I am working on a reported piece that looks at how employer-sponsored insurance (ESI) is changing and how it compares to insurance offered on the ACA exchanges [update: here it is]. The basic framework is provided by the Kaiser Family Foundation's 2014 Employer Health Benefits Survey. Here are the premises as they now stand. Informed input welcome!
1. The ACA has not strongly driven premium increases or cost-shifting to employees in ESI -- though employers offering more generous plans are beginning to react to the Cadillac tax, which takes effect in 2018. While premiums, deductibles and out-of-pocket (OOP) expenses have risen steadily, premiums rose more steeply from 2004 to 2009 than from 2009-2014, and deductibles have risen more or less steadily. The phase-out of grandfathered plans that don't comply with ACA coverage rules has meanwhile proceeded steadily; in 2014, just 26% of workers covered by ESI plans were in grandfathered plans, down from 36% in 2013, 48% in 2012 and 56% in 2011.
2. All that said, the constant cost-shifting has hit employees at small firms particularly hard. On average, they pay deductibles almost twice as high as employees of larger firms (an average of $1797 for individual coverage at firms with 3-199 employees, vs. $971 at larger firms). A higher percentage of small-firm employees (3-199 employees) remain in grandfathered plans (35% vs. 22% in larger firms).
1. The ACA has not strongly driven premium increases or cost-shifting to employees in ESI -- though employers offering more generous plans are beginning to react to the Cadillac tax, which takes effect in 2018. While premiums, deductibles and out-of-pocket (OOP) expenses have risen steadily, premiums rose more steeply from 2004 to 2009 than from 2009-2014, and deductibles have risen more or less steadily. The phase-out of grandfathered plans that don't comply with ACA coverage rules has meanwhile proceeded steadily; in 2014, just 26% of workers covered by ESI plans were in grandfathered plans, down from 36% in 2013, 48% in 2012 and 56% in 2011.
2. All that said, the constant cost-shifting has hit employees at small firms particularly hard. On average, they pay deductibles almost twice as high as employees of larger firms (an average of $1797 for individual coverage at firms with 3-199 employees, vs. $971 at larger firms). A higher percentage of small-firm employees (3-199 employees) remain in grandfathered plans (35% vs. 22% in larger firms).