The share of employers who offer insurance to their employees remained stable in California between 2013 and 2015. But the share of eligible employees who chose to enroll dropped from 86.4% to 80.2%.
Most Californians under age 65 with health insurance receive it through an employer, but since 2009 the availability of employer-sponsored insurance (ESI) in the state has been on the decline. A key question around the Affordable Care Act (ACA) was whether the reforms would further erode ESI coverage.
Availability of ESI for Workers’ Family Members Remained Stable, While Enrollment Dropped Among Low-Income Family Members
Many individuals obtain ESI as a spouse or dependent of another worker, so it is helpful to track trends in the availability and take-up of ESI at the family level. Between 2013 and 2014 (the latest year for which data are available) the share of families in California with any offer of ESI was statistically unchanged, as was the share of families with any ESI offer who enrolled all eligible family members. However, there was a significant decline in enrollment in ESI among low-income families. The share of families with incomes below 138% of the federal poverty level who were offered ESI and enrolled all eligible family members declined by nearly 13 percentage points from 49.4% to 36.7% (yellow line below).
The reduction in the share of employees and low-income family members deciding to enroll in ESI when eligible could be driven by multiple factors, including cost and the availability of alternative coverage options, such as Medi-Cal and subsidized coverage through Covered California.
Lacey Hartman is a senior research fellow at the State Health Access Data Assistance Center (SHADAC), where she leads a range of projects aimed at helping states use data to inform policy. Lacey previously worked as the research and policy director at Portico Healthnet and as a senior research economist in the Health Economics Program at the Minnesota Department of Health. She holds a master’s degree in public policy from the University of Minnesota and a bachelor’s in women’s studies and political science from Macalester College in St. Paul.