Trends in Enrollment, Offers, Eligibility and Take-Up for Employer-Sponsored Insurance: Private Sector, by State Medicaid Expansion Status, 2008-2015

From 2008 to 2015, the percentage of U.S. private-sector employees enrolled in a health insurance plan offered by their employer (enrollment rate) fell from 53.9 percent to 47.8 percent.. Declines in the percentage of employees who worked in an establishment that offered insurance (offer rate), the percentage of workers in offering establishments who were eligible for insurance (eligibility rate), and the percentage of eligible workers who enrolled in offered coverage (take-up rate), all contributed to the 6.1 percentage point drop in the enrollment rate. In spite of the steady decline from 2008 to 2015, employer-sponsored insurance (ESI) remains the primary source of health insurance coverage for individuals under age 65. The passage of the Affordable Care Act (ACA), in March 2010, provided an additional source of health insurance for many non-elderly adults by expanding Medicaid eligibility to adults with incomes up to 138 percent of the federal poverty level. The ACA's Medicaid expansion is optional, and the decision of whether to expand Medicaid, as well as the timing of expansions, varies across states. By the end of 2015, 29 states and the District of Columbia had expanded Medicaid, with the majority-20 states-expanding Medicaid eligibility on January 1, 2014. Expanded Medicaid eligibility may alter employers' incentives to offer insurance and may also alter employees' incentives to enroll in offered coverage. This Statistical Brief uses data for private-sector establishments in the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) to compare ESI trends across states that expanded Medicaid (expansion states) and states that did not expand Medicaid (non-expansion states). We categorized states as 'expansion states' if they expanded their Medicaid program any time between March 2010 and December 2015. This report examines ESI trends from 2008-two years before the first ACA-related Medicaid expansions-through 2015, the most recent year for which MEPS-IC data is available. We begin by comparing trends in ESI enrollment rates across expansion and non-expansion states. Then we examine whether trends in offer rates, eligibility rates and take-up rates contributed to differential trends in enrollment rates across expansion and non-expansion states. . In addition to overall trends, we examine trends for subgroups of private-sector establishments defined by firm size and wage level. In some cases, differences noted in the text may vary slightly from calculations due to rounding. Unless otherwise noted, all differences described in the text are significant at the p < .05 level, or better.