Abstract: We study regulations on the health insurance system for working-age U.S. households, consisting of employer-sponsored health insurance (ESHI), individual health insurance exchange (HIX), and Medicaid. We develop and estimate an equilibrium model with rich heterogeneity across local markets, households, and firms, which highlights the inter-relationship between various components of the health insurance system as well as their relationship with the labor market. We estimate the model exploiting variations across states and policy environments before and after the Affordable Care Act. In counterfactual experiments, we consider policies to cross subsidize between ESHI and HIX, which include pure risk pooling between the two markets as a special case. We find such policies would benefit most households, improve average household welfare, and decrease government expenditure. Furthermore, the welfare gains are larger if the cross subsidization is interacted with Medicaid expansion

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.

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.

Health Insurance has claimed a prominent place on the policy agenda in the United States. Critics argue that the status quo has lead to spiraling health care costs, an inequitable distribution of quality medical care, and that employer-provided health insurance has "locked" individuals into jobs, thereby interfering with the efficient matching of employers and employees. In contrast to the United States, Germany guarantees virtually all citizens health insurance. Insurance is portable, but the cost may change when an individual changes jobs, again leading to the potential for job-lock. This paper assesses the empirical magnitude of health insurance-related impediments to job mobility in the United States and Germany, The results show little evidence that health insurance provision interferes with job mobility in either the United States or Germany, thus suggesting that these employer-based systems for providing the health insurance portion of the social safety net do not alter this aspect of labor market efficiency.

This book, produced jointly by the World Bank, the University of California, Berkeley, and the WHO, aims to provide decision-makers at sub-national, national, regional and global levels with additional insights into how to address their workforce challenges rather than describe them. In order to optimize and align HRH investments and develop targeted policy responses, a thorough understanding of unique, country-specific labor market dynamics and determinants of these dynamics is critical. Policies need to take into account the fact that workers are economic actors, responsive to different levels of compensation and opportunities to generate revenue found in different sub-labor markets. Policies need to take into account the behavioral characteristics of the individuals who provide health care, but also the individuals who consume health care services and the institutions that employ health personnel. In other words, it is necessary to understand the determinants of both the supply (numbers of health workers willing to work in the health sector) and the demand for health workers (resources available to hire health workers), how these interact, and how this interaction varies in different contexts. This interaction will determine the availability of health personnel, their distribution as well as their performance levels, thus ensuring stronger health systems capable to deliver universal health coverage. The book is structured to be of use to researchers, planners, and economists who are tasked with analyzing key areas of health labor markets, including overall labor market assessments as well as and more narrow and targeted analyses of demand and supply (including production and migration), performance, and remuneration of health workers. The chapters, written by a number of internationally renowned experts on Human Resources for Health, discuss data sources and empirical tools that can be used to assess health labor markets across high-, middle- or low-income countries, but draws primarily from examples and case-studies in LMICs.

Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.

The United States is unique in the industrialized world in the number of people without health insurance. In 2002, nearly 44 million Americans did not have health insurance coverage. Despite long-running study of this problem, the political debate on health insurance is often based on conventional wisdom and studies that haven't been integrated into a careful theoretical framework. In Health Policy and the Uninsured, leading experts in health policy survey the literature on this subject, synthesizing a wide range of health insurance studies into a comprehensive overview of the uninsured. They consider the methodological hurdles involved in the research, explore the complex interaction between health insurance and labor supply, and highlight the special issues facing children, racial or ethnic minorities and immigrants, the near-elderly, and people with psychiatric or substance abuse disorders. This coordinated critique serves several purposes: First, it summarizes for policy makers what we do not know about the uninsured. Second, it provides a framework for the health policy research needed to fill the remaining gaps in our knowledge. And finally, it serves as a useful primer for economists and other policy analysts.