A distinctive feature of the health insurance market in the U.S. is the restriction of group insurance availability to the workplace. This has a number of important implications for the functioning of the labor market, through mobility from job-to-job or in and out of the labor force, wage determination, and hiring decisions. This paper reviews the large literature that has emerged in recent years to assess the impact of health insurance on the labor market. I begin with an overview of the institutional details relevant to assessing the interaction of health insurance and the labor market. I then present a theoretical overview of the effects of health insurance on mobility and wage/employment determination. I critically review the empirical literature on these topics, focusing in particular on the methodological issues that have been raised, and highlighting the unanswered questions which can be the focus of future work in this area.

Who really pays for health benefits? An accessible explanation of the economic theory behind this question

In the U.S., health insurance (HI) coverage is linked to employment in ways that can affect both wages and the demand for certain types of workers. That close linkage can also affect people¿s decisions to enter the labor force, to work fewer or more hours, to retire, and even to work in one particular job or another. This economic brief shows that the overall impact on labor markets (LM) is difficult to predict. Although economic theory and experience provide some guidance as to the effect of specific provisions, large-scale changes to the HI system could have more extensive repercussions than have previously been observed and also may involve numerous factors that would interact ¿ affecting LM in potentially offsetting ways.

First published in 1999, this volume responds to a large and growing interest among health policy and research circles on the use of purchasing alliances to leverage change in health care. This book gives detailed and useful specifics on how a leading alliance has fared in California, the most competitive health care market in the United States. Although it is generally accepted that large organizations are more effective purchasers of health insurance, little work has been done to carefully examine the reasons that underlie that phenomenon. Yet, creating interventions and designing potential solutions requires a thorough understanding of the issues. The econometric analysis adds to the limited literature on the influence of premium on choice behaviour for employees of small firms, and introduces an analysis of choice behaviour in a purchasing cooperative setting. The political section of this book presents a much more detailed historical account and analysis of California’s small group market reforms, the most significant health-related legislation in the state in the prior decade, than has been previously available. The conclusions are becoming particularly relevant, both in California and elsewhere, as the issues of reform of the individual market for health insurance comes to the forefront.

Increases in the cost of providing health insurance must have some effect on labor markets, either in lower wages, changes in the composition of employment, or both. Despite a presumption that most of this effect will be in the form of lower wages, we document in this paper a significant effect on work hours as well. Using data from the CPS and the SIPP, we show that rising health insurance costs over the 1980s increased the hours worked of those with health insurance by up to 3 percent. We argue that this occurs because health insurance is a fixed cost, and as it becomes more expensive to provide, firms face an incentive to substitute hours per worker for the number of workers employed.

The US does not have universal healthcare coverage for all its citizens. Instead, institutions have been cobbled together, with coverage varying from person to person. Some forms of health insurance are part of the compensation for employment, while others can be accessed whether the person is employed or not. Employers and the government provide most people their health insurance. The Affordable Care Act has mandated all employers with at least 50 full time employees to cover the health insurance of at least 95 percent of the employees. This coverage is borne as a cost by the employer. My thesis uses longitudinal data from the March Current Population Survey (CPS) conducted by the Census for the Bureau of Labor Statistics (which includes individual-level responses to many demographic and socioeconomic questions) to estimate the impact of insurance cost by observing two sets of time periods (before the mandate is imposed and after the mandate is imposed) to study what has been the impact on variables such as wages, for people who are the heads of their households and what the variation is based on (such as race, age, level of education, and marital status).