State Insurance Regulation and Employers' Decisions to Self-Insure (original) (raw)
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State mandated benefits and the small firm's decision to offer insurance
Journal of Regulatory Economics, 1992
In the last decade, the number of Americans without health insurance has grown, partly due to an erosion in employer-based coverage among workers. This paper examines the extent to which state-mandated benefit requirements and other state in surance regulations discourage small firms in the private sector from providing health benefits. Using data on 1320 firms observed in 1985 and 492 finns observed in 1988, we estimate two models of small firms' decisions to offer health insurance (one for each data set), and then use them to assess the effects that mandates had on purchasing decisions in bc~h years. We estimate that 19 percent of noncoverage among sample businesses in 1985 and 43 percent of noncoverage in the 1988 sample was attributable to state-mandated benefits. State continuation-of-coverage requirements were particularly burdensome for firms. With continued growth in the number of state mandated benefit requirements, we should expect a steady rise in the small firm's propensity to forgo insurance coverage.
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Journal of Business Venturing, 2014
We investigate the effect of health insurance on labor market transitions in and out of selfemployment as well as on the likelihood of being self-employed. We consider the role of individual health insurance coverage along with that from a spouse. Next, we examine a series of tax deductions granted to the self-employed through amendments made to the 1986 Tax Reform Act. Using data from the Current Population Survey for 1996-2007, we find significant but small effects of the after-tax health insurance premium on the entry rate, with no effect on exits from self-employment or the likelihood of being self-employed.
2000
Americans under the age of 65 depend on employers for their health insurance coverage more than any other source. Despite mounting rhetoric that employer-based coverage is rapidly disintegrating, nearly all large firms in the United States continue to offer health benefits to their employees. But there are key weaknesses in employer-provided coverage. These weaknesses, exacerbated by rising health care costs, have fueled the relentless rise in the number of people without comprehensive health insurance-now 47 million people, not counting the estimated 16 million adults who are underinsured.
A Reappraisal of Private Employers' Role in Providing Health Insurance
New England Journal of Medicine, 1999
In 1996, according to official figures, 61 percent of Americans received health insurance through employers. However, this estimate includes persons who relied primarily on government insurance such as Medicare, workers whose employers arranged their insurance but contributed nothing toward the premiums, and government employees whose private coverage was paid for by taxpayers. To estimate the number of persons whose principal health insurance was paid for in whole or in part by employers in the private sector and the number receiving government-funded insurance, we analyzed data from the March 1997 Current Population Survey. Approximately 130,000 persons representative of the noninstitutionalized U.S. population were sampled. We considered people to be covered principally by health insurance paid for by private-sector employers if they had no public insurance coverage and were covered by insurance from a non-governmental employer who paid all or part of their premiums. Those who were covered by Medicaid, Medicare, insurance resulting from former or current military service, or the Indian Health Service were considered to be receiving government insurance. In 1996, 43.1 percent of the population (90 percent confidence interval, 42.7 to 43.5 percent) depended principally on health insurance paid for by private-sector employers, 34.2 percent (90 percent confidence interval, 33.8 to 34.6 percent) had publicly funded insurance, 7.1 percent (90 percent confidence interval, 6.8 to 7.6 percent) purchased their own coverage, and 15.6 percent (90 percent confidence interval, 15.3 to 15.9 percent) were uninsured. In only six states was more than half the population covered principally by health insurance paid for by private-sector employers. Current definitions of health insurance overemphasize the role of private employers and underestimate the extent to which government pays for health insurance.
Self-Insurance In Times Of Growing And Retreating Managed Care
Health Affairs, 2003
This paper examines trends in self-insurance and in the content of selfinsured plans from 1993 to 2001. The percentage of employees enrolled in self-insured plans fell during these years. Much of the decrease was attributable to the decline of indemnity insurance and the rise of HMO and point-of-service plan enrollment. If the product mix had remained constant throughout these years, self-insured enrollment would have grown between 1993 and 1996 and then declined to its current 50 percent level. As a result of the Health Insurance Portability and Accountability Act (HIPAA), the use of preexisting condition clauses declined dramatically in self-insured plans. Self-insured and purchased plans cost similar amounts and provide similar benefits. Cost sharing is somewhat lower in self-insured PPO plans. During periods of rapid inflation, premiums increase more slowly for self-insured than for fully insured plans.
Another Look at the Effect of State Mandates for Health Insurance Benefits
2007
The research question we address is whether state laws that require health insurance policies to provide coverage for specified benefits have affected the size of the population without any private sector health insurance coverage. The laws are often alleged to increase the cost of insurance premiums and thus reduce incentives for smaller employers to offer and for individuals to purchase health insurance. Using data from the United States Census Current Population Survey (CPS) from 1996 to 2002, we measure the effects of 2 sets of high cost benefit mandates on the probability for workers to have health insurance through their employer. We use both individual and state level analyses. Generally we find weak and statistically insignificant effects associated with benefit mandates, though we see evidence that this relationship grows stronger over time. This journal article is available at ScholarlyCommons: http://repository.upenn.edu/wharton\_research\_scholars/43 Another Look at the Ef...
Government Mandates and Employer-based Health Insurance: Who is Still Not Covered
1999
Abstract In this paper we explore the probability that employees have employer-based health insurance. Health insurance is a fixed cost which when added to cash compensation raises the cost of a low-wage worker more than that of a non-low-wage worker. A worker who has high expected medical expenditures or whose family has such expenditures may raise the cost of health insurance for all workers in the firm, particularly in a small firm.
Self-Employment and the Role of Health Insurance
2010
We investigate the effect of health insurance on labor market transitions in and out of selfemployment as well as on the likelihood of being self-employed. We consider the role of individual health insurance coverage along with that from a spouse. Next, we examine a series of tax deductions granted to the self-employed through amendments made to the 1986 Tax Reform Act. Using data from the Current Population Survey for 1996-2007, we find significant but small effects of the after-tax health insurance premium on the entry rate, with no effect on exits from self-employment or the likelihood of being self-employed.