In 2024, roughly 53% of small business workers were at firms that offered health insurance, leaving just under half without the option.
A September analysis from the Congressional Budget Office reviewed the health insurance landscape for small businesses. Many states define small businesses as those with 50 or fewer employees, according to the report. In 2024, the most recent year of data for CBO’s review, small businesses employed about 38 million of 139 million private-sector workers.
Here are four things to know from the report:
1. Thirty-six percent of small business workers were enrolled in their employer’s health plan. Total enrollment, including workers and their families, in small businesses’ health insurance plans increased from 16.9 million in 2014 to 18.6 million in 2024.
2. Looking at owners of small businesses with at least one employee, one in five were uninsured in 2023.
3. Plans formed under the ACA accounted for 22%, 60% and then 50% of small businesses’ health plan enrollment in 2014, 2018 and 2024, respectively. The enrollment share for grandfathered and transitional plans dropped from 60% in 2014 to 4% in 2024, whereas the accessibility of self-insured plans and other alternatives, including association health plans, grew over time. The enrollment share for these plans increased from 18% in 2014 to 46% in 2024.
4. Over the decade, small business health plans’ enrollment-weighted average premiums increased 43% overall. During that same period, the average premium growth for large-employer plans was 47%.
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