Cost has deterred many small businesses from providing health insurance to their workers. Consumer-directed health plans, which are potentially less costly than traditional health plans, may be well suited to workers in small businesses. We study the factors that are associated with CDHP offering, determine the variation in CDHP offering among large and small firms, and develop models of persistence in CDHP offering. Our analysis of the Kaiser-HRET survey shows that small firms have been no quicker in their uptake of CDHPs than larger firms, and appear to display somewhat more churning in CDHP offering than large firms. Small firms that employ between three and 49 workers are less likely to offer HRA/HSA plans conditional on offering HD plans than large firms. Furthermore, conditional on offering some health insurance, firms that employ 200 to 499 workers appear to be less likely to offer both HRA/HSA plans and HD plans compared to larger firms. Our results suggest a limited role for the current incarnation of consumer-directed health plans in encouraging small business to provide insurance.
The RAND Health Insurance Experiment, Three Decades Later