Since the passage of the Patient Protection and Affordable Care Act (ACA), there has been speculation that an increasing number of small and medium-sized employers would convert their health plans from fully insured to self-insured plans. As well, a recent EBRI report found that the percentage of private-sector establishments offering self-insured health plans increased through 2016 but has since ebbed and flowed with no discernible long-term trend. This Fast Fact takes a look at these recent trends, which have been more clearly defined when examined by firm size.