This Week’s Issue Brief — Trends in Self-Insured Health Coverage: ERISA at 50
Employee Benefit Research Institute
EBRI is a nonprofit, independent & unbiased resource organization providing objective information about benefit programs
The Employee Retirement Income Security Act (ERISA) became law 50 years ago in 1974, providing the legal framework for the uniform provision of benefits by employers doing business anywhere in the United States. This uniformity allows multistate companies to “self-insure” health plans. But since the passage of the Patient Protection and Affordable Care Act of 2010 (ACA), there has been much speculation that an increasing number of small and medium-sized employers would convert their health plans from fully insured to self-insured plans. The rationale has been that several key ACA components would drive up the cost of health coverage, possibly making self-insurance a more attractive option for many employers, as it is viewed by many as generally less expensive than fully insured alternatives. This week’s Issue Brief uses data from the Medical Expenditure Panel Survey - Insurance Component to examine trends in offerings and utilization from 2010 to 2023 and explore what has happened to the availability of and enrollment in self-insurance since passage of the ACA.
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