The Robert Wood Johnson Foundation and State Health Access Data Assistance Center released a report finding that 60% of all insured Americans receive insurance through their work. This percentage is down from 70% in 2000, indicating a difference of 11.5 million individuals. The study notes that the decrease in receipt of employer coverage began prior to the 2010 implementation of the Affordable Care Act (ACA), and is caused by a combination of employers no longer offering coverage and employees no longer accepting it. Rising insurance costs is identified as the culprit responsible for the decline of employer-based health insurance.

According to a new study for the National Institute for Health Care Reform (NIHCR), offering employer-sponsored health insurance will continue to make fiscal sense for businesses employing most workers (81%) now offered insurance. The study found that the economic incentives to offer coverage will remain strong under the Affordable Care Act (ACA) for most larger, higher-wage firms,  but will weaken for small and low-wage employers. These smaller firms are the companies already more likely to drop coverage to due rising costs. Pre-ACA, all businesses had the option to offer health insurance coverage. After 2014, employer premium contributions remain tax exempt, and two new policies will take effect. First,  larger employers that do not offer affordable health insurance will be penalized and second, premium tax credits for lower-income people to purchase insurance in new state exchanges if they lack access to affordable employer coverage will be available. The economic incentive to cover employees is calculated by adding the dollar value of the employer-sponsored insurance tax subsidy and the value of avoiding the penalty for not offering insurance, and then subtracting the value of the premium tax credits that eligible workers could use in an exchange if their employer does not offer coverage. After 2014, the largest firms (500 or more workers) will continue to have a strong economic incentive, with an average incentive of $2,503 per employee. However, the smallest firms (fewer than 50 workers) will face lower economic incentives because they are exempt from the penalty. Certain industries, such as food service, entertainment, agriculture, forestry and fishing, will have less incentive to offer employer coverage, as their workers will be eligible for exchange subsidies. The study draws on data from the 2008-2010 Medical Expenditure Panel Survey.

A new Commonwealth Fund study found that the number of workers with health insurance coverage has been shrinking in small businesses over the past decade. 33 percent of workers in businesses with fewer than 50 employees received health insurance coverage through their employer in 2010, down from 42 percent in 2003. This trend has been particularly dramatic for employees making less than $15 an hour. The Commonwealth paper suggested that the Affordable Care Act (ACA) should mitigate this trend by improving the affordability and comprehensiveness of health insurance. To see the infographic showcasing the ACA's impact on small businesses and their employees, click here.