We find a clear downward trend in ESI coverage levels at both the national and state level, with substantial state-level variation in both the magnitude of these declines and in the current levels of ESI coverage in each state. Contributing to the general decline in ESI coverage are declines in the availability of ESI, declines in the take-up of ESI that is available, and declines in the take-up of ESI dependent coverage.
With ESI premium costs, we observe a clear upward trend both nationally and in the states, and we once again see wide state variation in both the degree of change and in current average premium levels. The average employee premium share for both single and family coverage rose slightly during the time period of the study, but a dramatic jump in total premium cost translated into a significant increase in the dollar amount of the average employee contribution to premium.
Because of the substantial state-level variation in ESI prevalence, availability, and cost—due to variation in contributing factors such as employment characteristics and population demographics—trends in ESI (including the impacts of the ACA) should continue to be monitored and evaluated at the state level.
The table below contains more detailed summary findings.
The full report and detailed state profile documents are available at the report main page.
This analysis uses state-level data from the Annual Social and Economic Supplement (ASEC) of the Current Population Survey (CPS) for the coverage component of the analysis and data from the Medical Expenditure Panel Survey – Insurance Component (MEPS-IC) for the employer and cost components of the analysis.
Because of limited sample size in some states, especially when considering subgroups within a state, we use two-year averages from the CPS to improve the precision of the estimates in this report. The MEPS-IC analysis also uses two-year averages, both to facilitate comparability with the CPS analysis and to improve the precision of the estimates.
The State Health Access Data Assistance Center (SHADAC) is a program of the Robert Wood Johnson Foundation and a part of the Health Policy and Management Division of the School of Public Health at the University of Minnesota.