There has been a great deal of surprise expressed in the media over the RAND’s latest report suggesting that more people have become insured through employer sponsored insurance (ESI) than through either Medicaid or the Exchanges under the ACA. One example is Adrianna McIntyre on The Incidental Economist who posted on Wednesday:

“I can’t overstate how stunning this finding is if it’s true; CBO expected that ESI gains and losses would pretty much break even in 2014 and that employer coverage would decline modestly in future years (p. 108).”

This result is precisely NOT stunning if you study the Massachusetts health reform.
In Massachusetts the expansion in ESI coverage ALSO led the total increase during the first year and half. Below is a  table summarizing the early returns in MA from a Massachusetts Division of Health Care Finance and Policy study in 2011.

http://www.mass.gov/chia/docs/r/pubs/11/2011-key-indicators-may.pdf

Notice how growth in ESI dominated both Medicaid and the Exchange in the first two years, before being surpassed by these other two.

I speculate that part of the reason so many Massachusetts employers dropped their plans in 2010 was because they knew they were not
compliant with the ACA new higher standard, but that is speculation. There was also a serious recession that affected employment and enrollment.