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.     

Self-funding health insurance for small employers: is it the right way to go?

Self-funding offers small employers an alternative approach to providing health care benefits for their employees. It may not be appropriate for every small employer but, in situations where it is feasible, self-funding offers employers a way to get a measure of control over health care costs while providing the benefits employees expect.     

Community Health Purchasing Alliances (CHPAs): how Florida CHPAs are affecting employers. A case study

Florida's health insurance reforms for small employers can be viewed as two distinct initiatives: insurance reform and the community health purchasing alliances (CHPAs). While small employer insurance reform legislation appears to have expanded access to coverage, the administrative structure of the CHPA still has a long way to go to capture the confidence of the marketplace.     

The impact of horizontal mergers and acquisitions on cost and quality in health care

Mergers and acquisitions among HMOs, hospitals and other health care providers can be disconcerting to benefits staff and employees, but they can be successfully managed. They may offer an employer the opportunity to improve the quality of care provided and to do so at reduced costs.     

Adverse selection in health insurance markets? Evidence from state small-group health insurance reforms

The past decade witnessed major changes in state laws governing the sale of health insurance to small employers. States took measures to restrict insurers' ability to distinguish between high and low-risk customers because of concern about the low rate of coverage among workers in small firms, the high prices in the small-group market and the absence of federal health reform. Using both individual-level and employer-level data, I test predictions about the effect of reforms on the employer-provided health insurance market. I estimate these effects for small firms and their workers using large firms and their workers in the same states, as well as large and small firms and their workers in non-reform states, as comparison groups. I find the reforms decreased the rate of employer coverage on average for workers in small firms by less than two percentage points. Within small firms, low-expenditure individuals experienced a larger decline in the rate of coverage through their employer, while the coverage rate of high-expenditure individuals rose slightly in some specifications. There is also evidence that comprehensive reforms increased premiums slightly for small employers, and that most of this increase was passed on to workers through higher employee contributions.     

Health benefits: employer liability and the need for change

The cost of health care benefits has been rising much faster than overall inflation recently, and employees are increasingly dissatisfied with the programs being offered. This has left many human resources professionals searching for a better way. Against this background, attempts to increase employer liability pose serious threats. While some employers might consider abandoning health benefits to avoid this expanded liability, other alternatives may be more appealing and may be equally effective at limiting liability.     

Are your employees minding their behavior?

Self-managed, "tailored" behavioral change programs cross both wellness and disease management issues and can impact the bottom line on health care costs of both employer and employee. For example, a back pain program can help change employee behavior to prevent the incidence and upflow of a condition to more severe and debilitating situations.     

The changing world of ancillary benefits

Amid salary and health care benefit cuts, ancillary benefits such as dental, life insurance, long-term disability and vision coverage can communicate employers' concern for their employees as well as serve as recruitment and retention tools. These benefits can be funded by the employer, the employee or both.     

Tax subsidies,the rational demand for insurance and the health care crisis

An individual's optimal insurance coverage depends on balancing his gain through avoiding risk against his loss through the distortion of demand. The U.S. tax system subsidizes the purchase of excessive health insurance by excluding employer premium payments from employees' taxable incomes and by permitting the deduction of a portion of individual premiums. The current operational model of demand for health insurance shows that the tax subsidy does substantially increase insurance coverage. Since much of the rise in health care costs can be attributed to the growth of insurance, the tax subsidy is responsible for much of what is widely perceived as a health care crisis.     

HEALTH INSURANCE AND LABOR FORCE PARTICIPATION: WHAT LEGAL RECOGNITION DOES FOR SAME‐SEX COUPLES

Using Current Population Survey data, I examine how same‐sex couples' labor force participation and health insurance coverage change as a result of their unions being legally recognized. The results indicate female same‐sex couples switch from arrangements where both members work to arrangements where only one member of the couple works. Being able to gain health insurance through a spouse's employer seems to play a major role in this change. Male same‐sex couples experience no change in their labor force participation or health insurance. (JEL J08, I13, J18)     

MEASURING THE IMPACT OF VALUING HEALTH INSURANCE ON LEVELS AND TRENDS IN INEQUALITY AND HOW THE AFFORDABLE CARE ACT OF 2010 COULD AFFECT THEM

A substantial part of the U.S. inequality literature focuses on yearly levels and trends in pre‐tax, post‐transfer cash income and its distribution over time and finds that median income appears to be stagnating, with income growth primarily coming at higher income levels. When we use data from the Current Population Survey for 1995–2008 and add the value of employer‐ and government‐provided health insurance coverage, not only does it increase the upward trend in the level of resources controlled by Americans, but also reduces the level of inequality in these resources and its upward trend. We then provide a highly stylized example of this broader income measure's value in capturing the impact of two key provisions of the Affordable Care Act of 2010—an expansion in Medicaid and the provision of subsidies to lower‐income families for purchasing private coverage on state‐run exchanges. Even though these incremental expansions build on existing systems of government‐provided health insurance, we find that the vast majority of the benefits would still accrue to the bottom three deciles of the income distribution when we include the value of employer‐ and government‐provided health insurance in our expanded yearly income measure. (JEL D31, H51, I14)     

How Productive Is Workplace Health and Safety?

In this paper, we investigate the causal impact of workplace health and safety practices on firm performance, using Danish longitudinal matched employer–employee data merged with unique cross‐sectional representative firm survey data on work environment conditions. We estimate standard production functions, augmented with workplace environment indicators, addressing both time‐invariant and time‐varying potentially relevant unobservables in the production process. We find positive and large productivity effects of improved physical dimensions of the health and safety environment, specifically, “internal climate” and “monotonous repetitive work”.     

不对称雇主学习、外部选择与雇员谈判力

本文在非合作博弈（策略式）单边不对称信息讨价还价框架下,按照外部约束（而不是威胁点）的思路来模型化外部雇主的竞争,以分析不对称雇主学习的程度对处于信息劣势的通用性雇员谈判力的决定作用。本文提出的框架弥补了已有文献的一些不足,同时为不对称雇主学习这一劳动经济学概念提供了一个讨价还价理论基础。     

Has the Affordable Care Act increased part-time employment?

We examine the impact of the Affordable Care Act (ACA) on part-time employment. Because the ACA’s employer health insurance mandate applies to individuals who work 30 or more hours per week, employers may try to avoid the mandate by cutting workers’ hours below the 30-hour threshold in order to avoid having to provide them with health insurance. Although the employer mandate only went into effect in 2015, many observers have argued that forward-looking employers began to shift towards a part-time workforce well in advance of the mandate. To test this hypothesis, we examine relative shifts across two categories of part-time workers (25–29 hours and 31–35 hours). We find some evidence of a shift from the 31–35-hour category into the 25–29-hour category after the passage of ACA in March 2010. However, that shift is not more pronounced among low-wage workers or among workers in industries and occupations most likely to be affected by the mandate. Thus, there is little evidence that the ACA has caused the shift across hours categories, or led to an increase in part-time employment. However, the ACA could cause a shift towards part-time work in the future as the mandate takes effect.     

Fair wages survive multiple sources of income inequality

When an employee in a gift exchange game earns significantly less than the employer, the source of employer income does not affect effort choices. However, to induce one unit of effort, the employer has to pay higher wages than in a game without payoff inequality.     

Employer size–wage effects: evidence from matched employer–employee survey data in the UK

This paper employs a random sample of matched employer–employee data from the UK to test seven possible explanations for the positive relationship between employer size and pay. Individual wage equations show a large employer size–wage premium. We then control for a range of establishment-level variables, based on seven hypotheses typically advanced to explain this premium. Each establishment-level factor reduces the wage premium, but a sizeable premium nonetheless remains. In adjudicating on these hypotheses, we find a strong association between the internal labour market and the employer size–wage premium. This finding supports the theory that the employer size–wage effect may be due to the higher costs of turnover or monitoring in larger firms. However, we find contrasting effects for public versus private sector establishments.     

Obesity-related costs and the economic impact of laparoscopic adjustable gastric banding procedures: benefits in the Texas Employees Retirement System

Objective: To assess the return on investment (ROI) and economic impact of providing insurance coverage for the laparoscopic adjustable gastric banding (LAGB) procedure in classes II and III obese members of the Texas Employees Retirement System (ERS) and their dependents from payer, employer, and societal perspectives.

Methods: Classes II and III obese employee members and their adult dependents were identified in a Texas ERS database using self-reported health risk assessment (HRA) data. Direct health costs and related absenteeism and mortality losses were estimated using data from previous research. A dynamic input–output model was then used to calculate overall economic effects by incorporating direct, indirect, and induced impacts. Direct health costs were inflation-adjusted to 2008 US dollars using the Consumer Price Index for Medical Care and other spending categories were similarly adjusted using relevant consumer and industrial indices. The future cost savings and other monetary benefits were discounted to present value using a real rate of 4.00%.

Results: From the payer perspective (ERS), the payback period for direct health costs associated with the LAGB procedure was 23–24 months and the annual return (over 5 years) was 28.8%. From the employer perspective (State of Texas), the costs associated with the LAGB procedure were recouped within 17–19 months (in terms of direct, indirect, and induced gains as they translated into State revenue) and the annual return (over 5 years) was 45.5%. From a societal perspective, the impact on total business activity for Texas (over 5 years) included gains of $195.3 million in total expenditures, $93.8 million in gross product, and 1354 person-years of employment.

Limitations: The analysis was limited by the following: reliance on other studies for methodology and use of a control sample; restriction of cost savings to 2.5 years which required out-of-sample forecasting; conservative assumptions related to the cost of the procedure; exclusion of presenteeism; and no sensitivity analyses performed.

Conclusion: This analysis indicates that providing benefits for the LAGB procedure to eligible members of the Texas ERS and their dependents is worthy of support from payer, employer, and societal perspectives.     

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.     

Layoffs,recalls and unemployment duration: evidence from Sweden

The question addressed in this paper is whether the possibility of exit from unemployment to the previous employer affects the duration of unemployment spells in Sweden. The empirical analysis is performed using an employee–employer dataset that includes a number of enterprise characteristics and provides information on individual tenure. The econometric approach employs estimation of a competing risk duration model to distinguish between exits to the previous employer and exits to a new job. The findings suggest that greater tenure raises the risk of transition to the previous employer, while high education levels increase the risk of obtaining a new job. Moreover, the impact of benefit exhaustion is observed only for transitions to new employment.