Small Businesses Decisions to Offer Health Insurance to Employees

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1 Smll Businesses Decisions to Offer Helth Insurnce to Employees Ctherine McLughlin nd Adm Swinurn, June 2014 Employer-sponsored helth insurnce (ESI) is the dominnt source of coverge for nonelderly dults in the United Sttes. Virtully ll usinesses with 200 or more workers offer coverge to t lest some of their employees, wheres mny smll usinesses do not offer it to ny. An importnt reson employers sy they offer coverge is so they cn recruit nd retin workers with the desired skills nd experience; the most common reson for not offering it is the cost. Some smll usinesses lso do not offer coverge ecuse they think their employees do not need or wnt it, perhps ecuse the employees otin etter (or less expensive) ESI through their spouses or do not feel compelled to crry helth insurnce t ll, especilly t the going price. The Affordle Cre Act (ACA) exempts usinesses with 50 or fewer full-time-equivlent (FTE) employees from the employer mndte, nd those with 50 to 99 FTEs re exempt until Nonetheless, severl provisions in the ACA, such s the smll usiness tx credit nd the Smll Business Helth Options Progrm (SHOP), my reduce smll usiness premiums nd prompt these employers to offer insurnce despite the exemption. Moreover, smll usinesses my feel greter pressure to offer coverge thn they did efore the ACA in view of the requirement tht ll individuls otin it. On the other hnd, Medicid expnsion nd the vilility of community-rted individul plns nd susidized coverge through the new helth insurnce exchnges my reduce the demnd for ESI, especilly mong low-income nd prt-time workers, leding usinesses exempt from the employer mndte to drop coverge. Mthemtic Policy Reserch conducted the Smll Business Helth Insurnce Survey, n online nd telephone survey tht took plce from Novemer 2012 to Septemer 2013, in order to gin insight into smll usinesses decisions whether to offer helth insurnce nd the likely effects on tht decision rought out y the ACA. The survey ws dministered in five of the 11 sttes in the Roert Wood Johnson Foundtion s Stte Helth Reform Assistnce Network: Alm, Colordo, Minnesot, New York, nd Oregon. Dt For our survey, we rndomly selected smll usinesses with 3 to 100 employees in ech stte from smple provided y Dun & Brdstreet. We weighted the responses in ech stte to reflect the popultion of usinesses in ech size ctegory nd to ccount for potentil nonrndom responses to the survey. The response rte ws 46 percent. Why Do Some Smll Businesses Offer Helth Insurnce? The percentge of usinesses with 3 to 100 employees tht offer helth insurnce rnged from 56 percent in Oregon to 67 percent in Minnesot. We sked usinesses tht offered coverge why they did so nd which reson ws most importnt. In ll five sttes, the most common reson mentioned ws tht offering coverge helps retin employees; the second most common ws tht it helps employees sty helthy nd productive; third ws tht it helps them recruit employees; nd fourth, tht the compny hs responsiility to provide this enefit to employees. When sked to choose the most importnt reson, however, the gretest proportion of employers in ll sttes except Colordo (from 30 percent in Alm to 45 percent in Oregon) sid it is the compny s responsiility to do so (Tle 1). Employers in Colordo were most likely to sy the min reson is to keep employees helthy nd productive (30 percent). Mthemtic Policy Reserch 1

2 Stte Percentge Sying Most Importnt Reson They Offer Helth Insurnce is: It s the Compny s Responsiility Retention To Keep Employees Helthy nd Productive It s Stndrd Benefit in My Industry c Recruitment d Alm 30% 24% 23% 9% 12% Colordo 20% 17% 30% 21% 4% Minnesot 41% 27% 10% 12% 11% New York 35% 30% 20% 3% 6% Oregon 45% 27% 20% 4% 3% Source: Mthemtic clcultions sed on dt from the Smll Business Helth Insurnce Survey. Note: Respondents were lso le to indicte other reson: the most common reson written in ws, We hve een offering helth insurnce for long time. Percentge for Colordo is significntly lower thn for Minnesot t, p < 0.1, nd Oregon, t p < Percentge for Minnesot is significntly lower thn for Colordo, t p < 0.1. c Percentge for Minnesot is significntly higher thn for New York nd Oregon, t p < d Percentge for Oregon is significntly lower thn for Alm nd Minnesot, t p < Percentge for Colordo is significntly lower thn for Alm, t p < 0.1. Although retention, recruitment, nd industry norms were, on verge, cited less frequently thn sense of compny responsiility s the min reson to offer coverge, these resons re likely to e interconnected. Tht is, if most usinesses in n industry offer coverge, every employer in tht industry will feel competitive pressure to offer coverge to help them recruit nd retin workers with the desired skills nd experience. We sked smll usinesses tht offered insurnce how mny of their employees were eligile for tht coverge. Responses vried cross the sttes, rnging from n verge of 57 percent in New York to 84 percent in Alm (Tle 2). We lso sked wht proportion of those who were eligile enrolled in (or took up ) the coverge offered. Tht verge lso vried, from 68 percent in Alm to 84 percent in Oregon (Tle 2). Stte Tle 1. Most Importnt Reson Cited for Offering Helth Insurnce Tle 2. Eligiility, Tke-up Rtes, Employee Ernings, nd Premium Costs in Businesses Tht Offer Coverge Averge Percentge of Employees Eligile for Helth Insurnce Averge Percentge of Eligile Employees Enrolled Averge Percentge of Full-Time Employees Erning <$50,000 c Percentge of Employers Covering Less Thn 25 Percent of Premiums Alm 84% 68% 80% 12% Colordo 77% 83% 66% 4% Minnesot 70% 79% 64% 2% New York 57% 83% 58% 7% Oregon 83% 84% 70% 9% Source: Mthemtic clcultions sed on dt from the Smll Business Helth Insurnce Survey. Percentge for New York is significntly lower thn for Alm, Colordo, nd Oregon, t p < 0.01 nd for Minnesot, t p < 0.1. Percentge for Minnesot is significntly lower thn for Alm nd Oregon, t p < Percentge for Alm is significntly lower thn for Colordo, New York nd Oregon, t p < c Percentge for Alm is significntly higher thn for Colordo nd New York, t p < The out-of-pocket premium cost reltive to workers ernings ppered to influence whether or not the workers enrolled in insurnce. Smll usinesses in Alm, which hd the lowest verge tke-up rte, were the most likely to cover less thn 25 percent of the premium nd lso hd the highest percentge of full-time workers erning less thn $50,000 per yer (Tle 2). In ech stte, usinesses where most full-time workers erned more thn $50,000 per yer hd higher tke-up rtes thn those where most erned less. In Alm, Colordo, nd New York, the verge tke-up rtes were higher in usinesses tht pid t lest 50 percent of the premium thn in those tht pid less thn 25 percent. Mthemtic Policy Reserch 2

3 The mjority of smll usinesses with prt-time workers offered helth insurnce (Tle 3). We sked these employers whether they offered coverge to their prt-time employees; the proportion tht did rnged from 11 percent in Alm to 38 percent in New York nd Oregon (Tle 3). The likelihood of offering coverge to prt-time workers ws not correlted with the percentge of employees who worked prt time. Stte Tle 3. Avilility of Employer-Sponsored Helth Insurnce to Prt-Time Workers Percentge of Businesses With Prt-Time Employees Tht Offer Helth Insurnce Tht Offered Insurnce to Prt-Time Employees Alm 51% 11% Colordo 55% 34% Minnesot 66% 15% New York 58% 38% Oregon 61% 38% Source: Mthemtic clcultions sed on dt from the Smll Business Helth Insurnce Survey. Percentge for Alm is significntly lower thn for Oregon, t p < 0.05 nd New York, t p < 0.1. Percentge for Minnesot is significntly lower thn for Oregon, t p < 0.1. How Likely Are Smll Businesses to Drop Coverge? We sked employers who offered insurnce whether they hd shopped for it in the previous yer, nd whether they recently hd considered dropping employee helth insurnce enefits ltogether. In ll sttes ut Alm, most usinesses tht offered coverge hd shopped for insurnce (Tle 4), indicting willingness to look for lower premiums nd/or different cost shring or coverge of preferred services or providers. Stte Tle 4. Shopping for Insurnce nd the Decision to Drop Coverge Among Businesses Tht Offer It Percentge of Businesses Tht Shopped for Insurnce in Previous Yer Considered Dropping Helth Insurnce Averge Percentge of Employees Covered Alm 36% 31% 56% Colordo 56% 23% 64% Minnesot 64% 25% 54% New York 55% 27% 45% Oregon 75% 21% 71% Source: Mthemtic clcultions sed on dt from the Smll Business Helth Insurnce Survey. Percentge for Alm is significntly lower thn percentges for Minnesot nd Oregon, t p < Percentge for Oregon is significntly higher thn percentges for Minnesot nd New York, t p < 0.01, nd for Alm, t p < 0.1. Percentge for Colordo is significntly higher thn percentge for New York, t p < A sustntil proportion of employers, from 21 to 31 percent, hd recently considered dropping coverge (Tle 4). In generl, usinesses with higher proportion of their employees covered y their ESI were less likely to consider dropping helth insurnce. Employers in Minnesot nd New York who sid the most importnt reson they offered coverge ws tht it ws the compny s responsiility were less likely thn other employers in those sttes to hve considered dropping coverge. In Colordo nd Oregon, employers who sid the most importnt reson ws tht it is stndrd enefit in their industry were less likely to hve considered dropping coverge. We sked employers whether vilility of individul coverge in the new helth insurnce exchnges would influence their decision to offer insurnce. Most sid the exchnges would hve no impct on their decisions, ut 5 to 20 percent sid the exchnges would mke them less likely to offer ESI. Mthemtic Policy Reserch 3

4 Why Do Some Smll Businesses Not Offer Helth Insurnce? We sked usinesses tht did not offer helth insurnce out their resons for not doing so nd which reson ws most importnt. In ll five sttes, the most common reson cited ws tht the usiness could not currently fford to offer coverge. In Alm, Minnesot, nd Oregon, the second most commonly cited reson ws, It s not my responsiility to provide this enefit. In Colordo nd New York, the second most commonly cited reson ws, My employees do not wnt or need it. When sked which of these resons ws most importnt, the most frequently chosen ws the usiness s inility to fford coverge (Tle 5). In Colordo, the perception tht employees did not wnt or need ESI ws mentioned lmost s often s the employer s inility to fford coverge (43 percent nd 49 percent respectively), nd more thn qurter of employers in New York indicted this perception s their most importnt reson for not offering it. Employers in Alm were more likely to sy offering insurnce ws not their responsiility (17 percent) thn to sy employees did not wnt or need it (6 percent). Tle 5. Most Importnt Reson Cited for Not Offering Helth Insurnce Stte Business Cnnot Currently Afford It Percentge Sying Most Importnt Reson They Do Not Offer Helth Insurnce Is: Employees Do Not Wnt or Need It It s Not My Responsiility to Provide This Benefit Other Alm 74% 6% 17% 3% Colordo 49% 43% 5% 3% Minnesot 59% 9% 6% 25% New York 71% 26% 0% 3% Oregon 70% 16% 1% 14% Source: Mthemtic clcultions sed on dt from the Smll Business Helth Insurnce Survey. Percentge for Colordo is significntly higher thn for Minnesot or Alm, t p < 0.1. Although reltively few employers in Colordo nd Minnesot tht did not currently offer helth insurnce hd offered it within the previous five yers, 23 percent hd offered it in New York nd 20 percent in Oregon (Tle 6). In Colordo, New York, nd Oregon, 32 to 44 percent of usinesses tht did not currently offer coverge hd shopped for insurnce in the previous yer, reflecting recent interest in offering coverge (Tle 6). Tle 6. Previous Offers of Helth Insurnce nd Shopping Behvior for Businesses Tht Do Not Offer It Stte Percentge of Businesses Tht Do Not Offer Tht Offered Insurnce Within Previous Five Yers Shopped for Insurnce in Lst Yer Alm 15% 8% Colordo 5% 38% Minnesot 9% 5% New York 23% 44% Oregon 20% 32% Source: Mthemtic clcultions sed on dt from the Smll Business Helth Insurnce Survey. Percentge for Minnesot is significntly lower thn for Colordo nd Oregon, t p < 0.1. Wht Would Influence Smll Business to Strt Offering Coverge? Severl provisions of the ACA re designed to mke it esier for smll usinesses to provide helth insurnce to their employees y reducing premium costs nd the costs of serching for insurnce. Other provisions (such s the individul exchnges with premium susidies nd Medicid expnsion) my ffect whether smll-usiness employees wnt or need insurnce through their employers. Employers were sked whether they were fmilir with these provisions nd were presented with follow-up questions out two in prticulr: the smll usiness tx credit nd the SHOP exchnge. In ll five sttes, most usinesses sid the tx credit would mke them more likely to strt offering insurnce (Tle 7). Reltively few in Alm, Minnesot, or Oregon sid the SHOP exchnge would influence them to strt offering coverge, ut in New York, 70 percent sid so (compred with 54 percent who cited the tx credit). Mthemtic Policy Reserch 4

5 Tle 7. Key ACA Provisions Tht Would Mke Businesses More Likely to Strt Offering Coverge Stte Percentge of Businesses Tht Sid the Following Would Mke Them More Likely to Strt Offering: Smll Business Tx Credit SHOP Alm 72% 32% Colordo 89% 78% Minnesot 55% 18% New York 54% 70% Oregon 72% 22% Source: Mthemtic clcultions sed on dt from the Smll Business Helth Insurnce Survey. Percentge significntly higher in Colordo thn in Minnesot, t p < 0.1. Percentge significntly higher in Colordo thn in Alm, Minnesot, nd Oregon, t p < Conclusions Mny smll usinesses reconsider their decisions to offer insurnce, nd wht insurnce to offer, with some frequency. A significnt minority of smll usinesses in New York nd Oregon not currently offering insurnce hd offered it within the previous five yers. In ll sttes except Alm, most usinesses tht offered insurnce (nd smller proportion of those tht did not) hd shopped for it in the previous yer. It is resonle to expect the chnges in the helth insurnce mrket stemming from vrious provisions in the ACA will influence those decisions. In four of the five sttes, the reson given most often s most importnt for offering helth insurnce ws tht it is the compny s responsiility. Although usinesses with fewer thn 50 FTE employees will remin exempt from the employer mndte, mny felt they should offer coverge nd, y inference, proly will continue. Among the sizele minority tht cited the ility to recruit nd retin workers s the most importnt reson for offering helth insurnce, however, the vilility of coverge in the individul exchnges my influence whether they continue to do so. Among usinesses tht did not offer ESI, the min reson given ws tht they could not fford it. Some sid the smll usiness tx credit nd the SHOP exchnges would encourge them to offer insurnce y mking it more ffordle. Employers in Colordo nd New York, however, frequently sid their workers did not need or wnt ESI. This sentiment my ecome more prevlent s the exchnges mke individul coverge ccessile to nd more ffordle for some of their workers. Prt-time workers re generlly less likely thn full-time workers to e eligile to prticipte in usiness s helth insurnce pln. The greter vilility of individul coverge under the ACA hs led some nlysts to predict n increse in prt-time work mong those who hd worked full time minly to otin ESI. It my lso influence workers who previously worked for lrge usinesses primrily to otin ESI to go to work for smll usinesses in jos tht might etter suit their eduction nd skills. The results of our survey suggest greter jo moility due to the ACA could chnge the lndscpe of ESI in wys smll employers my not yet nticipte nd lter their incentives nd resons for either offering or not offering coverge. Aout Mthemtic Policy Reserch Mthemtic Policy Reserch is dedicted to improving pulic well-eing y ringing the highest stndrds of qulity, ojectivity, nd excellence to er on informtion collection nd nlysis for our prtners nd clients. The compny hs een t the forefront of ssessing the effectiveness of policies nd progrms since This study ws funded y the Roert Wood Johnson Foundtion. Aout the Roert Wood Johnson Foundtion For more thn 40 yers the Roert Wood Johnson Foundtion hs worked to improve the helth nd helth cre of ll Americns. We re striving to uild ntionl Culture of Helth tht will enle ll Americns to live longer, helthier lives now nd for genertions to come. For more informtion, visit Follow the Foundtion on Twitter t or on Fceook t Mthemtic Policy Reserch 5

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