Health insurance and labor market outcomes: Joint decision-making within households

Most Americans obtain access to health insurance through an employer. In this paper, we ask how the link between health insurance and employment affects labor market choices such as whether to work full-time. To understand the effect of the incentives embedded in the employer-based insurance system, we study the joint decision-making of husbands and wives that determines the household's access to health insurance. We estimate the effect on a wife's (husband's) labor market outcomes of husband's (wife's) health insurance, allowing the health insurance of both spouses to be endogenous. Obtaining unbiased estimates of such effects is complicated by the likelihood that positive assortative mating creates correlations between a couple's characteristics and the possibility that there are important unobservable household income effects. Our innovation is to measure these biases by examining a second fringe benefit, paid sick leave, in addition to health insurance. We find that, as predicted, spouse's insurance has statistically significant negative effects on being offered own employer insurance as well as on the probability of working full-time with health insurance.     

Fringe benefits and small businesses: evidence from the federal reserve board small business survey

Data from the 1993 National Survey of Small Businesses (NSSBF) is used to analyse the factors affecting the provision of pensions and health insurance by small businesses. The race of the business owner is found to impact the provision of taxadvantaged fringe benefits, even after accounting for a wide range of other economic and demographic variables. It is not possible to determine why owner race impacts the provision of fringe benefits by small businesses but the significance of the race variable might reflect a lower level of marketing effort by financial service firms in minority-dominated communities. The owner education variable, which is also significant in both the pension and health insurance models, could also be a proxy for the availability of general information about the importance of fringe benefits. With the exception of the sole proprietorship variable, the demographic and economic variables appear to have similar effects on the provision of both pensions and health insurance by small businesses. Some sole proprietors appear to prefer pension benefits to health insurance benefits possibly because pensions allow the business owner to shield some assets in the case of bankruptcy.     

US state health expenditure convergence: A revisited analysis

This paper studies the evolution of US state health expenditure for a sample that covers 1966–2014. Our results provide evidence against the existence of a single pattern of behavior of personal health care expenditure across the US states. Rather, we can observe the existence of two statistically different convergence clubs. We cannot find evidence of convergence when we disaggregate health expenditure into its three main payers: Medicare, Medicaid and private health insurance expenditure, whilst we again find evidence of convergence clubs. However, the estimated clubs for Medicaid and private health insurance expenditure are statistically different that estimated for total health expenditure. Consequently, our results offer strong evidence of heterogeneity in the evolution of US health expenditure. The analysis of the forces that drive club creation shows that economic situation and some supply-side factors are important. We can also appreciate that some healthcare outcome variables are only related to private insurance health expenditure. The other health expenditures, thus, show a certain lack of efficiency which may be due to practices that have little benefit for patient health.     

Retirement and health behaviour

This article investigates whether and to what extent retirement changes health behaviour. For identification we use an instrumental variable approach that exploits exogenous variations in the early and normal retirement ages within and across 10 European countries. Our results reveal that among those who abstained from alcohol and vigorous or moderate exercise at baseline, retirement increased those activities. Non-smokers did not increase smoking upon retirement. Retirement led to less smoking for those who smoked before retiring. It also brought about an increase in vigorous exercise for those who had the behaviour at baseline. These results further vary by a person’s job type, but less so with respect to gender or geographic region. Overall, our findings provide new empirical evidence on the causal link between retirement and health behaviours and how such link relates to four sources of individual heterogeneity: gender, European geographic region, job type and baseline health behaviour.     

EMPLOYMENT EFFECTS OF HEALTH SHOCKS: THE ROLE OF FRINGE BENEFITS

This paper examines whether health shocks influence labour supply. Estimates rely on detailed health measures that not only are more homogeneous than commonly‐used self‐reported health measures, but they also can be interpreted as plausibly exogenous with respect to labour supply. Further, this paper investigates the unique role that certain fringe benefits, namely health insurance and paid sick leave, play in the link between health shocks and subsequent employment activity. Results show that, compared to commonly‐used self‐reported measures of health, health problems defined by the US government as ‘priority’ conditions correlate with smaller labour supply shifts, but non‐work‐related injuries lead to larger shifts. Second, the arrival of a health shock appears to reduce the probability of remaining employed full time, while also increasing the likelihood of quitting work. Relatively few full‐time workers who acquire health problems switch to part‐time employment. Third, in the event of a health shock, sick leave appears to facilitate reductions in employment activities, while employer‐provided insurance appears to hinder such adjustments.     

A guide to understanding long-term care insurance

Long-term care insurance is an increasingly popular benefit that has a number of advantages for both employers and employees. This coverage can protect employee assets and retirement savings and can be offered as a tax-free benefit if the plan is qualified. The premiums can be tax-deductible to employees, and the benefit is portable, since the policy is owned by the employee.     

WHAT ARE EMPLOYERS DOING TO CREATE A COMPETITIVE MARKET FOR HEALTH CARE IN THE TWIN CITIES?

Employers' willingness to control costs is a critical aspect of pro-competition strategies for the health-care market. Here, we present some of the first quantitative evidence of what employers do to control health-care costs. Our sample is 44 large private and public employers in Minnesota.
We develop a theoretical model in which the employer chooses cost-control "innovations"—along with wages, fringe benefits, and labor-force size—to maximize profits. The role of innovations is to reduce unit costs of offering fringe benefits.
Our data are from a 1982 survey. Eighty percent of the surveyed employers, representing nearly 200,000 employees, responded. Most respondents offer both indemnity insurance plans and health-maintenance organizations (HMOs). Many firms and individual health-insurance plans conduct cost-control activities, but less than half of the firms which offer HMOs have adopted level-dollar premium contributions for their family health-insurance policies. Few plans have increased their coinsurance and deductible requirements in the past five years.
We use probit equations to estimate the probability that a firm or a health plan will adopt cost-control activities. Our analysis suggests that many firms may soon make major plan-design changes to control health-care costs, although they have not yet done so.     

Long-term care insurance: an essential employee benefit

Growing numbers of employers are embracing long-term care insurance (LTCI) as an important new addition to their employee benefits package due to aging baby boomers, tax favorable legislation, the need for employee retention and rising costs of care. Even the best retirement plans can be gutted by the high costs of long-term care. The authors identify key components of LTCI and offer guidelines for selecting an LTCI company.     

The FBT - Does It Matter Who Pays?

The fringe benefits tax (FBr) has been criticised for being levied on employers. This criticism is based on a confusion between who has the liability to pay the tax and who bears the burden of the tax. We show that the burden of a fringe benefit tax is independent of who pays it. Furthermore our analysis suggests that the burden of the FBT will fall mainly on upper income groups. We also discuss how the imposition of the FBT will change the optimal mix of fringe benefits supplied by employers, with some benefits being ‘cashed out’.     

LOVE,TOIL, AND HEALTH INSURANCE: WHY AMERICAN HUSBANDS RETIRE WHEN THEY DO

The provision of health insurance has previously been shown to be an important determinant of retirement timing among older Americans, but the existing literature has largely ignored some aspects of the interspousal dependence of health insurance benefits. Specifically, the literature examines only how retirement may affect the health insurance available to the potential retiree but not how it might affect a spouse's options. Using data from the Health and Retirement Study, I find that the impact a husband's retirement might have on a wife's health insurance options has a statistically significant impact on a husband's rate of retirement that is independent of considerations of his own health insurance options. In households where the wife is the only one at risk of losing affordable health insurance if the husband retires, the husband is 30% less likely to retire than if neither spouse is at risk (a 5 percentage point decrease in the retirement rate). Based on these findings, prior research is missing one avenue that changes to the Medicare eligibility age and health insurance policy changes through the Affordable Care Act might impact the labor supply of older workers. (JEL I13, J26, J32)     

Health insurance and the labor supply decisions of older workers: Evidence from a U.S. Department of Veterans Affairs expansion

This paper exploits a major mid-1990s expansion in the U.S. Department of Veterans Affairs health care system to provide evidence on the labor market effects of expanding health insurance availability. Using data from the Current Population Survey, we employ a difference-in-differences strategy to compare the labor market behavior of older veterans and non-veterans before and after the VA health benefits expansion to test the impact of public health insurance on labor supply. We find that older workers are significantly more likely to decrease work both on the extensive and intensive margins after receiving access to non-employer based insurance. Workers with some college education or a college degree are more likely to transition into self-employment, a result consistent with “job-lock” effects. However, less-educated workers are more likely to leave self-employment, a result suggesting that the positive income effect from receiving public insurance dominates the “job-lock” effect for these workers. Some relatively disadvantaged sub-populations may also increase their labor supply after gaining greater access to public insurance, consistent with complementary positive health effects of health care access or decreased work disincentives for these groups. We conclude that this reform has affected employment and retirement decisions, and suggest that future moves toward universal coverage or expansions of Medicare are likely to have significant labor market effects.     

The micro-firm health insurance hypothesis

The objective of this study is to investigate the ‘micro-firm health insurance hypothesis’, a hypothesis that the greater the percentage of domestic firms that are ‘very small’, i.e. have four or fewer employees, the greater the percentage of the US population that will be without health insurance. The focus of this study is based on the premise that very small firms (as defined), ‘micro-firms’, which constitute 58.6% of all private sector firms in the US, face bargaining-power, financial, and competitive constraints that tend to limit their ability to provide group health insurance benefits to their employees, with the result being that employees at very small firms are relatively more likely than employees at larger firms to be without a health insurance fringe benefit. Weighted Least Squares (WLS) estimates provide strong empirical support for the hypothesis.     

FBT: How to Structure Remuneration Packages for 1986–87

The purpose of this article is to determine the optimal structure of remuneration packages in the new fringe benefits tax (FBT) environment. We will describe precisely how the optimal structure of remuneration packages depends upon the (marginal) rates of FBT, personal income tax and corporate tax. The fundamental decision rule for employers and employees to optimise the value of remuneration packages is quite simple. First substitute the FBT rate, f, and the employer's marginal tax rate, t, into I = f(1 + f - t)^-1. Then if the employee's marginal tax rate i is greater than I the employer should provide any benefits until i falls to the value I. At or below this point the employee would be better off to provide all subsequent benefits.     

Small business no longer has to mean small benefits

The Internet has drastically changed the benefits environment for small businesses. Formerly, employers with a small workforce were severely limited in providing benefits to their employees. Today, by utilizing the Web, many owners of small businesses are offering their employees benefit packages comparable to those offered at major corporations. This author offers suggestions for effective benefit shopping on the Internet.     

Group disability income: new policies emphasize employee appeal

Group disability insurance is a voluntary benefit that offers advantages to both employers and employees. Employees who want this kind of coverage realize that their employers have done much of the homework for them in terms of comparing benefits, rates and contract provisions. Employers recognize an opportunity to add a benefit that may help attract and retain valuable employees with little additional cost or administrative burden.     

The determinants of the demand for private health insurance under Medicare

Since the introduction of Medicare in 1984, the proportion of the Australian population with private health insurance has declined considerably. Insurance for health care consumption is compulsory for the public health sector but optional for the private health sector. In this paper, we explore a number of important issues in the demand for private health insurance in Australia. The socio-economic variables which influence demand are examined using a binary logit model. A number of simulations are performed to highlight the influence and relative importance of various characteristics such as age, income, health status and geographical location on demand. A number of important policy issues in the private health insurance market are highlighted. First, evidence is provided of adverse selection in the private health insurance pool, second, the notion of the wealthy uninsured is refuted, and finally it is confirmed that there are significant interstate differences in the demand for private health insurance.     

Labor market shocks and retirement: Do government programs matter?

This paper argues that labor market conditions are an important and often overlooked determinant of retirement transitions. In our analysis, we examine how the unemployment rate affects retirement and whether the Social Security (SS) system and Unemployment Insurance (UI) system influence how older workers respond to labor market shocks. We use pooled cross-sectional data from the March Current Population Survey (CPS) in our analysis. We find that downturns in the labor market increase retirement transitions and that the magnitude of this effect is comparable to that associated with moderate changes in financial incentives to retire and to the threat of a health shock facing older workers. Interestingly, retirements only increase in response to an economic downturn once workers become SS-eligible, suggesting that retirement benefits may help to alleviate the income loss associated with a weak labor market. We also estimate the impact of UI generosity on retirement and find little consistent evidence of an effect. This suggests that in some ways SS may serve as a more effective form of unemployment insurance for older workers than UI.     

Health insurer market power and employer size: an empirical evaluation of insurer concentration and wages through compensating differentials

This article explores the differentiated effects of health insurer market concentration on net compensation of employees across distinct firm sizes. Consistent with the existing literature evaluating insurer market concentration and the theory of compensating differentials, we find evidence of higher premiums and reduced net compensation for employees in markets with more concentrated insurers. Furthermore, we find evidence that the magnitude of these effects is distinctly smaller for large employers. This implies that mergers of large health insurance companies may have a significant impact on small businesses but that the effect is mitigated for larger employers.     

Analyses of retirement benefits with options

This study applies the contingent claim approach to evaluate retirement benefits with the options of choosing the maximum defined benefit and defined contribution pension plans. A least-squares Monte Carlo simulation values complex retirement benefits that feature the properties of multiple variables, early exercise, stochastic interest rates, and several embedded options. Furthermore, this study examines the impacts of different forms of early decrements of the value of retirement benefits with options.     

LABOR MARKETS AND HEALTH BENEFITS: THE OFFER AND RESTRICTIONS ON IT

This study argues that a multidimensional health benefit offer (i.e., offers of medical, dental, sick leave, or vision benefits) and the hours or tenure restrictions placed on it are affected by the relative demand for workers in the local labor market. Using the Bay Area Longitudinal Surveys (BALS), a database of low-skilled jobs, we show that an excess labor demand for workers' skills increases the firm's offer of health benefits and reduces the restrictions on them, while an excess labor supply increases restrictions. These findings suggest that research assessing the correlation between wages, skills, and whether or not a firm offers health insurance might understate the plight of the low-skilled worker since health care access may also be restricted by a failure to receive an array of health benefits and by the restrictions placed on the offer. Furthermore, public policies might place the issues of uninsurance of low-wage workers within the context of a lack of marketable skills since low-skilled workers might be able to enhance their ability to secure jobs that offer an array of health benefits if they acquire skills in short supply in the local labor market. ( JEL J3)