Health insurance matters greatly to employees. And now, in smaller companies, millions more workers have coverage than they did a decade ago.
According to the Center on Budget and Policy Priorities, a research organization and policy institute, the Affordable Care Act has been the difference maker.
In 2013, about a quarter of employees at small businesses -- those with fewer than 100 employees -- were uninsured. By 2022, that dropped to a record low of 16.3 percent, according to recent analysis from the CBPP.
Self-employed workers saw coverage gains as well, with their insurance rate dropping from 27.3 percent in 2013 to 16.4 percent in 2022 -- another record low.
The CBPP credited the sweeping health care reform law, which was enacted in 2010, for its success in creating a market with "policies that stabilized Medicaid coverage and enhanced premium tax credits to lower the cost of health coverage for millions of people in the ACA marketplace."
Overall, more than 6.2 million small-business employees and self-employed workers have now gained coverage "since the ACA's major coverage provisions were implemented," per the analysis.
Offering health insurance can be a challenge for small companies. In 2023, just over half of small businesses offered health insurance, according to a survey from the National Federation of Independent Business. (Note: For businesses with fewer than 50 full-time employees, offering health insurance is not required, according to the U.S. Department of Health and Human Services.) Of the 44 percent of companies that didn't offer coverage, 65 percent cited cost as the main reason. And with health insurance costs projected to rise even further this year, the offering could remain out of reach for many.
Enter the Affordable Care Act, which seems to be filling the gap in helping these companies' employees access health care. Between 2013 and 2022, 2.5 million more small-business employees and 1.3 million self-employed workers were covered by Medicaid, according to the CBPP analysis.
But small businesses that do choose to offer health insurance could still reap their own rewards. Sixty-three percent of the employers in the NFIB survey believe offering health insurance is important for recruiting and retaining employees. And in this year's Inc. Best Workplaces list, health insurance was table stakes for the winners, who offered health insurance almost across the board.
