Trends in Employer-Sponsored Insurance Offer and Coverage Rates, 1999-2014

Issue Brief
  1. The National Health Interview Survey (NHIS) is a national probability survey of American Households sponsored annually by the U.S. Census Bureau and the Center for Disease Control and Prevention (CDC). Although NHIS was started in 1957, the survey was redesigned in 1997; therefore, in most cases, this analysis uses the years 1999 through 2014. For more information on NHIS, please see http://www.cdc.gov/nchs/nhis.htm.

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  2. While individuals who are offered coverage that meets minimum value and affordability requirements may purchase coverage on the health insurance exchanges, they are not eligible for advanced premium tax credits or cost-sharing subsidies.

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  3. Individuals covered by Tricare are included among those with ESI. Some individuals have multiple types of coverage; individuals who are covered by a Medicaid or Medicare Part B in addition to an employer plan are not included. Individuals who are covered by Medicare Part A and an employer plan are assumed to have ESI as their primary coverage (less than 1% in 2014). Regardless of secondary coverage source, 57% of non-elderly people are covered by ESI.

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  4. Reschovsky, James, Strunk, Bradley, and Ginsburg, Paul. "Why Employer-Sponsored Insurance Coverage Changed, 1997–2003." Health Affairs.  May 2006 vol. 25 no. 3774-782.

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  5. According to the Bureau of Labor Statistics, the civilian labor force participation rate decreased from 67.2% in January 1999 to 62.9% in January 2014. http://data.bls.gov/timeseries/LNS11300000. During the same periods, the percentage of workers who usually work part-time increased. See the Bureau of Labor Statistics at http://www.frbsf.org/economic-research/publications/economic-letter/2013/august/part-time-work-employment-increase-recession/.

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  6. Kaiser Family Foundation, Health Research and Educational Trust. 2014 Employer Health Benefits Survey [Internet]. Menlo Park (CA): KFF; 2014 Sep [cited 2016 Jan 15]. Available from https://www.kff.org/report-section/ehbs-2014-section-two-health-benefits-offer-rates/.

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  7. Kaiser Family Foundation, Health Research and Educational Trust. 2014 Employer Health Benefits Survey [Internet]. Menlo Park (CA): KFF; 2014 Sep [cited 2016 Jan 15]. Available from https://www.kff.org/report-section/ehbs-2014-section-three-employee-coverage-eligibility-and-participation/.

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  8. This analysis uses the U.S. Census Bureau's definition of families and poverty thresholds. In 2014, the federal poverty threshold was $24,008 for a family of four including two children. "Poverty Thresholds 2014." U.S. Census Bureau. Social, Economic, and Housing Statistics Division. https://www.census.gov/hhes/www/poverty/data/threshld/.

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  9. It is important to note that NHIS uses the Census Bureau’s federal poverty thresholds, while HHS and this portion of the brief use federal poverty guidelines to determine eligibility for some public assistance programs.

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  10. Health Insurance Marketplace Calculator. http://www.kff.org/interactive/subsidy-calculator/.

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  11. A person's family poverty threshold is often, but not always, the same as his or her exchange marketplace eligibility level, which is based on the federal poverty guidelines.

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  12. In states that elected to expand Medicaid to the federal maximum, households up to 138% of the FPL will be eligible for Medicaid. Only households between 100 and 400% of the FPL are eligible for exchange subsidies. For more information on premium subsidies please see "Explaining Health Care Reform: Questions About Health Insurance Subsidies." Kaiser Family Foundation, October 2014. https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/.

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  13. Effects of the Affordable Care Act on Health Insurance Coverage: CBO’s March 2015 Baseline, Congressional Budget Office. https://www.cbo.gov/sites/default/files/cbofiles/attachments/43900-2015-03-ACAtables.pdf.

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