilb sl e a nd for health 55.0% 55.1% 53.8% an emp 80% 5l2oye .9% r, including benefit offerings with lower actuarial values. Second, while the tax 52.4% Statement of Paul 51 .0 Fro % nstin 51.1% 85% 80% policy recommendations: The mission is to provide objective and reliable research and 50.1% s bub ene se fiq ts ue (t nt he t a exli g re ibgilul ity atra ions te) , ha sets tb he ee s n ta mos ge for tly co the ns wi tad nt e ssp ince re49 ad .9 1 % a 9d 9op 6, tva ion ryof inghe from alth ab e low ne fiof ts 7 b5 y .4 There is no comprehensive dataset on employment-based health benefits that allow 49.2%s us to go 40% 50% 43% 48.3% cre dit is80.8% linked to the consumer’s income, it is also based on the second lowest cost silver 42% 47.5% 46.9% 47.4% Director, Health Benefits Research 41% 46.8% 46.3% 70% 40% 45.7% 76.7% information. All of EBRI’s research is available on the internet at ww 45.3w. % ebri.org. p emp erce loye nt irs n . 2T 0hi 14 s tfram o a hi ewo gh rk of wa 81s.3 re 39% pinf erce orce ntd i n by 19t9 he 6 (F paig ss ure age 6 of ). T ERI he39% SeA, lig 39% whi ibilit ch y ra pro tevi ha desd not a back to 38% the days 38% around the 38% passage of ERISA. However, t38% wo data source 38%s allow us to track policy, meaning that 37% it is a fixed numb 37%er of dollars. Cons 37% umers can use their tax credit to Employee Benefit Research Institute, Washington, DC 36% 80% 35% 34% 34% co cha ns ng ise te dnt much regul b ae tor cay useenv of iro the nme dint stri for bute ion mpof loye wo e rke bene rs fi ske t pwi lang ns. toward larger employers. 60% 60% 64.9% one data point — the percentage of people un 33% der ag 33% e 65 (the non-Medicare population) 33% going 40 30% % p Emp urch loye asers a’ co pol mmi icy of tme any nt tme o wo talrke tier r,he and alt h whi eslte a b ma lishe nyd choo its ro seot ssil ve ma r, ny a s ye iza ars bl ea g nu o.mb Eaerlr y pe urch xamp asle e s 30% 29% 29% b ack to 1970. The percentage of the nonelderly population with employment-based health b of roenze mp,l oyme becaus nt- eb tahe se d p re hemi alt um h pa ro ftg era r a ms pp ilncl ying ud te he the ta x mi cre ning dit, ilsumb ofte en ring zero , a nd or cl ra os ilro e a to d iitnd . T us hitrd rie , s T De he sp p i 50 tee % rce pre ntdaict geions of wo of rke a drs ecl eine ligi, btle he for emp hela oym lth co ent ve -b ra ag se ed b he y e asltth abco lisve hme rag nt e s sys izet eis m show has n in 51.8% 75% bene 30fi %ts was at or near 70 percent from 1970 to 1989 (Figure 1). Between 1989 and 2007, it 20% d buri eca ng us e the the la tte a x1 cre 800dsi t(I isns bta itsut ed e on of M a e sd ilve icine r p,ol 1993) icy wi. tEmp h an loye actua rs ri in alt he valsue e ind of us 70t ri pe esrce pro ntvi , d ite id s Fi de gmons ure 40%s t7ra atnd ed 8 co . nt Whi inu lee d e lire gis biilliie ty ncra e. te Tshe tre ACA nded p ro dow mpnwa ted rd a d in ebaa llt e fi rm about size is ts b p eot twe ent en ial1 i9 mp 96a a ct nd , ye t 16% 40% 14% 13% 13% 13% 13% varied between 68 percent and 62 percent. Since 2007, it has varied between 62 percent and 12% 12% 12% 12% 12% 12% 12% co typ mp icaa llny y t he doc ca tor se s t fu ha nt d e the d b co y d ns eume ductir ons purch from asewo s erke ithe rsr ’ a wa sig lve esr . or Emp a b loye ronze rs ha pol d icy a p a ra nd ct ionl cal y p 20 re 1d 3i ct (F ions igure tha 7), t etmp hey loye have rs wo bee ul n dt re rend duce ing t he upiw r a he rda lstih nce be ne (Fifi gture s offe 8).ri ng Wo srke hars ve i n not la rg fuell y firms were 11% 11% 11% 11% 11% 11% 11% 11% 10% 70% 34.2% United States Hous 10% e of Rep 10% resentatives 9% 20% 58 p 10e %rcent, and it was 61 percent in 2022. 30% ira ntre ere ly sttra in de psro up vid tio nga he gol ad lt h pol seicy. rvice Fo s urt to h, injure eved n or un d ille wo r the rke Ame rs, who rica n oft Re en scue wo rke Plad n iAct n re (mot ARPeA ) mos mate t ri lia ke lizly ed t. o T bhe e e re ligce ibnt le for data he ind altih cabte ene tha fitts, . aH ltow houg eve h r,t he eve pn erce thoug ntag h es ma of e llmp em loye ploye rs rs offe we rirng e l east 20% 22.5% cre geog ditra s,p b hi ut c re ceg rt ions ainl.y under the original ACA tax credit income levels, some people simply did Committee on Education and the Workforce lhe ike ally th to be offe nefi r ts he ha alt sh db ee clne ine fid ts, , two he rke eligrisb iiln ity sma ratle le sr for firms co ve we ra re g ea la mo mong st a swo like rke ly rs a sha wo verke rers ma in ine lad rg e The d 20 e % clines in coverage that occurred in the 1990s and early 2000s coincided with relatively 65% 10% 0% not qualify for a ta Sx ub cre cod mmi it and tte e ha on d tH oe p aa lty h, the Emp ent loyme ire pnt re, mi La um bor a,mount and P.e ns The ions y ha ve been more re firms lative to ly be st a eb lig leib . lT ehi for s she tab ailltit h y bis e ne larg fite sl y whe due n tto hety hewe co re nt offe inuere d d p. ro Tmi hisne pnce henome of lanon rge fi isrms due , whi to ch high incre 1998a1s 9e 99s2 0i0n 0 2he 001a 20lt 0h 2 20ins 03 2ura 004 2nce 005 20 0p 6re 200mi 7 20ums 08 200, 9 t 20houg 10 2011h 201t2he 201re 3 2 0we 14 2re 015 2ye 016a 2rs 017, 2s 01uch 8 2019a 2s 02 0129 029 17 20– 22220 00 230, It was during World War II that employers began to offer more formal health coverage. 10% 0% likely to purchase a lower AV policy. a hi re st or more ica1l9 9mi l6ike 19ni 97ly mum 199t8o 19offe 99p 20a 00rt r 2he i 0ci 01p 2a 0a l 0t 2th i 2on 00b 3e 20a ne 0nd 4 2fi 00 t 5mi s 2. 0 0ni 6 2mum 007 2008 2co 009nt 201ri 0 2b 01ut 1 2i0on 12 20re 13 2q 01ui 4 2re 015me 2016nt 201s 7 2i0n 18t 2he 019 20s 2t 0a 20t2e 1s 20. 22S 2t 0a 23tes when the correlation was far from perfect. 60% Because the National War Labor Board (NWLB) froze wages, employers sought ways to get 0% Fewer Than 10 1,000 or More Less Than 50 Source: Various Employee Ben 10 efi –t 24 Res Ee m arc plh oy In ee stis tute surv 25 ey –s99 . Employees 100 –999 Employees 0% generall 1y 996re 19q 97ui 199re 8 1 9t 9ha 9 200t0 a 20 0mi 1 20ni 02 mum 2003 2004p 20e 05rce 2006nt 200a 7g 20e 08 of 2009wo 2010rke 2011rs 201 2offe 2013 2re 014d 2 0co 15 2ve 016ra 201g 7 2e 0 18mus 2019 2t 0 2e 0nrol 2021 20l 22or 20 2ha 3 ve Employees Employees Employees around the wage controls to attract scarce workers (Helms, 2008). In 1943, the NWLB ruled E Whi RISA le the a la t 50 ndsca pe of employment-based health benefits is evolving, it remains a cornerstone Source: Medical Expenditure Panel Survey - Insurance Component (MEPS-IC). The more recent stability in premiums coincided with stability in the percentage of the Source: Medical Expenditure Panel Survey - Insurance Component (MEPS-IC). coverage from another source. As a result, it is common for small employers to offer coverage Refere Sonc urce:e Mes dic al Expenditure Panel Survey - Insurance Component (MEPS-IC). -10% that employer contributions to insurance did not count as wages and thus did not increase of the American health insurance system. nonelderly population with employment-based health coverage. In 2022, employment-based ERISA’s 50th Anniversary: The Value of Employer-Sponsored Health t ERI o aS llA wo eff rke ect rs ive , a ly nd p re it e ismp als ts o smore tate aco nd mmo locan l re thg aul n ain tion larg of er se filrms f-fu nd for ed the , e mp emp loye loye r-r pro to vi pd ae y dt he he alth taxable income, and they were not subject to the wage freeze. As a result, health insurance Fronstin, SouP rca e:ul ww. w.c2 dc0 .g0 ov7 /n. chs"T /data he /nh sr/n Fut hsr0ure 17.pd f aof nd Em Emp ployeel oyme Benefit Resnt earc -B h Ina ss titue ted e stiH me atea s l fro th m thB e e Curre ne nfi t Po ts pu:la tiH ona Su ve rve y.Employers health coverage continued to be the most co Figure mmon 6 source of health coverage, whether Benefits b Cha ent ene ire irma fi tp sre .n T mi G he oo um sdco , for Ra penk e of mp ing thi loye s M ha eemb -s onl g ee r y ne De co ra ve Stae rul d ani g see ome . r, a nd de g M re ee m of bers de of batte he . Psro ub pco one mmi ntst tof eeERI , tha Snk A you Figure 8 became an attractive means to recruit and retain workers. Employers began to offer health Percentage of Privat Figure e-Secto 4 r Workers Eligible Reached a Tipping Point?" EBRI Issue Brief, no. 312 (Employee Benefit Research examining the entire population (55 percent covered) or the population under age 65 (61 for the opporPercent tunity to ag ae pof pe a Priv r bat efore e-Secto you r tW od orkers Elig ay. ible for Health Insurance, by preemption point to the creation of a uniform and predictable regulatory environment for for Health Coverage, 1996 –2023 Distribution of Private Figure -Secto 2r Establishments and coverage to their workers to be competitive in the labor market, and the number of persons Institute). Worker Opinions About Health Coverage percent covered) (Figure 2). Among the population under age 65, 21 percent had Medicaid, Establishment Size, 2013 –2023 Percentage of Population, by Health Insurance Source, 2022 Their Employees, 2023 employers concerning their ERISA-governed benefit offerings, while its detractors believe that 90% with employment-based health coverage started to increase. By the end of the war, health 70% 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 while 8 percent had private, non-group coverage, which includes marketplace coverage. 70% DistributionT of ota Elm Ppl op oul ye ati rson Di Un stde ribu r A tion ge of 65 Employees Fronstin, Paul, Stuart Hagen, Olivia Hop Sep pe te , mb and e r Jake 10, 2024 Spieg el. 2021. "The More Things Change, state and 81.3% local governments ought to have a greater role in pursuing health care reform Workers have historically rated their own health coverage as favorable and have 80.5 %cont8i0nu .8%ed to 79.5% 80.3% 78.9% insurance co 79.2ve % rage in the U7ni 8.5t %ed S 7t 8a .5% tes had tripled (Weir, Orloff, and Skop 78.0ol % , 1988). 77.9% 78.4% 78.8% 80% 78.5% 78.1% 78.2%78.0% 77.5% 77.8%77.8% 77.7% 77.6% 77.1% 76.8% the More 61% They Stay the Same: An Analysis of the Generosity 76of .5%Employment-Based 76.0% beyond their current ability to regulate health insurance. 75.4% do so through 2023. Just over one-half (55 percent) of those with health coverage were Employer Sponsorship of Health Benefits 60 90% % 59% 60% It has also been suggested that the tax-preferred status of employment-based health Health Insurance, 2013–2019." EBRI Issue Brief, no. 545 (Employee Benefit Research 70% extremely or very satisfied with their current plan in 2023, and 33 percent were somewhat 55% On Thursday, September 12, 2024, EBRI is releasing the findings from a series of focus groups When examining the period of 1996–2023, the percentage of employers offering health coverage led to the rise in its prevalence and comprehensiveness (Gabel, 1999) and that the Institute). satisfied (Figure 9). Only 12 percent said they are not too satisfied or not at all satisfied. These with 50b %enefits decision makers at large employers (Spiegel and Fronstin, forthcoming). Three 60 85% % benefits was at a near record low in 2023, with less than one-half of employers offering health tax-exempt status of health coverage has encouraged employers to offer it and to provide 50% figures are essentially unchanged since the late 1990s. 46% Gabel, Jon R. 1999. "Job-Based Health Insurance: 1977–1998: The Accidential System Under main themes emerged in the roundtable discussions. First, under ERISA preemption, there is a benefits at that point (Figure 3). However, it is important to put this number in context. During more comprehensive coverage than they otherwise would have (Sheils and Haught, 2004). 50% 40% Scrutiny." Health Affairs 18 (6): 62–74. uniform 80% landscape of regulations, rather than a patchwork of state-level regulations, which Generosity of Health Coverage the same period, 2000 was the year with the greatest percentage of employers offering 40% Employers today offer health coverage because of their belief that offering it has a positive 40% makes it possible for an employer operating in more than one state to administer and offer coverage — 59 percent. And the percentage has ebbed and flowed over time. Institute of Medicine. 1993. Employment and Health Benefits: A Connection At Risk. Edited by EBRI explored trends in actuarial value (AV) — or relative generosity of health plans — in the imp30 act % on the overall success of the business. And it can be argued that the Employee benefits equitably to their employees. Employers view the consistent benefits made possible 75% 30%Marilyn J. Field and Harold T. Shapiro. Washington, DC: National Academy Press. 30% e Tmp he love oyme ralnt l p-e brce asent d ahe gea lof th e co mp veloye rage rs ma offe rke ring t s ince cove 2013 rage i(F s ro hens avi tiln, y inf Ha lue gence n, edt b ay l.,t 2 he 0 2fac 1).t T tha het Retirement Income Security Act of 1974’s (ERISA’s) pre-emption of state law has created an by ERISA preemption as a tool for increasing work force mobility. If a worker for a firm with 21% 19% 19% s ACA mallre eq mp uire loye d e rs mp are loye in rs la wi rge th p5 a0 rt or re s more pons ifu blle l- tfor imet-he eq ui de va clilne ent i n emp cove loye rag ee s . tM o os offe t e r mp helaoye lth rs pl a in ns envi 2 20 ro 0% %nment of national uniform standards for employee benefit plans, thus giving employers Sheils, John, and Randy Haught. 2004. "The Cost Of Tax-Exempt H 21% ealth Benefits In 2004." opera 70% tions in multiple states moves from a satellite office in one state to the company 20% t the hat U pni ro te vid d e Sd ta a te mi s a ni re mum smava ll, lwhi ue lof e mos at leta e smp t 60 lo p ye erce es wo nt. rk In in otlhe arg r ewo firms rds, (F the igs ure e e mp 4). loye rs had to the regH uleaatlor th y Aff me aa irs ns W4 to -co 10nt 6– inu W4 e -t1o 12 offe . r health benefits as they do today. headquarters in another, they know they will have access to a similar menu of benefits. 15% T10 he % views expressed in this statement are solely those of Paul Fronstin and should not be attributed to the 10% 14% 10% provide health plans with at le 8% ast a 60 percent AV. 12% Seco 65nd % , ERISA preemption reduces administrative costs and burdens, thus enabling employers Employee Benefit Research Institute (EBRI) or the EBRI Education and Research Fund, nor any of its programs, 10% The diminishing percentage of employers offering health coverage has been limited to small T Sp he iere ge we l, Jake re q ue and st ions Paul a Fro s to ns whe tin. tFo hert r hcomi employe ng. rs" ERI hadS A rea ache t 50d : a N o tip M piid ng life p Cri oint si swi for th ERI heaS ltA h 9% 10% 8% offic 0% ers, trustees, sponsors, or other staff. The Employee Benefit Re 3%search Institute is a nonprofit, nonpartisan 2% 2% 6% to deliver richer benefits and lower-cost coverage to their workers. Third, ERISA preemption 1% 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 20211% 2022 2023 W emp heln oye the rs . ACA Betwe pas es n ed 1, 99 the 6 a re nd wa 20 s 2co 3, nce among rn tha etmp the loye req rsui wi retme h fe ntwe for r te ha mp n l1 oye 0 ers mp offe loye ring es, he it alth benefits in 2007 (Fronstin, 2007). At the time, there were numerous references to the “death” Preemption." EBRI Issue Brief (Employee Benefit Research Institute). education and research organization established in Washington, DC, in 1978. EBRI does not take policy positions, 0% foste 60rs % innovation that would otherwise be stifled by different states requiring different Empn loy ome r d nt-ba oes s eidt lobPb riy, vate ad nov no -gc roate up specifi Tc RICA poRE licy recommen Medi dca ati reons, or recMe eiv die caf idederal fun Vd A/C in HA g.M PVA d co eve cre ra ag se e So d t u o rcfrom e:p Mero dicvi a3 l Ex d 4p.2 e en d p ip tulre a e ns Pa rce ne lwi nt Survt eh tyo -a In2 t su 2 ra le .5 nca e s Com pte 6 prce o0 ne np nt t (M eEPS . rce It -IC). nt de AV cre a wo seul d d from ince6 nt 4i.9 viz p ee e rce mp nt loye to rs 51 t.8 o re pe drce uce nt of employment-based health benefits. Not long after, the Patient Protection and Affordable Fewer Than 10 Employees 10 –24 Employees 25 –99 Employees 100 –999 Employees 1,000 or More Employees 0% Health Coverage Weir, Margaret, Ann Shola Orloff, and Theda Skopol. 1988. The Politics of Social Policy in the coverages or administrative rules. Fewer Than 10 Employees 10 –24 Employees 25 –99 Employees 100 –999 Employees 1000 or More Employees a the mong gene emp rosilt oye y of rst he witir h p 1l0 ans –2 4 t o emp thel oy 60e p es e, rce and nt ifl t oo der. cre Us aisng ed dfrom ata from 80.8 mos perce tly nt the to l7 a6 rg .7 e p ge ro rce upnt Care Act of 2010 (ACA) was passed, and similar debate ensued on whether employers would Source: Medical Expenditure Panel Survey - Insurance Component (MEPS-IC). United States. Princeton, NJ: Princeton University Press. Source: Employee Benefit Research Institute estimates from the Current Population Survey. a ma mong rket , eEB mp RI loye res rs e a wi rch th s 2how 5–99 ed e mp thaltoy , aese of s (F 20 ig1ure 9, t5 hi)s . I ha n s co not ntra ha stp , p whe enen d.we Bot loo h tk he at alve arg ra eg r e and Source: Medical Expenditure Panel Survey - Insurance Component (MEPS-IC). stop offering coverage. There were also contrary views at the time. Note: The estimates by type of coverage are not mutually exclusive; people can be covered by more than one type of health insurance during the year. Employers remain committed to providing health benefits to employees and their families. If e me mp dlioye an AV rs, we were fi nd ab out tha t8 t3 he p e prce erce ntnt in ag ee a ch witye h a 1r 00 from –9992 0 e1 mp 3–loye 201e 9s . offering health benefits ERISA preemption were eroded, however, benefits executives would worry about higher costs 9 9 9 9 9 9 9 9 9 9 90 0 0 0 0 0 0 0 0 0 01 1 1 1 1 1 1 1 1 1 1 D D D D D D D D D D D Str Str Str Str Str Str Str Str Str Str Stre e e e e e e e e e ee e e e e e e e e e et t t t t t t t t t t, , , , , , , , , , , SW SW SW SW SW SW SW SW SW SW SW, , , , , , , , , , , Su Su Su Su Su Su Su Su Su Su Suit it it it it it it it it it ite e e e e e e e e e e 8 8 8 8 8 8 8 8 8 8 80 0 0 0 0 0 0 0 0 0 02 2 2 2 2 2 2 2 2 2 2, , , , , , , , , , , W W W W W W W W W W Wa a a a a a a a a a as s s s s s s s s s sh h h h h h h h h h hin in in in in in in in in in ing g g g g g g g g g gt t t t t t t t t t to o o o o o o o o o on n n n n n n n n n n, , , , , , , , , , , D D D D D D D D D D DC C C C C C C C C C C 2 2 2 2 2 2 2 2 2 2 20 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 02 2 2 2 2 2 2 2 2 2 24 4 4 4 4 4 4 4 4 4 4 | | | | | | | | | | | ( ( ( ( ( ( ( ( ( ( (2 2 2 2 2 2 2 2 2 2 20 0 0 0 0 0 0 0 0 0 02 2 2 2 2 2 2 2 2 2 2) ) ) ) ) ) ) ) ) ) ) 6 6 6 6 6 6 6 6 6 6 65 5 5 5 5 5 5 5 5 5 59 9 9 9 9 9 9 9 9 9 9- - - - - - - - - - -0 0 0 0 0 0 0 0 0 0 06 6 6 6 6 6 6 6 6 6 67 7 7 7 7 7 7 7 7 7 70 0 0 0 0 0 0 0 0 0 0 | | | | | | | | | | | in in in in in in in in in in inf f f f f f f f f f fo o o o o o o o o o o@ @ @ @ @ @ @ @ @ @ @e e e e e e e e e e eb b b b b b b b b b br r r r r r r r r r ri. i. i. i. i. i. i. i. i. i. i.o o o o o o o o o o or r r r r r r r r r rg g g g g g g g g g g 85.2% 81.2% 1970 1971 1972 1973 1974 1975 1976 1977 81.2% 1978 81.8% 82.8% 1979 1980 77.8% 1981 1982 1983 1984 1985 1986 77.8% 1987 79.0% 1988 1989 79.5% 1990 1991 76.0% 1992 1993 1994 1995 76.0% 1996 81.9% 1997 1998 1999 2000 76.9% 2001 2002 75.3% 2003 2004 75.3% 2005 81.1% 2006 2007 2008 2009 2010 77.9% 2011 2012 2013 78.9% 78.9% 2014 82.2% 2015 2016 2017 2018 2019 2020 2021 79.4% 2022 78.0%