Chartbook #22: Medical Expenditure Panel Survey Insurance Component 2017 Chartbook

Acknowledgments

This chartbook was prepared by Jessica Vistnes, G. Edward Miller, Philip Cooper, Patricia Keenan, and Asako Moriya of the Center for Financing, Access, and Cost Trends (CFACT) in the Agency for Healthcare Research and Quality (AHRQ). Primary editing was performed by Jessica Vistnes and Edward Miller.

The authors appreciate the efforts of Eneli Coakley, Zhengyi Fang, and Bidong Liu of Social & Scientific Systems, Inc. in preparing the exhibits in the chartbook, the data production work of Brandon Flanders of the U.S. Census Bureau, and the production assistance of Doreen Bonnett, Nicole Shulman, and Michelle Roberts of AHRQ.

Reviewers of this publication were Joel W. Cohen, Director of CFACT; Steve Machlin, Director of the Division of Statistical Research and Methods in CFACT; Steve Hill and Julie Hudson, Senior Economists in the Division of Research and Modeling in CFACT; and Sandy Decker and Paul Jacobs, Service Fellows in the Division of Research and Modeling in CFACT.

Table of Contents

The data used in this report are from the Insurance Component of the Medical Expenditure Panel Survey. Information about this survey, including sample design, data collection, sample sizes, and response rates, can be found at https://meps.ahrq.gov/survey_comp/Insurance.jsp.

This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without specific permission of copyright holders.

Agency for Healthcare Research and Quality
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www.ahrq.gov

Suggested Citation

Medical Expenditure Panel Survey Insurance Component 2017 Chartbook. Rockville, MD: Agency for Healthcare Research and Quality; October 2018. AHRQ Publication No. 18(19)-0034. https://meps.ahrq.gov/mepsweb/data_files/publications/cb22/cb22.shtml.

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Introduction

The Medical Expenditure Panel Survey Insurance Component (MEPS-IC) is an annual survey of private employers and State and local governments. The MEPS-IC produces national and State-level estimates of employer-sponsored insurance, including offered plans, costs, employee eligibility, and number of enrollees. The MEPS-IC is sponsored by the Agency for Healthcare Research and Quality and is fielded by the U.S. Census Bureau.

This chartbook provides both single-year and multiyear trend analyses using private-sector MEPS-IC data from 2004 to 2017. To best convey key information from the MEPS-IC, the report is presented in five sections: Health Insurance Offer Rates; Employee Eligibility and Enrollment; Health Insurance Premiums; Employee and Employer Premium Contributions; and Employee Cost Sharing. Each section provides charts and discussion with links to MEPS-IC data tables that contain the estimates and standard errors for each exhibit.

Many of the estimates in this publication are categorized by firm sizes that are relevant to recent changes in national healthcare policy. Note that the firm-size categories used in the charts and tables are based on actual employment counts rather than full-time equivalent (FTE) counts, because the MEPS-IC does not collect FTE employment figures.

Each section discusses the estimates to highlight trends and differences by employer and workforce characteristics. If a comparison of estimates is presented in the discussion, any differences are statistically significant at the 0.05 level, unless otherwise noted. In some cases, differences noted in the text, in estimates as well as statistical significance of comparisons, may vary slightly from calculations performed using data in the exhibits or MEPS-IC data available on the MEPS website due to rounding.

In addition, compared with tests performed in the 2016 MEPS-IC Chartbook, tests performed in this year's chartbook used estimates containing additional digits after the decimal place. This change may have resulted in different conclusions than the 2016 chartbook regarding comparisons of estimates. All dollar estimates are nominal (not adjusted for inflation).

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Background

The IC is one of three annual component surveys that make up MEPS. The other two components are the Household Component (HC) and the Medical Provider Component (MPC). The HC is a nationally representative survey of the U.S. civilian noninstitutionalized population that collects data at both the person and household levels. The MPC collects information from a sample of physicians, hospitals, home health agencies, and pharmacies that provided services to HC respondents.

The MEPS-IC uses two independent samples: the private sector and the public sector. The private-sector sample is composed of about 42,000 business establishments from more than 7 million establishments found on the Business Register at the U.S. Census Bureau, with 5.4 percent of the sample determined during the data collection process to be out of scope. In 2017, the response rate for the private sector was 65.8 percent of the remaining in-scope sample units.

An establishment is a single business entity or location. Firms (also often referred to as companies) can include one or more establishments. An example of a multi-establishment firm is a chain of grocery stores, where the establishments of the firm are the sites of the individual grocery stores. The charts and tables in this publication report characteristics within firm-based size categories.

The public-sector sample of the MEPS-IC selects almost 3,000 State and local government agencies. However, this report focuses only on the private sector. Additional information on MEPS-IC sampling can be found in Sample Design of the 2017 Medical Expenditure Panel Survey Insurance Component (Davis, 2018).

There was no MEPS-IC survey to collect 2007 data due to the transition from retrospective to current-year data collection. This methodological change improved the accuracy and timeliness of the IC estimates. More information about this design change can be found in Switching From Retrospective to Current-Year Data Collection in the Medical Expenditure Panel Survey - Insurance Component (Kearney & Sommers, 2007).

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Data Presentation

For purposes of the analyses presented in this chartbook, the District of Columbia is treated as a State. In addition, exhibits are organized by category (e.g., premium type, firm size), so references to exhibits in the text may not be in numeric order (e.g., Exhibits 3.1, 3.3, and 3.5 instead of 3.1, 3.2, and 3.3).

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References

Davis K. Sample design of the 2017 Medical Expenditure Panel Survey Insurance Component. Methodology Report #31. Rockville, MD: Agency for Healthcare Research and Quality; July 2018. https://meps.ahrq.gov/data_files/publications/mr31/mr31.shtml. Accessed August 17, 2018.

Kearney A, Sommers J. Switching from retrospective to current-year data collection in the Medical Expenditure Panel Survey - Insurance Component. ICES-III: Third International Conference on Establishment Surveys, Conference Proceedings, Montréal, Québec, Canada; June 2007.

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Executive Summary

Overview

Employer-sponsored insurance (ESI) is the primary source of health insurance coverage for individuals under age 65. This chartbook uses data for private-sector establishments in the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) to describe trends in employer coverage, premiums, and benefits from 2004 to 2017. The MEPS-IC is an annual survey of private employers and State and local governments and is designed to be representative of all 50 States and the District of Columbia. The large sample size (about 42,000 private-sector establishments), combined with a response rate of 65.8 percent in 2017, permits analyses of variations in ESI by firm size and across States that are not readily available from other sources.

Examining trends by firm size and across States is important due to variation in insurance markets along these dimensions. Historically, insurance markets have differed by firm size due to smaller firms' more limited ability to pool risk and their higher administrative costs compared with larger firms. State variation in ESI markets may reflect differences in employment patterns, healthcare prices, and utilization, as well as differences in State approaches to regulating private insurance and administering Medicaid.

The period presented in the chartbook, 2004 to 2017, shows trends through a period of change in national healthcare policy that could have affected national ESI trends, as well as trends by firm size. This chartbook describes trends and patterns in ESI overall, by firm size, and by State. All differences noted are at the 0.05 significance level unless otherwise specified. All dollar estimates are nominal (not adjusted for inflation).

Summary of Findings

Employee Enrollment in Health Insurance

Between 2016 and 2017, there was no significant change in the overall percentage of private-sector employees enrolled in a health insurance plan offered by their employers ("enrollment rate"). There was also no significant change in the enrollment rate in any firm-size category.

The enrollment rate reflects the combination of employers' decisions about offering health insurance and employee eligibility for such coverage, as well as employees' decisions to take up coverage if eligible. Offer rates, eligibility rates, and take-up rates, as well as coverage rates among employees offered insurance, are described further below.

Availability of Coverage: Offer Rates

There was no significant change in the overall percentage of employees working at establishments where insurance was offered ("the offer rate") between 2016 (84.3 percent) and 2017 (84.5 percent). In addition, there were no significant year-to-year changes between 2014 and 2016 (Exhibit ES.1).

While there were no significant year-to-year changes between 2014 and 2017, offer rates increased from 83.2 percent in 2014 to 84.5 percent in 2017, after decreasing by 1.7 percentage points from 2013 to 2014. These changes resulted in no significant difference in offer rates between 2013 and 2017. Between 2004 and 2013, the overall percentage of employees who worked for employers that offered health insurance declined from 86.7 percent to 84.9 percent, with almost all of the decline occurring between 2009 and 2012.

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Premiums

In 2017, average annual health insurance premiums per enrolled employee with private-sector employer coverage were $6,368 for single coverage, $12,789 for employee-plus-one coverage, and $18,687 for family coverage. These amounts represent increases of 4.4 percent for single coverage and 5.5 percent for both employee-plus-one and family coverage over 2016 levels (Exhibit ES.8).

The 2016 to 2017 growth rates for single premiums and employee-plus-one premiums (4.4 percent and 5.5 percent, respectively) were higher than the growth rates for these types of coverage from 2014 to 2015 and 2015 to 2016, which ranged from 2.2 percent to 2.7 percent. The 2016 to 2017 growth rate for family premiums (5.5 percent) was higher than the growth rate for 2015 to 2016 (2.2 percent). Between 2004 and 2017, premiums for the three types of coverage grew by between 71.9 percent and 86.8 percent (average annual growth rates of between 4.3 percent and 4.9 percent, data not shown).

From 2016 to 2017, growth rates for all three types of premiums were close to smoothed longer term growth rates (data not shown). Specifically, there were no significant differences between the 2016 to 2017 growth rates and the average annual growth rate from 2004 to 2017 for single coverage (4.4 percent vs. 4.3 percent), employee-plus-one coverage (5.5 percent vs. 4.7 percent), or family coverage (5.5 percent vs. 4.9 percent) (Exhibit ES.9).

From 2010 through 2017, average single premiums were lower in medium firms (50 to 99 employees) than in small (fewer than 50 employees) or large firms (100 or more employees) (p <0.10 for the differences in 2017) (Exhibit ES.10). From 2004 to 2017, there were no significant differences by firm size in the growth of single premiums, as single premiums grew by 70.6 percent ($3,763 to $6,421) in small firms, 66.1 percent ($3,711 to $6,163) in medium firms, and 73.1 percent ($3,684 to $6,377) in large firms (Exhibit ES.10).

In 2004, employee-plus-one premiums were higher in small firms ($7,373) than in medium firms ($6,945) or large firms ($7,002). From 2004 to 2017, however, employee-plus-one premiums grew more rapidly in large firms (83.9 percent) than in medium firms (71.8 percent) and small firms (70.3 percent). By 2017, average employee-plus-one premiums in large firms ($12,878) were higher than in medium firms ($11,931) and small firms ($12,558) (p <0.10) (Exhibit ES.11).

In 2004, there were no statistically significant differences in average family premiums by firm size. However, from 2004 to 2017, family premiums grew faster at large firms than at smaller firms (88.8 percent in firms with 100 or more employees vs. 74.3 percent in firms with 50 to 99 employees and 78.3 percent in firms with fewer than 50 employees). Thus, by 2017, family premiums in the largest firms ($18,911) were about 7 percent higher than in firms with 50 to 99 employees ($17,735) and firms with fewer than 50 employees ($17,649) (Exhibit ES.12).

One factor that may partially explain higher family premiums in larger firms is they are much more likely to offer employee-plus-one coverage than smaller firms (e.g., 95.5 percent of employees in firms with 1,000 or more employees have offers of employee-plus-one coverage compared with 63.8 percent of employees in firms with fewer than 10 employees) (Section 1, Exhibit 1.13). Thus, at large firms, two-person families are less likely to be included in the risk pool for family policies, and average family premiums would tend to be higher than they would have been if two-person families were in the family policy risk pool along with larger families. At many small firms, on the other hand, workers seeking coverage for themselves and a single dependent may purchase a family policy if no employee-plus-one coverage is offered, which would tend to make the average family policy premium lower in those firms.

In total, 12 States had average annual premiums for single coverage that were significantly lower than the national average of $6,368. These States were Alabama, Arkansas, Florida, Georgia, Hawaii, Idaho, Louisiana, Nevada, Oregon, South Carolina, Tennessee, and Utah. Another 8 States had average annual single premiums that were significantly higher than the national average. These States were Alaska, Connecticut, Delaware, Massachusetts, New Jersey, New York, Rhode Island, and Wyoming (Exhibit ES.13).

Employee Premium Contributions

In 2017, enrolled employees paid 22.2 percent of total premiums for single coverage, 27.6 percent for employee-plus-one coverage, and 27.9 percent for family coverage (Exhibit ES.14). The percentages of premiums paid by enrolled employees in 2017 for these three coverage types were not significantly different from their 2016 levels.

Average employee contributions in 2017 were $1,415 for single coverage, $3,531 for employee-plus-one coverage, and $5,218 for family coverage, representing increases of 6.8 percent, 4.6 percent, and 5.3 percent, respectively, over 2016 levels. (Exhibit ES.15).

From 2004 to 2017, the percentage of premiums contributed by employees increased by 4.1 percentage points, 4.0 percentage points, and 3.5 percentage points for single, employee-plus-one, and family coverage, respectively (Exhibit ES.14). This was because employee contributions increased more rapidly than employer contributions over the entire period for each type of coverage (Section 4, Exhibits 4.1, 4.3, 4.4, and 4.5).

Plan Benefits: Deductibles

The percentage of enrolled employees in a health insurance plan with a deductible increased from 2016 (84.5 percent) to 2017 (87.5 percent) (Exhibit ES.16). Except for 2011 and 2016, this percentage increased in every year from 2004 to 2017 (p <0.10 in 2013). From 2004 to 2017, the percentage of enrollees in plans with deductibles increased from 58.7 percent to 87.5 percent.

Among enrollees with deductibles, the average individual deductible increased from $1,696 in 2016 to $1,808 in 2017 (Figure ES.17). The average family deductible increased from $3,069 in 2016 to $3,396 in 2017(Section 5, Exhibit 5.3). Average individual deductibles were higher in small ($2,136) and medium firms ($2,361) than in large firms ($1,681) in 2017. Family deductibles were also higher in small ($4,447) and medium firms ($4,218) than in large firms ($3,195) in 2017.

Conclusion

AHRQ hopes this chartbook helps to make MEPS-IC data more readily usable by providing trends nationally and by firm size, by presenting national and State-level estimates in one document, and by providing additional firm-size cuts relevant to recent policy changes. More information is available at www.meps.ahrq.gov. AHRQ welcomes feedback on additional ways to make the data more usable to the public.

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Section 1: Health Insurance Offer Rates

Availability of Coverage to Active Employees and Retirees

In 2017, almost all employees (98.9 percent) in firms with 100 or more employees worked at establishments that offered health insurance. In comparison, about half (48.3 percent) of employees at firms with fewer than 50 employees worked where health insurance was offered (Exhibit 1.1).

Historically, smaller employers have been less likely to offer coverage than larger employers for a number of reasons, including:

• Smaller risk pools, which result in higher premium costs (holding benefits constant),
• Higher administrative costs, and
• Lack of dedicated staff to select and administer health benefits.

Because of changes in national healthcare policy, employers began facing new incentives regarding their employer-sponsored insurance decisions. For example, starting in 2014 and throughout the 2014 through 2017 period, most people were required to either obtain health insurance or make an individual shared responsibility payment. Employer shared responsibility provisions began to take effect for employers with 100 or more full-time-equivalent employees in 2015 and for employers with 50 or more employees in 2016.

This section presents estimates of the percentage of employees who work where coverage is offered (the "offer rate"). It also provides information on the characteristics of offered coverage, including the availability of dependent coverage, choice of plans, and retiree coverage. In addition, this section presents estimates of the percentage of offering establishments that self-insure at least one plan.

Offer Rates Overall and by Firm Size, 2004 to 2017

All Employers

• There was no significant change in the overall percentage of employees working at establishments where insurance was offered ("the offer rate") between 2016 (84.3 percent) and 2017 (84.5 percent). In addition, there were no significant year-to-year changes between 2014 and 2016 (Exhibit 1.1).
• While there were no significant year-to-year changes between 2014 and 2017, offer rates increased from 83.2 percent in 2014 to 84.5 percent in 2017, after decreasing by 1.7 percentage points from 2013 to 2014. These changes resulted in no significant difference in offer rates between 2013 and 2017.
• Between 2004 and 2013, the overall percentage of employees who worked for employers that offered health insurance declined from 86.7 percent to 84.9 percent, with almost all of the decline occurring between 2009 and 2012. During that time, offer rates declined in each year (p <0.10 for 2012).

Small Employers (Firms With Fewer Than 50 Employees)

• There were no significant changes in the offer rates at small employers between 2016 (47.7 percent) and 2017 (48.3 percent) or between 2015 and 2016. This period of relative stability followed a 7-year period between 2008 and 2015 during which offer rates declined from 61.6 percent to 47.6 percent, with significant declines in every year except 2013 (Exhibit 1.1).
• From 2016 to 2017, offer rates in the smallest firms (fewer than 10 workers) increased by 2.4 percentage points to 30.8 percent, the first significant year-to-year increase in offer rates at firms of this size in the 2004 to 2017 period. This increase offset a 2.0 percentage point decline from 2015 to 2016 (p <0.10). Between 2008 and 2015, offer rates at the smallest firms declined each year (except 2012 and 2013), falling from 45.0 percent in 2008 to 30.4 percent in 2015 (Exhibit 1.2).
• There was no statistically significant change in offer rates for employees in firms with 10 to 24 workers between 2016 (54.0 percent) and 2017 (52.8 percent) or between 2015 and 2016. However, between 2013 and 2015, offer rates at such firms declined by a total of 6.7 percentage points, 3.8 percentage points from 2013 to 2014 and 2.9 percentage points from 2014 to 2015 (p <0.10). Offer rates for employers of this size were relatively stable from 2004 to 2008 but declined by 10.2 percentage points between 2008 and 2013, from 69.5 percent in 2008 to 59.3 percent in 2013 (Exhibit 1.2).

Medium Employers (Firms With 50 to 99 Employees)

• There was no significant change in offer rates at medium employers (50 to 99 employees) from 2016 (88.6 percent) to 2017 (86.3 percent). In 2016, the first year that the federally mandated employer shared responsibility provisions took effect for firms of this size, offer rates increased by 3.3 percentage points, from 85.3 percent in 2015 to 88.6 percent in 2016 (Exhibit 1.1).
• Offer rates in 2017 for medium employers were not significantly higher than in 2015, but they were higher than in 2014 (p <0.10) (Exhibit 1.1).
• From 2013 to 2014, offer rates for employers of this size declined by 4.0 percentage points, after increasing by 2.9 percentage points from 2012 to 2013 (p <0.10), resulting in no significant difference in the 2012 and 2014 offer rates at medium employers (Exhibit 1.1).
• Between 2008 and 2012, offer rates at medium employers declined from 90.7 percent to 84.1 percent (Exhibit 1.1).

Large Employers (Firms With 100 or More Employees)

• The offer rate at large firms (100 or more employees) was unchanged in the 2-year period between 2015 (98.8 percent) and 2017 (98.9 percent) (Exhibit 1.1).
• Offer rates at firms with 100 to 999 employees were unchanged between 2016 and 2017, after increasing from 2015 to 2016 (p <0.10) (Exhibit 1.2).
• While there were no significant year-to-year changes in offer rates at firms with 1,000 or more employees in the 2015 to 2017 period, offer rates at the largest employers were slightly lower in 2017 (99.5 percent) than in 2015 (99.8 percent, p <0.10) (Exhibit 1.2).
• Offer rates at large employers (100 or more employees) increased from 97.3 percent in 2014 to 98.8 percent in 2015, the first year that the federally mandated employer shared responsibility provisions took effect for firms of this size. This increase occurred after a 0.7 percentage point decline from 2013 to 2014 and raised the 2015 offer rate for large employers above that for 2013 (Exhibit 1.1).
• The 2014 to 2015 increase in offer rates for large employers occurred among employers with 100 to 999 employees and those with 1,000 or more employees. Offer rates for employers with 100 to 999 employees increased from 92.7 percent in 2014 to 96.1 percent in 2015, offsetting the decline that occurred from 2013 (95.2 percent) to 2014 (92.7 percent). Offer rates for the largest employers increased from 99.1 percent to 99.8 percent from 2014 to 2015 (Exhibit 1.2).

Offer Rates by State, 2017

• Nationwide, 84.5 percent of all private-sector employees worked at establishments that offered insurance. The availability of workplace coverage varied substantially across the country (Exhibit 1.3). This variation was driven in part by differences in the distribution of workers by employer size across States (data not shown) and by differences across States in offer rates at smaller employers (Exhibit 1.4).
• States with offer rates exceeding the national average were Arizona, District of Columbia, Hawaii, Kentucky, Maryland, Massachusetts, New York, and Pennsylvania (Exhibit 1.3).
• States with offer rates below the national average in 2017 were Alaska, Arkansas, Idaho, Maine, Montana, New Mexico, North Carolina, Oregon, South Dakota, Utah, Vermont, and Wyoming (Exhibit 1.3).

Offer Rates at Small Employers, by State, 2017

• Nationwide, a little less than half (48.3 percent) of employees of small firms (fewer than 50 employees) worked at establishments that offered insurance. However, the availability of workplace coverage varied substantially across the country (Exhibit 1.4).
• States with small-employer offer rates exceeding the national average were the District of Columbia, Hawaii, Maryland, Massachusetts, New Jersey, New York, Pennsylvania, and Rhode Island (Exhibit 1.4).
• States with small-employer offer rates below the national average were Alaska, Arkansas, Florida, Georgia, Idaho, Indiana, North Carolina, Oregon, Utah, and Wyoming (Exhibit 1.4).

Offer Rates at Employers That Are Predominantly Low Wage vs. Higher Wage Establishments, by Firm Size, 2004 to 2017

• In 2017, workers at predominantly low-wage small employers (fewer than 50 employees) faced offer rates that were less than half the rate at small employers with higher wages (24.2 percent vs. 57.6 percent) (Exhibit 1.5). (Predominantly low-wage establishments are defined as those where 50 percent or more of an establishment's workforce were low wage. Wage levels used in the question about the wage distribution in the MEPS-IC questionnaire have been adjusted to account for changing wages over time. In 2017, low-wage employees were defined as those earning less than $12.00 per hour.)
• There were no significant changes in offer rates between 2016 and 2017 for any of the four subgroups of establishments jointly defined by firm size and wage level (Exhibit 1.5).
• There were no significant changes in offer rates at small employers with higher wages (establishments that were not predominantly low wage) between 2015 (58.4 percent) and 2017 (57.6 percent). Between 2014 and 2015, offer rates at such employers declined by 2.6 percentage points, which followed a 4.6 percentage point decline from 2013 to 2014. The total percentage point decline that occurred from 2013 to 2015 (7.2 percentage points) is about the same as that from 2008 to 2013 (7.6 percentage points). Offer rates at higher wage small employers in 2017 (57.6 percent) were 14.8 percentage points lower than in 2004 (72.4 percent) (Exhibit 1.5).
• There were no significant changes in offer rates at low-wage small employers between 2015 and 2017. Between 2014 and 2015, offer rates at such employers declined from 26.6 percent to 23.1 percent. This decrease followed a period of no significant change from 2012 to 2014. Offer rates at low-wage small employers declined by 10.5 percentage points between 2004 (38.5 percent) and 2012 (28.0 percent). Most of the decline in offer rates at low-wage small employers in this period occurred after 2008 (Exhibit 1.5).
• Offer rates at large employers (50 or more employees) with a predominantly low-wage workforce remained at a relatively high level in 2017 (94.0 percent). In the 2-year period between 2014 and 2016, offer rates at such employers increased by a total of 4.9 percentage points, composed of 1.8 percentage points between 2015 and 2016 and 3.1 percentage points between 2014 and 2015. These increases more than offset the 2.8 percentage point decline from 2013 to 2014 and brought the 2016 offer rate at large, predominantly low-wage employers (94.5 percent) to one of the highest rates in the 2004-2016 period, where it remained in 2017 (94.0 percent) (Exhibit 1.5).

Offer Rates by Industry, 2017

• Workers in mining and manufacturing had the highest likelihood of working where health insurance was offered (94.3 percent) while workers in the agriculture, fisheries, and forestry sector had the lowest offer rate (62.2 percent) among all industry sectors. Workers in construction and the other services category also had relatively low offer rates (74.4 percent and 75.2 percent, respectively) (Exhibit 1.6).
• Among workers at small firms (fewer than 50 employees), those employed in mining and manufacturing (67.1 percent) or wholesale trade (70.4 percent) had the highest likelihood of working where health insurance was offered (Exhibit 1.7).

Offer Rates by Selected Employer Characteristics, 2017

• Workers at nonprofit employers were more likely to work where health insurance was offered (92.8 percent) than workers at for-profit employers. Among for-profit employers, the offer rate was higher at incorporated employers (85.3 percent) than at unincorporated employers (74.1 percent) (Exhibit 1.8).
• Offer rates increased with the firm's age, from 47.6 percent at firms 0 to 4 years old to 57.2 percent, 70.8 percent, and 93.3 percent for firms ages 5-9 years, 10-19 years, and 20 or more years, respectively (Exhibit 1.8).
• Workers at establishments that were part of firms with two or more locations had higher offer rates than those with only one location (98.5 percent vs. 64.1 percent) (Exhibit 1.8).
• Offer rates increased with the percentage of workers at the establishment who worked full time. Workers at establishments where 75 percent or more of the employees worked full time had an offer rate of 90.3 percent, compared with 81.6 percent, 76.7 percent, and 53.7 percent for workers at establishments with 50 to 74 percent, 25 to 49 percent, and 0 to 24 percent full-time employees, respectively (Exhibit 1.8).
• Employees in higher wage establishments were more likely to work where health insurance was offered than those in predominantly low-wage establishments (88.4 percent vs. 71.8 percent) (Exhibit 1.8).

Offer Rates by Selected Employer Characteristics and Firm Size, 2017

• Among large firms (100 or more employees), employees who worked at an employer that had been in business fewer than 20 years were less likely to be offered health insurance than employees at older firms. Offer rates ranged from 92.4 to 97.6 percent at employers in business fewer than 20 years versus 99.3 percent for employers in business 20 years or more (Exhibit 1.9).
• Also among large firms, the offer rate increased with the concentration of full-time workers. In 2017, the offer rate increased from 93.2 percent for employers with 0 to 24 percent full-time workers to 98.2 percent for employers with 25 to 49 percent full-time workers, and then to 99.5 and 99.4 percent for employers with 50 to 74 percent and 75 percent or more full-time workers, respectively (Exhibit 1.10).
• Overall, 48.3 percent of workers in establishments that were part of firms with fewer than 50 workers were offered coverage in 2017 (Exhibit 1.1). However, there was substantial variation by establishment characteristics. For example, compared with other categories (e.g., for profit, only one location), offer rates were notably higher for small employers that:
• Were nonprofit (62.0 percent),
• Were in business for 20 or more years (61.6 percent),
• Had more than one location (73.4 percent),
• Had workforces with 75 percent or more of employees working full time (60.9 percent), or
• Had workforces that were not predominantly low wage (57.6 percent) (Exhibits 1.9 and 1.10).
• Offer rates were lower for workers in predominantly low-wage establishments than in higher wage establishments, regardless of whether they worked at a firm with fewer than 50 workers (24.2 percent vs. 57.6 percent), 50 to 99 workers (72.7 percent vs. 92.0 percent), or 100 or more workers (97.3 percent vs. 99.3 percent) (Exhibit 1.10).

Availability of Self-Insured Plans, 2004 to 2017

• Among employers that offered insurance, 13.3 percent to 17.7 percent of establishments in the three firm size categories with fewer than 100 workers self-insured at least one plan in 2017. By contrast, 37.2 percent and 78.6 percent of offering establishments in firms with 100 to 999 and 1,000 or more employees, respectively, self-insured at least one plan. There were similar differences by firm size in the percentage of eligible employees who worked for an employer that self-insured at least one plan (Exhibits 1.11 and 1.12).
• Between 2015 and 2017, the percentage of offering establishments that self-insured at least one plan first rose and then fell back to its 2015 level in 2017 (39.0 percent in 2015, 40.7 percent in 2016, 39.2 percent in 2017; p <0.10 for the 2016 to 2017 decline) (Exhibit 1.11).
• The largest firms were the only firm size category to experience a significant change in the percentage of establishments that self-insured at least one plan from 2016 to 2017, falling from 81.9 percent to 78.6 percent. This decline brought the 2017 level for the largest firms to its lowest level in the 2004 to 2017 period (Exhibit 1.11).
• Among employers who offered insurance, there was no significant change from 2016 to 2017 in the overall percentage of eligible employees who worked for an employer that self-insured at least one plan (57.3 percent in 2016 and 58.2 percent in 2017). However, employers with 100 to 999 workers experienced an increase in this measure from 37.4 percent in 2016 to 42.0 percent in 2017, a rate higher than those observed from 2004 to 2013 (Exhibit 1.12).
• In 2016, the percentage of eligible employees at the largest firms who worked for an employer that self-insured declined, but there was no significant change in 2017. Both the 2016 and 2017 rates for the largest employers (82.8 percent in 2016 and 82.2 percent in 2017) were lower than rates from 2008 to 2015, which ranged from 85.8 percent to 89.0 percent) (Exhibit 1.12).

Availability of Dependent Coverage, 2017

• In 2017, 98.3 percent of all workers who were eligible for single coverage were also offered coverage for their dependents. The likelihood of a dependent coverage offer increased with firm size. In 2017, the percentage of eligible employees who were offered coverage for their dependents was:
• 83.0 percent in firms with fewer than 10 workers,
• 91.9 percent in firms with 10 to 24 workers,
• 97.6 percent in firms with 25 to 99 employees,
• 99.1 percent in firms with 100 to 999 employees, and
• 99.9 percent in firms with 1,000 or more employees (Exhibit 1.13).
• In 2017, 91.6 percent of all eligible workers were offered employee-plus-one coverage as an option in addition to an offer of single coverage. The likelihood of employee-plus-one coverage as an option increased with firm size. In 2017, the percentage of eligible workers with an offer of employee-plus-one coverage was:
• 63.8 percent in firms with fewer than 10 employees,
• 79.6 percent in firms with 10 to 24 workers,
• 88.8 percent in firms with 25 to 99 employees, 91.9 percent in firms with 100 to 999 employees, and
• 95.5 percent in firms with 1,000 or more employees (Exhibit 1.13).

Availability of a Choice of Plans at Employers That Offer Health Insurance, by Firm Size, 2004-2017

• The likelihood that a worker at an offering establishment had a choice of plans increased with firm size in all years from 2004 to 2017. In 2017, the percentage of workers with a choice of plans was 34.9 percent in firms with fewer than 50 employees, 59.3 percent in firms with 50 to 99 employees, and 81.0 percent in firms with 100 or more workers (Exhibit 1.14).
• There was no significant change in the percentage of employees with a choice of plans between 2016 and 2017 (71.7 percent in 2016 and 72.4 percent in 2017). This followed a period where these rates increased by 3.2 percentage points from 2014 to 2015 and by 1.5 percentage points from 2015 to 2016 (p <0.10). The 2015 to 2016 increase reflected a significant increase in plan choice for medium employers (50 to 99 employees) and the 2014 to 2015 change reflected significant increases for small (fewer than 50 employees) and large employers (100 or more employees) (Exhibit 1.14).
• The availability of plan choice was significantly higher in 2017 than in 2004 for small employers (34.9 percent vs. 24.7 percent), medium employers (59.3 percent vs. 36.7 percent), and large employers (81.0 percent vs. 70.2 percent) (Exhibit 1.14).

Availability of a Choice of Plans at Employers That Offer Health Insurance, by Industry and Selected Employer Characteristics, 2017

• Workers in financial services and real estate and in retail trade were more likely to be offered a choice of plans than workers in all other industries (Exhibit 1.15). Exhibit 1.16 shows variation by firm size.
• Workers at for-profit, unincorporated employers were less likely to be offered a choice of plans than workers at for-profit incorporated employers or at nonprofit employers (68.5 percent vs. 73.1 percent and 72.6 percent, respectively) (Exhibit 1.17). Exhibit 1.18 shows variation by firm size.
• Workers in firms in business for 20 or more years were more likely to be offered a choice of plans (76.1 percent) than employees at younger firms (59.6 percent, 53.6 percent, and 59.9 percent at firms in business for 0 to 4, 5 to 9, and 10 to 19 years, respectively) (Exhibit 1.17).
• Workers at establishments that were part of firms with two or more locations were more likely to be offered a choice of plans than those at firms with only one location (82.2 percent vs. 50.3 percent) (Exhibit 1.17).
• Workers at establishments where 0 to 24 percent of employees worked full time were less likely to be offered a choice of plans than workers at other establishments (63.9 percent compared with a range of 70.6 percent to 75.7 percent for establishments with 25 percent or more full-time workers) (Exhibit 1.17). Exhibit 1.19 shows variation by firm size.
• Workers in predominantly low-wage establishments were less likely to be offered a choice of plans than workers in higher wage establishments if they worked for a medium employer (51.7 percent vs. 61.9 percent) (Exhibit 1.19). However, there was no significant difference in the likelihood of being offered a choice of plans for U.S. workers overall (72.4 percent for low-wage employers and higher wage employers, Exhibit 1.17) or in small and large firms (Exhibit 1.19).

Availability of Retiree Coverage, 2004 to 2017

• In 2017, workers who retired from establishments that were part of the largest employers (1,000 or more workers) were the most likely to be offered retiree coverage. In 2017, 27.6 percent of these large employers offered coverage to retirees under age 65, a decline from the 2016 rate of 32.4 percent (Exhibit 1.20). A smaller percentage, 20.3 percent in 2017, offered coverage to retirees age 65 and over, a decline from the 2016 rate of 24.8 percent (Exhibit 1.21).
• In contrast, in 2017, between 1.6 percent and 7.0 percent of establishments in firms in all other size categories (fewer than 10, 10 to 24, 25 to 99, and 100 to 999 workers) offered retiree coverage to retirees under age 65 or age 65 and over (Exhibits 1.20 and 1.21).
• The availability of retiree coverage in the largest firms declined by 17.2 percentage points (under age 65) and 21.8 percentage points (age 65 and over) between 2004 and 2017. In 2004, 44.8 percent and 42.1 percent of establishments in the largest firms offered coverage to retirees under age 65 and age 65 and over, respectively. By 2017, 27.6 percent of the largest employers offered retiree coverage to retirees under age 65 and 20.3 percent offered retiree coverage to retirees age 65 and over (Exhibits 1.20 and 1.21).

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Section 2: Employee Eligibility and Enrollment

In 2017, 47.7 percent of private-sector employees (59.9 million workers) were enrolled in a health plan through their employer ("the enrollment rate"). Among establishments that offered insurance, 56.5 percent of employees were enrolled in coverage through their employer (the "coverage rate") and 76.8 percent were eligible for health insurance (the "eligibility rate"). Among eligible employees, 73.5 percent were enrolled in their employer's health insurance (the "take-up rate").

This section presents estimates for 2004 to 2017 for private-sector employees for the following:

• Enrollment rate (percentage of all employees enrolled in their employer's health insurance plan regardless of whether the establishment offered health insurance). (Note that in this calculation the number of enrollees is equal to zero at employers that do not offer coverage),
• Coverage rate (percentage of all employees enrolled in their employer's health insurance plan at establishments that offered health insurance),
• Eligibility rate (percentage of employees eligible for health insurance through their employer at establishments offering health insurance), and
• Take-up rate (percentage of eligible employees who enrolled in their employer's health insurance).

The coverage rate is equal to the eligibility rate multiplied by the take-up rate, and the enrollment rate is equal to the coverage rate multiplied by the offer rate (the percentage of employees who work at employers that offer insurance). Information on offer rates can be found in Section 1.

This section also presents estimates for 2004 to 2017 for the percentage of enrollees in single, employee-plus-one, and family coverage and examines variation in coverage, eligibility, and take-up rates by firm size, industry, and other employer characteristics. It also presents coverage rates by the State in which the establishment was located.

Changes From 2004 to 2017

Overall

• Between 2016 and 2017, there was no significant change in the overall percentage of private-sector employees enrolled in a health insurance plan offered by their employers ("enrollment rate"). However, the number of enrollees increased from 58.2 million to 59.9 million in this period (p <0.10) (Exhibits 2.1 and 2.2).
• Among employees in establishments that offered health insurance, there were no significant changes in coverage, eligibility, or take-up rates between 2016 and 2017. However, coverage, eligibility, and take-up rates in 2017 were lower than earlier in the 2004 to 2017 period. Specifically, coverage rates were significantly lower in 2017 than in all years from 2004 to 2014 and eligibility rates were significantly lower than in all years from 2004 to 2013 except 2006. Take-up rates were significantly lower in 2017 than in all years from 2004 to 2015 (Exhibits 2.3, 2.5, and 2.7).
• Between 2004 and 2016, coverage rates declined by 6.6 percentage points, with significant year-to-year declines in 2006, 2010, and 2016 (p <0.10). The decline between 2004 and 2013 reflects a decline in take-up rates as there was no long-term significant decline in eligibility rates between 2004 and 2013. In contrast, the decline between 2013 and 2016 reflects a decline in the eligibility rate as well as the take-up rate (Exhibits 2.3, 2.5, and 2.7).

By Firm Size

• Between 2016 and 2017, there was no significant change in the enrollment rate in any firm-size category and no significant change in the number of enrollees in small firms (fewer than 50 employees) and medium firms (50-99 employees). However, the number of enrollees in large firms (100 or more employees) increased from 45.3 to 46.9 million (p <0.10) (Exhibits 2.1 and 2.2).
• There were no significant changes in coverage, eligibility, or take-up rates in large firms (100 or more employees) between 2016 and 2017. Within the large firm category, there were also no significant changes at firms with 100 to 999 and with 1,000 or more employees (Exhibits 2.3 through 2.8).
• Coverage rates in large firms (100 or more employees) were relatively stable between 2015 and 2016 (57.1 percent in 2015 and 56.6 percent in 2016), after declining from 58.3 percent to 57.1 percent between 2014 and 2015 (p <0.10). The 1.7 percentage point decline between 2014 and 2016 for large firms mainly reflects a decline in take-up rates in this 2-year period, as there were no significant changes in large firms' eligibility rates. Large firm take-up rates fell by 1.8 percentage points from 2014 to 2015 and by 1.6 percentage points from 2015 to 2016. From 2013 to 2014, there were no significant changes in coverage rates for employees in large firms due to offsetting changes from a decline in eligibility (2.9 percentage points) and an increase in take-up rates (2.3 percentage points) (Exhibits 2.3, 2.5, and 2.7).
• There were no significant changes in coverage, eligibility, or take-up rates in small or medium firms between 2016 and 2017. However, between 2015 and 2016, coverage rates declined by 1.5 percentage points in small firms (fewer than 50 employees, p <0.10) and by 4.6 percentage points in medium firms (50-99 employees). These declines reflect decreases in take-up rates, as there were no significant changes in eligibility rates at small or medium firms. From 2013 to 2014 and from 2014 to 2015, there were no significant changes in coverage, eligibility, or take-up rates for employees in small firms. Comparing rates in 2013 and 2015 for medium firms, there were also no significant changes in coverage, eligibility, or take-up rates (Exhibits 2.3, 2.5, and 2.7).
• Between 2004 and 2013, coverage rates fell for employees in small, medium, and large firms (p <0.10 for medium firms). Over this entire period, coverage rates declined by 4.4 percentage points for employees overall (from 62.6 percent in 2004 to 58.2 percent in 2013), although many of the year-to-year changes were not statistically significant. The decrease in coverage rates across the three firm-size categories reflected declining take-up rates, since eligibility rates did not significantly change between 2004 and 2013 for employees in any of these categories (Exhibits 2.3, 2.5, and 2.7).

Changes From 2004 to 2017 by Percentage of Establishment's Workforce That Is Low Wage and by Firm Size

• Between 2016 and 2017, coverage rates at large low-wage employers (50 or more employees and 50 percent or more of the establishment's workforce earning less than $12.00 per hour) increased from 27.4 percent to 29.5 percent and eligibility rates increased from 49.7 percent to 51.9 percent (p <0.10). There was no significant change in the take-up rate for large low-wage employers in this period. There were also no significant changes in coverage, eligibility, or take-up rates in the 2016 to 2017 period for small low-wage employers or for small or large higher-wage employers (Exhibits 2.9, 2.10, and 2.11).
• Between 2015 and 2016, there were no significant changes in coverage rates, eligibility rates, or take-up rates for employees of large low-wage employers. In the previous year, coverage rates had declined by 3.9 percentage points for employees at such firms due to a 6.3 percentage point decline in take-up rates. The 2014 to 2015 decline in take-up rates at large low-wage employers reversed a 6.0 percentage point increase from 2013 to 2014. Eligibility rates at such employers, which had declined by 9.9 percentage points between 2013 and 2014, remained at this lower level in 2015 (48.0 percent) and 2016 (49.7 percent). Despite the 2016 to 2017 increase in eligibility rates for large low-wage employers (p <0.10), the rate in 2017 (51.9 percent) remained below the 2013 level (59.4 percent) (Exhibits 2.9, 2.10, and 2.11).
• Similar to trends at large low-wage employers, there were no significant changes in coverage rates, eligibility rates, or take-up rates for workers in small low-wage employers between 2015 and 2016. Coverage rates for workers at such employers had declined by 3.7 percentage points from 2014 to 2015 (p <0.10), reflecting a 6.5 percentage point decline in take-up rates (Exhibits 2.9, 2.10, and 2.11).
• For employees at higher wage large employers, coverage rates declined by 2.2 percentage points between 2015 and 2016, reflecting a decline in take-up rates of 2.2 percentage points. Coverage rates and take-up rates at higher wage small firms declined by 1.6 percentage points and 1.9 percentage points, respectively. There were no significant changes in eligibility rates for employees at higher wage employers of either size (Exhibits 2.9, 2.10, and 2.11).
• In 2004, employees in small and large low-wage employers had similar coverage rates (41.4 percent and 41.0 percent, respectively). Between 2004 and 2013, coverage rates declined for employees at both small and large low-wage employers, with some differences in the exact timing of the declines. Despite these differences, employees at small and large low-wage employers ended the period with almost identical coverage rates (33.3 percent at small employers and 33.2 percent at large employers in 2013) (Exhibit 2.9).
  
  In 2014 and 2015, coverage rates at large low-wage employers were lower than at small low-wage employers (p <0.10 for 2014). However, in both 2016 and 2017, there was no significant difference between coverage rates at small and large low-wage employers (28.9 percent and 29.5 percent in 2017, respectively) (Exhibit 2.9).
• Between 2004 and 2017, coverage rates declined by 7.7 and 7.0 percentage points, respectively, at small and large higher wage employers. Throughout the 2004 to 2017 period, coverage rates were higher at large higher wage employers than at small higher wage employers (Exhibit 2.9).
• Eligibility rates at small low-wage employers were lower than at large low-wage employers for most years in the 2004 to 2013 period. However, between 2013 and 2014, eligibility rates at large low-wage employers fell by 9.9 percentage points. This decline brought the 2014 eligibility rates for such employers in line with those for small low-wage employers. In 2015, eligibility rates at small low-wage employers were higher than at large low-wage employers (p <0.10). In both 2016 and 2017, there was no significant difference between eligibility rates for workers at small and large low-wage employers (Exhibit 2.10).
• Between 2004 and 2013, take-up rates declined for workers at employers in all four wage/size categories. While workers at small low-wage employers had higher take-up rates than those at large low-wage employers in most years from 2004 through 2013, the 2013 to 2014 rise in the take-up rate at large low-wage employers brought their rate to a level that was not significantly different from the 2014 level for small low-wage employers (Exhibit 2.11).
• From 2014 to 2016, take-up rates followed similar patterns at large and small low-wage employers and there were no significant differences between rates at these employers. Take-up rates at large and small low-wage employers declined from 2014 to 2015, and there were no significant changes in rates between 2015 and 2016 for either type of employer (Exhibit 2.11).

Estimates by Selected Characteristics, 2017

Differences by Firm Size, 2017

• In 2017, enrollment rates varied significantly across all firm sizes. Workers in firms with fewer than 50 employees had the lowest enrollment rate (26.7 percent), workers in medium firms (50-99 employees) had an enrollment rate of 45.0 percent, and workers in large firms (100 or more employees) had the highest enrollment rate (56.5 percent) (Exhibit 2.1).
• In 2017, the coverage rate was significantly lower in medium firms compared with small and large firms. Workers in small firms had a lower coverage rate (55.4 percent) than workers in large firms (57.1 percent), which were both higher than the coverage rate in medium firms (52.2 percent) (Exhibit 2.3).
• The different enrollment rates between small and large firms in 2017 reflect higher offer rates and coverage rates at large employers compared with small employers. The higher enrollment rate for large firms compared with medium firms also reflects higher offer rates and coverage rates at large firms compared with medium firms. The higher enrollment rate for medium firms compared with small firms is driven by the higher offer rate at medium firms, since workers in medium firms had a lower coverage rate than workers in small firms (Exhibits 1.1, 2.1, and 2.3).
• In 2017, workers in small firms had higher eligibility rates and lower take-up rates than workers in large firms. The lower coverage rate for workers in medium firms compared with small firms was driven by the lower eligibility rate for workers in medium firms compared with workers in small firms. The lower coverage rate for workers in medium firms compared with large firms was driven by the lower take-up rate for workers in medium firms compared with large firms since there was no significant difference in eligibility rates for workers in medium and large firms (Exhibits 2.3, 2.5, and 2.7).
• The coverage rate in 2017 for workers in the smallest firms (fewer than 10 employees) was higher than coverage rates for workers in the four other firm sizes (10-24, 25-99, 100-999, and 1,000 or more employees). This higher coverage rate reflects the higher eligibility rate for workers in the smallest firms compared with workers in all other firm-size categories and higher take-up rates compared with workers in all but the very largest firms (Exhibits 2.4, 2.6, and 2.8).
• Workers in the largest firms (1,000 or more employees) had a higher coverage rate than workers in firms with 10 to 24, 25 to 99 workers, and 100 to 999 workers due to a higher take-up rate. The take-up rate in the largest firms was higher than in all other firm-size categories (p <0.10 for the comparison with the smallest firms) (Exhibits 2.4, 2.6, and 2.8).

Differences by State, 2017

• The coverage rate varied by State in 2017, although most States were not significantly different from the national average of 56.5 percent. Five States were significantly below the national average: Massachusetts (51.8 percent), New Jersey (52.1 percent), New Mexico (49.9 percent), Rhode Island (51.2 percent), and Vermont (48.0 percent). The five States significantly above the national average were Hawaii (61.5 percent), Idaho (61.4 percent), Michigan (61.8 percent), Montana (61.8 percent), and South Carolina (60.5 percent) (Exhibit 2.12).

Differences by Industry, 2017

• Employees working in mining and manufacturing had a higher coverage rate (78.3 percent) than any other sector. The high coverage rate in mining and manufacturing was due to a higher eligibility rate than all other sectors (95.4 percent) and a higher take-up rate (82.0 percent) than all sectors except utilities and transportation and financial services and real estate (Exhibits 2.13, 2.14, and 2.15).
• Employees working in utilities and transportation, wholesale trade, and financial services and real estate also had relatively high coverage rates (70.4 percent, 71.9 percent, and 74.4 percent, respectively). These rates were also due to a combination of high eligibility rates (88.0 percent, 90.3 percent, and 92.1 percent, respectively) and high take-up rates (80.0 percent, 79.7 percent, and 80.8 percent, respectively) (Exhibits 2.13, 2.14, and 2.15).
• Conversely, employees working in retail trade and in other services had lower coverage rates than most sectors (39.2 percent and 36.7 percent, respectively), a product of having lower eligibility rates (57.6 percent and 60.2 percent, respectively) and lower take-up rates (68.1 percent and 61.0 percent, respectively) than most other sectors (Exhibits 2.13, 2.14, and 2.15).

Differences by Selected Firm Characteristics, 2017

• Employees in establishments that were for profit and unincorporated had a lower coverage rate than employees in establishments that were either nonprofit or for profit and incorporated (50.6 percent vs. 56.1 percent and 57.7 percent, respectively). The eligibility rate was higher at for-profit incorporated establishments (78.3 percent) than at for-profit unincorporated establishments (73.1 percent) and nonprofit establishments (73.5 percent). Employees in nonprofit establishments had a higher take-up rate than those in for-profit unincorporated establishments or for-profit incorporated establishments (76.3 percent vs. 69.3 percent and 73.8 percent, respectively) (Exhibits 2.16, 2.17, and 2.18).
• Employees in firms that were 20 years old or older had a higher coverage rate (57.8 percent) than employees in firms that were less than 5 years old, 5 to 9 years old, and 10 to 19 years old (51.2 percent, 51.3 percent, and 51.6 percent, respectively). Since there were no significant differences in eligibility rates, the differences in coverage rates were due to a higher take-up rate for employees in firms 20 years old or older versus younger firms (75.2 percent vs. rates of 67.2 percent or 67.3 percent) (Exhibits 2.16, 2.17, and 2.18).
• Employees in firms with multiple locations had a higher coverage rate than those with a single location (58.2 percent vs. 52.7 percent). Since there was no difference in eligibility rates for firms with multiple locations and firms with a single location (76.8 percent for both), the difference in coverage rates was due to a higher take-up rate in firms with multiple locations (75.7 percent vs. 68.6 percent) (Exhibits 2.16, 2.17, and 2.18).
• The coverage rate increased directly with the percentage of full-time employees at an establishment, increasing from 14.0 percent for employees in establishments with 0 to 24 percent full-time employees to 66.2 percent in establishments with 75 percent or more full-time employees. The eligibility rate followed the same pattern, increasing from 26.3 percent to 87.2 percent. Take-up rates also followed a similar pattern, increasing from 53.2 percent in establishments with 0 to 24 percent full-time employees to 75.9 percent in firms with 75 percent or more full-time employees (p <0.10 for the comparison between the two lowest categories) (Exhibits 2.16, 2.17, and 2.18).
• Employees in higher wage establishments (less than 50 percent of the employees earned less than $12.00 an hour) had more than double the coverage rate of employees in predominantly low-wage establishments (50 percent or more of the employees earned less than $12.00 an hour) (63.2 percent vs. 29.5 percent). This difference was due to both a higher eligibility rate (83.0 percent vs. 51.6 percent) and a higher take-up rate (76.1 percent vs. 57.1 percent) among employees in higher wage establishments compared with those in predominantly low-wage establishments (Exhibits 2.16, 2.17, and 2.18).

Enrollment in Single, Employee-Plus-One, and Family Coverage

Overall

• In 2017, 54.6 percent of enrollees had single coverage, 19.0 percent had employee-plus-one coverage, and 26.5 percent had family coverage (Exhibits 2.19, 2.20, and 2.21).
• Between 2016 and 2017, the percentage of enrollees with single coverage declined from 55.3 percent to 54.6 percent (p <0.10) and the percentage with employee-plus-one coverage increased from 17.8 percent to 19.0 percent. There was no significant change in the percentage of enrollees with family coverage (Exhibits 2.19, 2.20, and 2.21).
• Between 2004 and 2017, the percentage of enrollees with single coverage increased from 47.3 percent to 54.6 percent and the percentage with employee-plus-one coverage increased from 17.4 percent to 19.0 percent. The percentage with family coverage decreased from 35.2 percent to 26.5 percent (Exhibits 2.19, 2.20, and 2.21).

By Firm Size

• In 2017, a lower percentage of enrollees in large firms than in small and medium firms enrolled in single coverage (52.1 percent vs. 63.5 percent and 63.3 percent, respectively). A higher percentage enrolled in employee-plus-one coverage (20.2 percent vs. 13.9 percent and 15.8 percent, respectively) and family coverage (27.7 percent vs. 22.6 percent and 20.9 percent, respectively) (Exhibits 2.19, 2.20, and 2.21).
• The percentage of enrollees with employee-plus-one coverage increased with firm size in every year from 2008 through 2017 (Exhibit 2.20).
• Between 2016 and 2017, the percentage of enrollees in large firms (100 or more employees) enrolled in single coverage declined from 53.1 percent to 52.1 percent and the percentage with employee-plus-one coverage increased from 18.6 percent to 20.2 percent. There was no significant change in the percentage with family coverage at large firms. There were also no significant changes in single, employee-plus-one, and family coverage at small or medium firms in this period (Exhibits 2.19, 2.20, and 2.21).
• The 2016 to 2017 decline in single coverage at large firms occurred at firms with 100 to 999 employees (p <0.10) while the increase in employee-plus-one coverage occurred both at firms with 100 to 999 employees and firms with 1,000 or more employees. While there was no significant change in family coverage overall or in the large firm category (100 or more employees), the percentage of enrollees with family coverage in firms with 1,000 or more employees declined from 30.0 percent in 2016 to 29.1 percent in 2017 (p <0.10) (Exhibits 2.22, 2.23, and 2.24).

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