This paper, funded by Blue Cross Blue Shield of Louisiana, explores the increased adoption by small employers of level-funded health plans and the potential future impacts on small group health insurance market dynamics. The study models the decision-making process of rational employers when choosing between fully insured, ACA small group health plans and underwritten level-funded plan alternatives. The study uses data from BCBSLA's fully insured ACA small group population to model population movements and claim cost changes. In the report, we discuss:

• The theoretical framework used
• Data and the model
• Results for an average simulation and 90% confidence interval

This paper was commissioned by Blue Cross Blue Shield of Louisiana.