The uninsured rate in Minnesota rose in 2025 for the first time since 2017, reaching 5.8% after an all-time low of 3.8% in 2023. This increase in uninsurance was driven primarily by declines in public coverage (e.g., Medicaid).
While it is known that uninsurance is rising and public coverage saw declines in Minnesota, less is known about how these trends have specifically affected workers in Minnesota, and how coverage has shifted among workers at large (more than 50 employees) vs. small (50 or fewer employees) employers in the state.
Generally, the majority of non-elderly working adults (ages 19–64) are covered by private coverage—predominantly via employer-sponsored insurance (ESI), with a smaller share of adults insured by individual coverage purchased through the marketplace. However, workers with low incomes or a disability may be eligible for public coverage. Nationally, the share of working adults with public coverage is substantial: Data from the Current Population Survey (CPS) found that 13.8 million nondisabled, non-elderly working adults reported having Medicaid in 2024.
Using data from the Minnesota Health Access Survey (MNHA), we examined changes in health insurance coverage between 2023 and 2025 among working adults at large and small employers, limiting our analysis to individuals working more than 20 hours per week.
Along with a clear picture of rising uninsurance and declining public coverage, this analysis of Minnesota’s health insurance coverage rates among working adults helps to illustrate the substantial role public coverage plays in providing health insurance to Minnesota’s workers.
More Minnesota Workers Go Without Coverage in 2025; Workers at Small Firms Hit Hardest
Figure 1 shows the change in coverage distribution between 2023 and 2025 among working adults in Minnesota by firm size.
As can be seen in the figure below, workers at both large and small employers reported significant increases in uninsurance between 2023 and 2025. However, while uninsured rates increased for both large and small employers, workers at small employers saw a larger jump in uninsurance with an over four percentage point (PP) increase from 2023 to 2025, while those at large employers saw a smaller jump (1.9 PP) during the same period. However, given the relatively low uninsurance for large firm workers in 2023 (2.2%), the increase nearly doubled their uninsured rate in 2025.
Other key findings include:
- The increase in uninsurance coincided with a decline in public coverage rates: Public coverage decreased by 4.9 PP for workers at large firms, and by 9.2 PP for those at small employers.
- Individual coverage increased slightly for large firm workers and was unchanged for small firm workers.
- ESI coverage rates did not change significantly for workers at either small or large employers in MN.
Figure 1. Changes in Health Insurance Coverage Among Working Adults (19–64) in Minnesota by Employer Size, 2023–2025
Small vs. Large Employers: Workers at Small Employers More Likely to Have Public Coverage and Have Higher Rates of Uninsurance
As we discuss above, data from the 2023 and 2025 MNHA show that uninsurance increased and public coverage declined for Minnesota workers at both large and small employers. Now, we want to focus on differences in the types of workers’ coverage at large vs. small employers. While workers at both types of employers experienced growing uninsurance, the 4.1 PP jump in uninsurance at small firms from 2023 to 2025 widens the existing coverage gaps by employer size.
Coverage differed significantly for workers at small employers compared with those at large employers in both years (noted by ‘#’ in Figure 1).
Key differences by firm size in 2025 include:
- Uninsurance was significantly higher for employees in small firms vs. large firms: 13.2% of workers at small firms reported being uninsured compared to 4.1% of large firm workers.
- Public coverage was significantly higher among small firm workers (22.1%), but also reported by a sizeable share of large firm workers (12.3%).
- Individual coverage was significantly higher for workers at small firms (8.4%) compared with large firms (1.8%).
- ESI health insurance was reported by the majority of workers, but the rate was 25.5 PP higher for those at large firms compared with workers at small firms.
Discussion
Our findings using Minnesota Health Access Survey data reveal that uninsurance increased and public coverage decreased significantly for workers at both large and small employers from 2023 to 2025. Further, coverage rates were significantly different between the two employer types: In 2025, 13.2% of workers at small firms were uninsured—triple the rate of uninsurance among workers at large firms (4.1%). The growing uninsurance coincided with steep decreases in public coverage.
A worker’s coverage status may be affected by several factors, including whether their employer offers coverage; if so, whether the coverage is affordable; ESI eligibility, which may depend on hours worked per week and duration of employment; and lastly, the availability of alternative coverage sources, e.g., whether a worker is eligible for public coverage programs based on their income or disability status.
Small employers are less likely to offer health insurance, and small firm offer rates have been declining both nationally and within Minnesota. Small employers are less likely to offer this benefit due to costs, and growing health benefits costs are projected to continue.
Shifts in coverage status are especially important to understand and address as both workers and employers face higher insurance costs, and additional declines in public coverage are anticipated. The July 2025 federal budget reconciliation bill (Public Law No: 119-21, originally H.R. 1) includes substantial cuts to Medicaid in 2027, and this bill also includes rule changes that make individual marketplace coverage harder to access.
We found substantial public coverage rates among both large and small firm workers, which could reflect a lack of ESI offers or low pay. A U.S. Government Accountability Office (GAO) analysis of 2025 data from 11 states found that companies who employed the largest number of Medicaid recipients or Supplemental Nutrition Assistance Program (SNAP) beneficiaries represented 17 of the top 50 Fortune 500 companies by number of employees. This suggests that some large firms may be offloading employee benefits costs to the public.
The higher rates of individual marketplace coverage among small firm workers suggest that this group may be particularly vulnerable to coverage losses or changes associated with the expiration of enhanced premium subsidies at the end of 2025 as well as the marketplace rule changes in H.R. 1. A small share of employers provide a cash benefit for employees to purchase individual market coverage (Individual Coverage Health Reimbursement Arrangement). These employees may be impacted by rising individual market premiums and rule changes such as tighter eligibility verification, higher maximum out-of-pocket limits, and reduced enrollment options for low-income adults.
The increasing rates of uninsurance among workers in Minnesota and the substantially higher rates among workers at small employers are troubling because of the implications for population health and the economic wellbeing of Minnesotans. Health insurance coverage is associated with better health and reduced mortality. Expanding coverage has been shown to improve access to health care. Notably, coverage for children may have far-reaching effects on their mortality, disability, and employment status as adults.
Learn More
In another recent analysis examining 2025 MNHA data, our researchers looked at rates of Minnesotans who were concerned about losing coverage in the next year, and the reasons for their concerns about losing health insurance.
Trends of growing concern about coverage loss were consistent across coverage types. However, comparing Minnesotans with public vs. private insurance highlights differing reasons for the concerns about coverage loss. Learn more here.
About the Data Source: Minnesota Health Access Survey (MNHA)
The Minnesota Health Access Survey is a biennial state-based population survey that collects information on Minnesotans’ health insurance coverage and health care access. The survey measures how many people in Minnesota have health insurance and how easy it is for them to get health care.
The Minnesota Health Access Survey is conducted as a partnership between the Minnesota Department of Health (MDH) and SHADAC, which is part of the Health Policy & Management Division of the School of Public Health at the University of Minnesota.
The survey had responses from more the 16,000 Minnesotans across the state and was conducted between September and December 2025.
Works Cited
- https://www.health.state.mn.us/data/economics/hasurvey/docs/mnha2025.pdf
- https://www.gao.gov/assets/gao-26-108703.pdf
- https://statspolicy.gov/assets/fcsm/files/docs/2024-conference-docs/I/I5.3_MEISELBACH.pdf
- https://www.health.state.mn.us/data/economics/chartbook/docs/section3.pdf
- https://www.journals.uchicago.edu/doi/abs/10.1162/AJHE_a_00045
- https://www.mercer.com/en-us/insights/us-health-news/survey-health-benefit-costs-expected-to-jump-in-2027/
- https://www.gao.gov/assets/gao-26-108703.pdf
- https://files.kff.org/attachment/Employer-Health-Benefits-Survey-2025-Annual-Survey.pdf
- https://journals-sagepub-com.ezp1.lib.umn.edu/doi/epdf/10.1177/1077558703254101
- https://www.annualreviews.org/docserver/fulltext/publhealth/46/1/annurev-publhealth-061022-042335.pdf?expires=1792595422&id=id&accname=guest&checksum=CED0CC722E19BE34504F68E10307A37C
- https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.1491
- https://www.aeaweb.org/articles?id=10.1257/aer.20171671
- https://www.shadac.org/news/minnesotans-worried-about-losing-health-insurance-coverage-MNHA-survey-data