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Changing Trends In Employer-Sponsored Insurance Before and Since the Great Recession- Colin Planalp
- 1. CHANGINGTRENDS IN EMPLOYER- SPONSORED INSURANCE BEFORE AND SINCETHE GREAT RECESSION Colin Planalp, MPA State Health Access DataAssistance Center (SHADAC) University of Minnesota, School of Public Health Minnesota HSR Conference March 3, 20153/6/2015
- 2. Acknowledgments Co-authors: • Julie Sonier, Minnesota Management and Budget (work conducted while at SHADAC) • Brett Fried, SHADAC “State-levelTrends in Employer-sponsored Health Insurance: A State-by-state Analysis” • www.shadac.org/ESIreport2015 Supported by a grant from the RobertWood Johnson Foundation 2
- 3. Background Concerns voiced about ACA effects on ESI What were trends before implementation of ACA? • Decline in ESI since early 2000s • But did those trends change more recently? 3 -New York Times, Oct. 8, 2014
- 4. Research questions 4 Has ESI changed since the Great Recession? 1. Did ESI trends differ pre- and post-recession? 2. How did trends vary by worker and employer types? 3.What were the drivers of worker ESI trends pre- and post-recession?
- 5. Study timeline 5 Early 2000s - decline of ESI begins 2014 - Full ACA implementation 2007-2009 - Recession 2004/2005 2012/20132008/2009
- 6. Study timeline 6 Early 2000s - decline of ESI begins 2014 - Full ACA implementation 2007-2009 - Recession Pre-recession Post-recession
- 7. Data source Medical Expenditure Panel Survey- Insurance Component (MEPS-IC) • National survey of private and public employers about ESI offers, eligibility, enrollment, cost, plan characteristics • Sponsored by the Agency for Healthcare Research and Quality Our analysis: • Focused on private-sector employers • Uses 2-year averages to improve precision of estimates 7
- 8. Findings: Employer offers of ESI 8
- 9. Employers offering ESI 9 55.7% 42.7% 95.9% 55.7% 42.1% 96.4% 50.0% 35.0% 95.8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Total employers Small employers Large employers 2004/2005 2008/2009 2012/2013 Significant increase Significant decrease at 95% confidence level
- 10. Factors in worker ESI: Offer, Eligibility, andTake-up 10
- 11. Factors in worker ESI coverage 11 Offer Eligibility Take-up 1. Does a worker’s firm offer coverage? 2. Does the worker meet eligibility for coverage? 3. Does the worker take up that coverage?
- 12. Worker Offer, Eligibility andTake-up 12 86.8% 78.5% 79.7% 87.7% 78.8% 77.8% 84.8% 77.8% 75.3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Offer Eligible Take-up 2004/2005 2008/2009 2012/2013 Significant increase Significant decrease at 95% confidence level
- 13. Trends by worker, employer type 13 Part-time workers begin with lower offer, eligibility and take-up • Take-up: PT saw greater post-recession drop (6.8 point drop vs. 2.1 point drop) Workers in small firms begin with lower offer • Offer: Small firm saw greater post-recession drop (7.6 point drop vs. 0.8 point drop)
- 14. Drivers of workers’ ESI coverage rates 14
- 15. Drivers of Workers’ ESI coverage 15 Pre-recession period (2004/2005 to 2008/2009) Post-recession period (2008/2009 to 2012/2013) Offer Eligibility Take-up Offer Eligibility Take-up Total Part-time Full-time Small firms Large firms Number of dots shows relative impact (e.g., one dot is smallest impact, three dots is largest impact). Color of dots shows direction of impact (e.g., green has positive effect on ESI coverage, red has negative effect on ESI coverage).
- 16. Drivers of Workers’ ESI coverage 16 Pre-recession period (2004/2005 to 2008/2009) Post-recession period (2008/2009 to 2012/2013) Offer Eligibility Take-up Offer Eligibility Take-up Total Part-time Full-time Small firms Large firms Number of dots shows relative impact (e.g., one dot is smallest impact, three dots is largest impact). Color of dots shows direction of impact (e.g., green has positive effect on ESI coverage, red has negative effect on ESI coverage).
- 17. Drivers of Workers’ ESI coverage 17 Pre-recession period (2004/2005 to 2008/2009) Post-recession period (2008/2009 to 2012/2013) Offer Eligibility Take-up Offer Eligibility Take-up Total Part-time Full-time Small firms Large firms Number of dots shows relative impact (e.g., one dot is smallest impact, three dots is largest impact). Color of dots shows direction of impact (e.g., green has positive effect on ESI coverage, red has negative effect on ESI coverage).
- 19. Minnesota: Employers offering ESI 19 54.0% 55.7%54.5% 55.7% 49.6% 50.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Minnesota U.S. 2004/2005 2008/2009 2012/2013 Significant increase Significant decrease at 95% confidence level
- 20. Minnesota: Worker Offer 20 88.7% 86.8%87.7% 87.7% 84.9% 84.8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Minnesota U.S. 2004/2005 2008/2009 2012/2013 Significant increase Significant decrease at 95% confidence level
- 21. Minnesota: Worker Eligibility 21 76.8% 78.5%78.6% 78.8% 75.4% 77.8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Minnesota U.S. 2004/2005 2008/2009 2012/2013 Significant increase Significant decrease at 95% confidence level
- 22. Minnesota: WorkerTake-up 22 79.3% 79.7%78.1% 77.8% 73.6% 75.3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Minnesota U.S. 2004/2005 2008/2009 2012/2013 Significant increase Significant decrease at 95% confidence level
- 23. Conclusions ESI trends have changed since Great Recession • Pre-recession period — relative stability in ESI • Post-recession — consistent declines in ESI Drivers of worker ESI coverage have changed • Pre-recession period —Take-up was primary driver • Post-recession — Offer was primary driver Policy implications • When assessing impact of ACA, need to consider other factors’ effects on ESI 23
- 24. COLIN PLANALP, MPA RESEARCH FELLOW CPLANALP@UMN.EDU State Health Access Data Assistance Center (SHADAC) University of Minnesota, Minneapolis www.SHADAC.org 3/6/2015
Hinweis der Redaktion
- Probably seen news reports like these—raising concerns that employers are dropping coverage as result of the ACA. There have been concerns raised about the effects of the ACA on ESI. However, before anyone can answer that question, its important to know where ESI was in the lead up to ACA implementation. In the long-term, ESI has been steadily declining since early 2000s. Our question: In light of recent history, particularly the Great Recession of 2007-2009—has that long-term-trend changed.
- We examined ESI at three points in time.
- And we used these three points to look at trends in a period before and during the recession; and a period during and after the recession.
- Used data from the MEPS-IC, a national survey of employers from AHRQ. We examined private-sector employers. And we used 2 year averages (although for simplicity of presentation, I’ll refer to these by one-year).
- The three bars here show the three different time periods we examined. An arrow represents a significant change from the prior year; an up arrow represents a significant increase, and a down arrow represents a significant increase. During the pre-recession period, we found no significant changes in employers offering coverage. During the post recession period we found significant declines among employers as a whole, as well as small and large employers. The decrease was much larger for small employers – 7.7 percentage points vs. 0.6 percentage points for large firms.
- In examining trends among workers, we looked at the three factors that determine whether a worker is covered by ESI.
- You can see here the relationship of those three components—how the gradually narrow the number of workers with ESI. First, whether a workers’ employer offers coverage. Second, whether a worker is eligible for the coverage. Third, whether a worker chooses to enroll in that coverage.
- In the pre-recession period, the factors affecting worker ESI coverage were mixed – more workers were employed in firms that offered coverage, the percent of workers eligible for coverage was statistically stable, and fewer workers were taking up coverage. During the post-recession period, however, all three factors of offer, eligibility and take-up were down significantly.
- Here we see the differences between PT and FT workers. PT workers in 2005 were already had lower offer, eligibility and take-up. On top of that, they saw a much larger post-recession decline in take-up – more than 3 times larger. Workers in small and large firms have similar eligibility and take-up, but those in small firms have lower levels of offer. Then post-recession, they experienced a decline in offer that was more than 9 times as large as their counterparts in large firms.
- Here, we are going to look how offer, eligibility and take-up impacted workers’ ESI coverage rates. We did this using a mathematical decomposition analysis.
- The number of dots tells you the size of the factors’ impact on ESI coverage, with one dot being the smallest impact and three being the largest. The color of the dots tells you the direction of the impact. A green dot denotes a positive impact on ESI coverage, while a red dot denotes a negative impact. For U.S. workers as a whole, take-up had the largest impact on ESI coverage—a negative one; however, this decreasing take-up was balanced out by increasing offer and eligibility.
- During the post-recession period, the declining number of workers whose employers offered coverage had a greater impact. You also can see that in this period, all three factors had a negative impact on ESI coverage.
- In the interest of time, I won’t describe the results by worker and employer type, but you can find them in SHADAC’s 2015 ESI report if you are interested.
- Minnesota largely mirrors the overall national trends in ESI. However, it becomes harder to detect significant changes by job-type and firm-size because the sample sizes are smaller.
- The trends in Minnesota employers as a whole are very similar to U.S. employers, with stable offers pre-recession and significant decreases post-recession.
- Even though Minnesota did not experience a significant pre-recession increase in workers whose employer’s offer coverage, its post-recession trend is very similar.
- There was no significant change in the pre- or-post-recession period in Minnesota for worker eligibility for ESI.
- In worker take-up of ESI, Minnesota experienced a significant decline in the post-recession period, similar to the U.S. However, Minnesota didn’t experience a significant change in the pre-recession period.