Large employers for the most part have stayed the course by continuing to offer health coverage to their workers, according to the report. Nearly all large employers offered health coverage before enactment of the Affordable Care Act and continued to do so through 2017. Over this period, the percentage of employers with 1,000 or more employees that offered coverage was consistently near or above 99 percent and was 99.3 percent in 2017.

In contrast to large employers, small and mid-sized companies did not stay the course — the percentage of small and mid-sized employers offering health benefits started falling as far back as 2009. However “there appears to be the beginning of a rebound” in offerings among these employers starting between 2015 and 2017, according to the report.

Broken down by employer size:

• For employers with fewer than 10 employees, those offering health benefits declined from 22.7 percent in 2015 to 21.7 percent in 2016, then increased to 23.5 percent in 2017.
• For employers with 10 to 24 employees, those offering health benefits increased from 48.9 percent in 2015 to 49.4 percent in 2016.
• For employers with 25 to 99 employees, those offering health benefits increased from 73.5 percent in 2015 to 74.6 percent in 2016.
• For employers with 100 to 999 employees, the percentage offering health benefits increased from 92.5 percent in 2014 to 95.1 percent in 2015.

In 2017, circumstances appear to have changed again for some small employers, making it more advantageous to offer health coverage, due in large part to the low unemployment rate and relatively low and less volatile premium increases, according to the report.

“When unemployment is low, recruiting and retaining workers becomes a bigger challenge for employers, including some smaller employers, which in turn often means improving compensation and benefits,” the authors write.

As more employers offer health plans, they will “naturally” continue to look for ways to control health care costs, according to HRDive. “Some large corporations, like Intel, Cisco Systems, Walmart and Boeing, are taking a bold step by bypassing insurance companies and negotiating prices directly with health care providers,” they write.

Other cost-cutting strategies include offering second-opinion services, focusing on health care outcomes and preventive care and finding ways to change the payment and delivery of health care services through performance networks​, accountable care organizations and centers of excellence.