Health Affairs January 17, 2025
Mark Meiselbach, Jean M. Abraham

The predominant form of health insurance in the United States is employer-sponsored insurance, providing coverage for more than 180 million people in 2023. However, access to employer-sponsored insurance varies substantially between workers at large and small firms. Among large firms with at least 50 employees, more than 95 percent of employees are offered health insurance by their employer; among smaller firms only half of employees are offered health insurance.

A Sustained Long-Term Decline

Over the past two decades, the small-group market has experienced a steady and long-term decline. In 2002, approximately 47 percent of small employers offered health insurance as a fringe benefit, compared to 30 percent in 2023. In contrast, the percentage of large employers offering health insurance has...

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