This study, based mainly on the 1989-98 March Current Population surveys, finds that state-mandated health insurance benefits and small-group health insurance reform had no statistically significant effects on labor market outcomes such as the quantity of work, wages, and whether an employee worked for a small or large firm. The number and type of state-mandated health insurance benefits were unrelated to weeks of work, wages, and the prevalence of private insurance coverage, but positively associated with weekly work hours. Extensive small-group health insurance reform was associated with a slight decline in the prevalence of private insurance coverage in small firms, and this reform affected both full- and part-time employees. Less extensive reforms were not generally related to the prevalence of private insurance coverage. Overall, the authors do not find strong evidence that insurance regulations affected labor market outcomes, although they appear to cause a small decrease in private coverage.

This dissertation continues the tradition of identifying the unintended consequences of the US health insurance system. Its main contribution is to estimate the size of the distortions caused by the employer-based system and regulations intended to fix it, while using methods that are more novel and appropriate than those of previous work. Chapter 1 examines the effect of state-level health insurance mandates, which are regulations intended to expand access to health insurance. It finds that these regulations have the unintended consequence of increasing insurance premiums, and that these regulations have been responsible for 9-23% of premium increases since 1996. The main contribution of the chapter is that its results are more general than previous work, since it considers many more years of data, and it studies the employer-based plans that cover most Americans rather than the much less common individual plans. Whereas Chapter 1 estimates the effect of the average mandate on premiums, Chapter 2 focuses on a specific mandate, one that requires insurers to cover prostate cancer screenings. The focus on a single mandate allows a broader and more careful analysis that demonstrates how health policies spill over to affect the labor market. I find that the mandate has a significant negative effect on the labor market outcomes of the very group it was intended to help. The mandate expands the treatments health insurance covers for men over age 50, but by doing so it makes them more expensive to insure and employ. Employers respond to this added expense by lowering wages and hiring fewer men over age 50. According to the theoretical model put forward in the chapter, this suggests the mandate reduces total welfare. Chapter 3 shows that the employer-based health insurance system has deterred entrepreneurship. It takes advantage of the natural experiment provided by the Affordable Care Act's dependent coverage mandate, which de-linked insurance from employment for many 19-25 year olds. Difference-in-difference estimates show that the mandate increased self-employment among the treated group by 13-24%. Instrumental variables estimates show that those who actually received parental health insurance as a result of the mandate were drastically more likely to start their own business. This suggest that concerns over health insurance are a major barrier to entrepreneurship in the United States.

The Affordable Care Act (ACA) remains one of the most controversial pieces of legislation in a generation, and the full impacts of the law continue to be debated. Initial forecasts of how many individuals would gain health insurance coverage, as well as how the law's subsidies and regulations would impact the labor market, differ considerably from subsequent studies that have examined its effects. In this paper I use updated data from the American Community Survey (ACS) from 2012-2016 to analyze the impact of the ACA and its attendant expansion of Medicaid in 32 states and the District of Columbia. Specifically, I investigate the relationship between the law and health insurance coverage, labor force participation, and number of hours worked per week. I find that both the ACA and Medicaid expansions are significantly associated with substantial increases in health insurance coverage. As predicted by economic theory, I find that the ACA is associated with a decrease in labor force participation, but the Medicaid expansion separately is not. I also find that a significant and positive relationship between the ACA and the number of hours worked per week. Together, this paper supports the conclusion that the ACA has effectively increased the number of Americans with health insurance coverage, and provides important insight into its more complicated relationship with the labor force.

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 Affordable Care Act's taxes, subsidies, and regulations significantly alter terms of trade in both goods and factor markets. We use a multi-sector (intra-national) trade model to predict and quantify consequences of the Affordable Care Act for the incidence of health insurance coverage and patterns of labor usage. If and when the new exchange plans are competitive with employer-sponsored insurance (ESI), our model suggests that more than 20 million people will leave ESI as a consequence of the law. Behavioral changes that are captured in the model could add about 3 million participants to the new exchange plans: beyond those that would participate solely as the result of employer decisions to stop offering coverage and beyond those who would have been uninsured. Industries and regions will grow, decline, and change coverage on the basis of their relative demand for skilled labor.

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.

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.