Employer Sponsored Health Plan Trends in High Enrollment States

AHIP has released an overview of employer-sponsored health plan coverage across all 50 states and the District of Columbia, with California, Texas, and New York seeing the highest populations of employer-sponsored health plan enrollees.

“Health insurance providers are proud to partner with America’s employers to provide comprehensive health coverage to working families,” Thornton continued. “We’ll continue to offer new and innovative solutions so employers can choose plans that meet the diverse needs of their employees.”

The resource is designed to provide a snapshot of the impact that employer-sponsored health plans have on states’ coverage rates, healthcare systems, and economies. 

AHIP provided state-by-state statistics on factors such as the number of employees covered by employer-sponsored health plans in the state, the number of jobs that health insurance creates in the state, and the number of covered providers.

The state with the highest share of individuals covered under employer-sponsored health plans was California with 18,985,300 employees covered by employer-sponsored health insurance.

Nearly half of all Californians were covered under an employer-sponsored health plan. Almost six in ten employer-sponsored health plans in the state were fully insured (58 percent), with the remaining four in ten being self-funded (42 percent). 

Nearly nine out of ten employees (87 percent) were in companies that offer insurance and eight in ten had an option of more than one health plan.

Employee contributions to premiums as a share of median income fluctuated over time in California, hitting 7.3 percent in 2019 before dropping to 6.3 percent in 2020. 

More than half of all California employees had access to benefits such as employee assistance programs and dental care (55 percent each). Over four in ten employees had access to vision care and wellness programs (43 percent each).

AHIP found that over 38,200 providers in California received employer-sponsored health plan payments as well as 102 community hospitals.

The state with the next largest population of employees covered by an employer-sponsored health plan was Texas with 13,992,200 covered employees. 

Like California, almost half of the state’s population was covered under employer-sponsored insurance (48 percent). The other 52 percent of Texas found healthcare coverage through the individual health insurance marketplace, Medicare, Medicaid, another form of insurance, or was uninsured.

Employer health plans in Texas tended to be self-insured, with over six in ten employer-sponsored health plans being self-funded and the remaining four in ten being fully insured. 

Employee contributions to their premiums as a share of median income were higher in California than in Texas from 2015 to 2020. In 2015, Texan employee contributions to their premiums consumed 8.2% of their median income, but by 2020 this share increased to 8.7%. 

Employee access to dental and vision care was lower in Texas than in California. But nearly half of all Texans who were covered by employer-sponsored health plans had access to employee assistance programs. 

Most workers in Texas were in companies that offer health insurance (83 percent) and more than three-quarters had an option of more than one health plan through their employer-sponsored sponsored coverage (76 percent).

AHIP also discovered that 22,878 physicians received payments through employer-sponsored health plans, as did 149 community hospitals.

New York had the third-largest population of employees covered through employer-sponsored health plans. 

Of the three states with the largest populations of employer-sponsored health plan enrollees, this state had the highest share of workers who had access to employer-sponsored coverage through their employers at 88 percent. Additionally, 74 percent of employees had more than one health plan option for coverage through their employers.

Like Texas, many employers were self-funded (59 percent) but a strong contingent was fully insured (41 percent).

Employee contributions to premiums as a share of median income amounted to 7.1 percent in 2015, dropped to 6.0 percent in 2019, and jumped up to 6.6 percent in 2020.

Over 32,480 providers in the state were financed by employer insurance payments as were 47 community hospitals.

“Americans have real choices and real control in the care, coverage, and protection they receive through work,” said Jeanette Thornton, senior vice president of product, employer, and commercial policy at AHIP. “By building on the strength, stability, and success of employer-provided coverage, we can ensure that more Americans have access to the affordable, high-quality care they deserve.”

Employer-sponsored health plans currently play an important role in healthcare coverage. These plans are seeing steep spending growth, rising from a 3.4 percent spending growth rate in 2020 to a 6.3 percent spending growth rate in 2021.

A little over half of all employees (51 percent) were satisfied with employer-sponsored health plan benefits in 2021, an EBRI survey found.