Employer-based health coverage declining at small firms, study finds

Although most Americans still receive health insurance coverage through their employers, new findings from the Commonwealth Fund (PDF) show that fewer than half of U.S. employees in small firms were eligible for and were offered health insurance through their jobs in 2010, compared with 58% in 2003.

From 2001 to 2011, the study noted, the portion of individuals under the age of 65 who were covered by employer health plans fell to 57% from 68%. During this period, fewer workers in small firms—or those with 50 or fewer workers—were offered health insurance, were eligible to enroll in their company's health plans, and were actually enrolled. About 49% of employees in small firms were both eligible and offered such coverage in 2010.

Meanwhile, one-third received benefits through their jobs, down from about 42% in 2003. Some of the reasons why workers might not be eligible include not working a sufficient number of hours or being in a waiting period for coverage. As a comparison, about 90% of employees in large firms of 100 or more workers were both eligible and offered coverage through their employers in both 2003 and 2010, and about 70% enrolled in the plans.

"Consequently, workers in small firms were far more likely to be uninsured than those in large firms: 40% of workers in firms with fewer than 50 workers were uninsured at some point in 2010, more than twice the rate of those working in firms with 50 workers or more (15%),” wrote Ruth Robertson, Kristof Stremikis, Sara Collins, Michelle Doty and Commonwealth Fund President Karen Davis.

In the study, the authors at the private Commonwealth Fund—which has supported the Patient Protection and Affordable Care Act—contend the 2010 law will improve both the "affordability and comprehensiveness" of coverage for workers in small businesses through the statute's provisions to offer health insurance exchanges, tax credits for small businesses, premium subsidies and new essential health benefit standards; and to expand Medicaid coverage for families with incomes under 400% of the poverty level.



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