Declines in Employer‐Sponsored Insurance between 2000 and 2008: Examining the Components of Coverage by Firm Size

Abstract

Objective. To examine trends in employer-sponsored health insurance coverage rates and its associated components between 2000 and 2008, to provide a baseline for later evaluations of the Affordable Care Act, and to provide information to policy makers as they design the implementation details of the law. Data Sources. Study Design. We examine time trends in employer offer, eligibility, and take-up rates. We add a new dimension to the literature by examining dependent coverage and decomposing its trends. We investigate heterogeneity in trends by firm size. Data Collection. The MEPS-IC is an annual survey, sponsored by the Agency for Healthcare Research and Quality and conducted by the U.S. Census Bureau. The MEPS-IC obtains information on establishment characteristics, whether an establishment offers health insurance, and details on up to four plans. Principal Findings. We find that coverage rates for workers declined in both small and large firms. In small firms, coverage declined due to a drop in both offer and takeup rates. In the largest firms, offer rates were stable and the decline was due to falling take-up rates. In addition, enrollment shifted toward single coverage and away from dependent coverage in both small and large firms. For small firms, this shift was due to declining offer and take-up rates for dependent coverage. In large firms, offers of dependent coverage were stable but take-up rates dropped. Within the category of dependent coverage, the availability of employee-plus-one plans increased in all firm size categories, but take-up rates for these plans declined in small firms.

Impact of Premium Subsidies on the Take-up of Health Insurance: Evidence from the 2009 American Recovery and Reinvestment Act (ARRA)

“…We expect that the ARRA subsidy only affects those who are eligible for COBRA, but given our identification only comes from comparing take-up between time periods, the use of a control group is very important for disentangling the policy effect from other changes over time that affected unemployed workers, such as fewer job opportunities in tight labor markets, as well as the declining take-up of employer insurance in general (Vistnes et al, 2012). Gruber and Madrian (1997) use the same control group as ours (those losing jobs at the same time but not eligible for COBRA) in their study of the effect of the COBRA law itself.…”

E‐Verify mandates and unauthorized immigrants' health insurance coverage

“…In addition to affecting whether an unauthorized immigrant is employed, state E‐Verify mandates may affect unauthorized immigrants' health insurance coverage by altering the types of jobs available to these individuals. In 2008—the year of the first universal E‐Verify mandate—87% of employees were offered employer‐sponsored health insurance (Vistnes et al, 2012). Yet this statistic masks substantial variation by firm size.…”

Men as Dependents? Marriage and Changes in Health Insurance Coverage among Working-age Adults in the United States, 1988 to 2008

“…Employer offers of health insurance for workers have fluctuated in recent decades (Vistnes et al 2012), but the trend in premium costs for workers is clear: ESI insurance premiums grew faster than wages or inflation for almost every year from 1988 to 2007 (Buchmueller and Monheit 2009). All else equal, these changes are expected to reduce ESI coverage rates and increase uninsurance rates for working-age adults.…”