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Under ACA, Employment Rates and Employer-sponsored Insurance Rose along with Coverage Expansion

November 16, 2018

Findings from a new Urban Institute analysis indicate that health insurance coverage gains under the Affordable Care Act (ACA) were well-targeted to workers and their dependents who most needed help.

Following the passage of the ACA during 2010, some opponents of the law took the position that the ACA would have negative effects on employment and employer-sponsored insurance (ESI). But the analysis, prepared for the Robert Wood Johnson Foundation, tells a different story. The ACA increased coverage substantially for workers, without creating an appreciable negative impact on ESI or employment.

The analysis used federal data from the American Community Survey and the Current Population Survey. Researchers found that between 2010 and 2016, employment increased, as did health insurance coverage offered to these workers. Workers in historically low-insurance rate jobs experienced an increase, including restaurant and retail workers. For purposes of the analysis, “worker” refers to people who are currently employed.

Key findings:

  • Overall, employment increased by 8.2 percent as coverage rose by 9.6 percent
  • Among employees earning less than $15 per hour (jobs in food preparation and service; farming, forestry, and fisheries; building and grounds maintenance; personal care; health care support; and transportation and material moving), ESI coverage increased by 6.8 percent
  • Non-ESI coverage increased by 71.1 percent (e.g., Medicaid, marketplace coverage)

The concerns that had been raised about the ACA's potential impact on workers were two-fold:

  • With the addition of new types of coverage through Medicaid expansion and the ACA marketplaces, employers would try to save money by decreasing ESI, because their workers would have other options
  • When the employer mandate took effect during 2015, workplaces with more than 50 full-time workers had to provide ESI. Some ACA critics said workplaces would try to avoid that threshold by laying off workers or reducing the hours of workers to reduce the number of full-time employees

The Urban Institute reported that neither of these predictions came to fruition following passage of the ACA. In addition, the report did not find evidence of a corresponding “crowd-out” effect on ESI coverage.

This type of analysis further informs the ongoing public policy discussion about the future of the ACA. HAP will continue to advance the success stories of expanded health care coverage and advocate for protecting and strengthening the ACA.

For more information about HAP’s work to protect and strengthen the ACA, contact Laura Stevens Kent, HAP’s vice president, federal legislative advocacy.

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