"The share of private-sector establishments offering health plans that include at least one self-insured option has generally increased since the mid-1990s, well before the ACA.... Large firms are far more likely than small and medium-sized firms to offer a self-insured plan. Since the ACA's major provisions took effect, self-insurance rates have risen among small and medium-sized firms, while declining among larger firms -- though these trends may have begun to reverse in 2024."  MORE >>