> It is not accurate that most employer-provided health care is provided by firms that self-insure. Self-insurance is common among firms with more than 5000 employees, and sharply less common with firms with smaller numbers of employees. Though the majority of the American workforce is employed by "large enterprises", the definition of that term is "firms with more than 500 employees".

According to this Wikipedia article it's 81% of workers getting health insurance through an employer are self-insure plans[1].

There's also an inherent bias towards healthier small organizations going the self-insure route. If I'm running a small shop and intimately know all the people involved (ex: family business), I know more about our healthcare needs and risks than any insurance company could. Based on that I can self insure and keep costs down or defer to getting policies on the individual market. Rational actors who are "more sick" will do that latter.

> Regardless of that: we already know what happens when the economics of health insurance for a region become unfavorable for insurers: they simply exit the individual (and, ultimately, the small-group) marketplace. No law requires insurers to offer products on the individual and small-group marketplace, and, without the mandate, it's reasonably straightforward to predict that many/most insurers will leave those markets.

And that's what congress needs to solve. Keeping the mandate might delay the implosion but it doesn't stop it.

[1]: https://en.wikipedia.org/wiki/Self-insurance#Size_of_self-fu...

The resource Wikipedia links to is a 404, but the text on that WP article does not seem to accurately sum up the 2017 Kaiser study.

The link has a stray forward slash ("/") at the end of the link, but otherwise has no problems. Slide 20 of the correct resource says (in graph form) that "81% of covered workers in firms with 200 or more workers are in partially or completely self-funded plans", which is indeed not what the text on Wikipedia claims. A footnote on the same slide says "Sixty-one percent of covered workers are in a partially or completely self-funded plan in 2014." (Please accept my apologies for not fixing these two issues on Wikipedia.)

The 2017 edition of the underlying report is available at https://www.kff.org/health-costs/report/2017-employer-health... . The report states multiple times that "Sixty percent of covered workers are in a self-funded health plan." The following portion is relevant to your discussion a few comments up: "Eighty-one percent of covered workers in firms with 1,000 to 4,999 workers and 91% of covered workers in firms with 5,000 or more workers are in self-funded plans in 2017". Figures 10.1 and 10.2 show these numbers in graphical form.