title: Declines in employer-sponsored insurance between 2000 and 2008: examining the components of coverage by firm size.
abstract: OBJECTIVE
  To examine trends in employer-sponsored health insurance coverage rates and its associated components between 2000 and 2008, to provide a baseline for later evaluations of the Affordable Care Act, and to provide information to policy makers as they design the implementation details of the law.
  
  
  METHODS
  Private sector employer data from the 2000, 2001, and 2008 Medical Expenditure Panel Survey-Insurance Component (MEPS-IC).
  
  
  METHODS
  We examine time trends in employer offer, eligibility, and take-up rates. We add a new dimension to the literature by examining dependent coverage and decomposing its trends. We investigate heterogeneity in trends by firm size.
  
  
  METHODS
  The MEPS-IC is an annual survey, sponsored by the Agency for Healthcare Research and Quality and conducted by the U.S. Census Bureau. The MEPS-IC obtains information on establishment characteristics, whether an establishment offers health insurance, and details on up to four plans.
  
  
  RESULTS
  We find that coverage rates for workers declined in both small and large firms. In small firms, coverage declined due to a drop in both offer and take-up rates. In the largest firms, offer rates were stable and the decline was due to falling take-up rates. In addition, enrollment shifted toward single coverage and away from dependent coverage in both small and large firms. For small firms, this shift was due to declining offer and take-up rates for dependent coverage. In large firms, offers of dependent coverage were stable but take-up rates dropped. Within the category of dependent coverage, the availability of employee-plus-one plans increased in all firm size categories, but take-up rates for these plans declined in small firms.
authors.affiliation: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, 540 Gaither Road, Rockville, MD 20850, USA. Jessica.Vistnes@ahrq.hhs.gov
authors.forename: Jessica
authors.initials: J
authors.lastname: Vistnes
authors.forename: Alice
authors.initials: A
authors.lastname: Zawacki
authors.forename: Kosali
authors.initials: K
authors.lastname: Simon
authors.forename: Amy
authors.initials: A
authors.lastname: Taylor
mesh_terms: D004608:Eligibility Determination; D005249:Fees and Charges; D006264:Health Benefit Plans, Employee / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D019538:Health Care Surveys; D006801:Humans; D007342:Insurance Benefits; D019458:Insurance Coverage / Q000191:economics / Q000639:trends*; D017057:Medically Uninsured / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act; D014481:United States