EBRI Issue Brief

Trends in Self-Insured Health Plans Since the ACA

Sep 30, 2021 9  pages


How has the Patient Protection and Affordable Care Act of 2010 (ACA) affected trends in the availability of and enrollment in self-insured health plans among private-sector establishments offering health plans and their covered workers? Using data from the Medical Expenditure Panel Survey - Insurance Component (MEPS-IC), this paper examines recent trends with a particular focus on 2013 to 2020.

Key findings:

  • The percentage of all private-sector establishments offering health plans increased through 2016 but has ebbed and flowed since.
  • Between 2013 and 2016, the percentages of small and medium-sized establishments offering at least one self-insured plan both increased.  They have also bounced up and down since.
  • Between 2013 and 2017, the self-insurance trend for large establishments declined. A rebound started in 2018, but the rebound did not hold in 2020.
  • Overall, the percentage of workers in self-insured plans has been bouncing around between 58 percent and 60 percent since 2013.
  • Self-insurance varied substantially by state.  Overall, the percentage of private-sector enrollees in self-insured plans ranged from 34.8 percent in Hawaii to 72.7 percent in North Carolina.