Small firms, bigger changes: Health insurance coverage take-up rates in small firms after the ACA (Kattih, Mansour, & Mixon, 2019)

The study was a nonexperimental analysis that used a statistical model to examine the impact of the ACA on employee health insurance take-up rates in small firms. The authors compared changes in employee health insurance coverage take-up—the proportion of a firm’s employees who are covered by employer health insurance—among small firms with fewer than 50 employees to changes among a comparison group of larger firms with more than 50 employees from 2006 to 2017, controlling for other firm characteristics. This period covers the passage of the ACA through the implementation of the law. The authors examined impacts of the ACA from 2010 through 2014, the period when firms could have anticipated the law and when all provisions of the law were finally implemented. The authors used larger firms as a comparison group because specific ACA provisions were targeted to small employers and would therefore not likely have affected large employers. The analysis was restricted to firms that did not begin offering health insurance on or after 2014 because the employer mandate provision of the ACA implemented in 2014 required large firms not currently doing so to provide health insurance coverage to their employees. The analysis was also restricted to firms with non-grandfathered health insurance plans (plans that were established after March 23, 2010). The sample included 549 small firms and 2,630 large firms identified across all regions of the United States. The study used data from the Kaiser Family Foundation and Health Research Educational Trust Survey of Employer Health Benefits, which includes private and nonfederal public employers with more than two employees.