Issue Briefs
Self-Insured Health Plans: Recent Trends by Firm Size, 1996-2016
Since the passage of the Patient Protection and Affordable Care Act of 2010 (ACA), there has been speculation that an increasing number of small and midsized employers would convert their health plans from fully insured to self-insured plans. The rationale has been that several of the key ACA components—creditable coverage, affordability, essential benefits, and various taxes and fees—would drive up the cost of health coverage, thus possibly making self-insurance (which is viewed by many as generally less expensive than fully-insured alternatives) a more attractive alternative for many employers. While the percentages of smaller establishments with at least one self-insured plan did indeed increase between 2015 and 2016, self-insurance in large establishments declined. As a result, the overall percentage of enrollees in self-insured plans fell from 60 percent to 57.8 percent between 2015 and 2016. Read the full article and accompanying Fast Fact.
Has Enrollment in HSA-Eligible Health Plans Stalled?
Are we seeing fewer enrollments in HSA-eligible health plans? It’s hard to tell. Some surveys look at year-over-year growth of enrollment in HSA-eligible plans, which seems to be leveling off. Other surveys look at the number of health savings accounts being established, which continues to rise – for instance, EBRI finds that 21 percent of all HSAs were established in 2016. Are plan participants driving these differences as they change jobs and/or dis-enroll from HSA-eligible plans while maintaining ownership of existing HSAs and establishing new ones with new plans and / or new employers? What role does public policy play? )