Transamerica Center for Health Studies is a national non-profit and thought leader empowering Americans to achieve the best health outcomes, value, and protection from their healthcare. The results of the study – conducted by The Harris Poll through a 20 minute online survey among 1,350 U.S. business decision makers (ages 18+) in August/September 2018 – represent the sixth annual survey from Transamerica Center for Health Studies. Sub-samples of businesses with 1-49 full-time employees, businesses with 50-499 full-time employees, and businesses with 500 or more full-time employees were created and weighted based on employer size to be representative of U.S. businesses.  A full methodology is available in the report.

Read the full report here and see the key findings below:

Healthcare Benefits

Employers offer benefits at highest level since 2013.

  • Eighty-five percent of employers report offering health benefits to their full-time and part-time employees. (pg. 13)
  • In general, offering benefits rises significantly with the size of company with small businesses least likely to be providing healthcare benefits to full- and part-time employees (59 percent). (pgs.13, 91)

Size continues as most common barrier to providing insurance.

  • The top reasons for not offering – and being unlikely to offer – health insurance include: company not being big enough (50 percent), concerns about cost (28 percent), and the mandate not applying to them (28 percent). (pg. 35)

Major health offerings are fairly consistent with 2017.

  • Companies are offering several benefits at higher rates than in 2015. Health savings accounts have risen the most dramatically (33 percent in 2015 to 45 percent in 2018). (pg. 92)
  • Holding steady from last year, employers most commonly feel that offering the best health benefits package is the most important benefit-related priority (16 percent), followed by ensuring our employees have access to enough quality providers (physicians and hospitals) to meet health needs (11 percent), and lowering out-of-pocket healthcare costs (10 percent). (pg. 14)
  • Five percent of medium and large companies mistakenly believe the mandate doesn’t apply to them. (pg. 25)

Changes made to healthcare benefits tip to the positive but with notable negative changes as well.

  • Nearly three in 10 (28 percent) employers have made changes to healthcare benefits offered in the past 12 months. (pg. 20)
  • Most commonly, employers report they added health insurance (36 percent) or added other healthcare benefits (32 percent). However, around one in 10 (11 percent) say they reduced or eliminated company contribution to cover costs for healthcare benefits (other than health insurance) and nine percent say they did the same to cover cost for health insurance. (pg. 19)

Policy Changes 

Awareness is relatively high for potential healthcare policy changes - how they would like their organization to react seems to be related to the size of the organization.

  • Over three in five (61 percent) employers say their company is extremely/very aware of the potential changes to healthcare policy coming out of Washington D.C. (pg. 23)
  • When asked how they would like their employer to react if the employer mandate is removed by Congress and the President, about one-fifth would like to evaluate coverage options (24 percent), not make any change (25 percent), or would like to increase coverage (16 percent). (pg. 25)
  • Small businesses most commonly say they would not make any changes (33 percent) whereas large companies are most likely to say they would like to evaluate their coverage options (31 percent). Midsize companies say they are split between the two (26 percent each). (pg. 25)

Most employers report employees have expressed fears in regard to changes in healthcare policy.

  • Most employers (72 percent) report that employees have expressed at least some fears with respect to changes in healthcare policy; most commonly, losing their healthcare due to pre-existing conditions (27 percent). (pg. 27)

Though the future is unknown, there is little change in the percentage of employers who say they will buy a plan and provide it to employees.

  • Most employers currently buy and provide plans to employees (67 percent) and the percentage who say they will do the same in the future (61 percent) is largely unchanged from 2017 (59 percent). (pg. 29)

Nor do employers predict a change in quality of health insurance.

  • Similar to 2015, about two in five (39 percent) employers expect the quality of health insurance to improve in the next 12 to 36 months. (pg.36)


Most employers are taking action to manage healthcare costs.

  • Eight in 10 employers (80 percent) say they are doing something to manage costs. (pg. 40)
  • About three in 10 (29 percent) say they are offering a variety of PPO plans, encouraging use of generic medications (28 percent), and offering an HMO health plan (28 percent). (pg.40)
  • With that said, one-quarter of employers (25 percent) say they are extremely or very likely to reduce their contribution to health insurance. (pg. 63)


Most companies are taking action to combat costs in reaction to concerns about employees.

  • Most employers – regardless of size – are as concerned about the affordability of health insurance for their employees (73 percent) as they are about employees being able to afford their out of pocket healthcare expenses (72 percent). (pg.65)
  • The majority of employers who are concerned about affordability (89 percent) are taking some action to combat cost. (pg. 68)
  • Most commonly the actions they are taking are comparison shopping for the best health insurance options and finding ways to reduce premiums (36 percent). (pg. 68)

Wellness (Health Promotion) Programs

Wellness offerings remain steady despite widespread positive impacts.

  • Most employers perceive their wellness programs to have positively impacted job satisfaction (77 percent), workers’ commitment (73 percent), turnover (61 percent), and absenteeism (59 percent). (pg. 45)
  • And, about four in five employers believe their wellness programs have had a positive impact on workers’ health (79 percent), productivity and performance (77 percent), and about seven in 10 (71 percent) see a positive impact on company healthcare costs. (pg. 44)
  • However, more than one-third of employers (36 percent) say they do not offer these types of programs to their employees. (pg. 42)    

Employees continue to underestimate wellness offerings.

  • While employees are slightly more likely than they were in the past to say their employer offers wellness programs (39 percent), it is substantially less than employers report (64 percent). (pg. 42)
  • Consistent since 2015, 84 percent of employers say leadership is committed to improving the health of their employees, but only around four in 10 employees (40 percent) feel the same way. (pg. 49)

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