Employer-provided Health Insurance Research Articles

Documenting Food Insecure U.S. Children in the Wake of the Pandemic

Many households experienced significant negative economic impacts from job or work opportunity loss during the COVID-19 pandemic, including loss of income, loss of employer-provided health insurance, possible housing insecurity, and increases in food insecurity. Results from a sample of 929 U.S. households show that 53% of households with children reported some indications of food insecurity in 2020. The food security score divergences between households with and without children are stark, with food insecurity being worse among households with children. Food insecurity for households with children was exacerbated by pandemic-era disruptions; the societal costs of these food insecurity challenges are only beginning to be recognized. This analysis adds evidence to the notion of the uneven toll of the pandemic and documents explicit and disproportionate negative consequences for households with children. As new policies are debated and economic recovery continues, households with children who have fallen down the socioeconomic ladder should not be omitted. Much of the attention during the pandemic has been on older segments of the population more susceptible to COVID-19 and its complications, while younger children, who were less susceptible initially and/or less obviously impacted by the virus itself were discounted. Pandemic ramifications expand beyond morbidity and loss of life, and long-ranging implications, especially for households with children, should be recognized when recovery-era policies are enacted to ensure they are not left behind. In particular, as pandemic-era support programs, including school lunch programs, expire the tolls on children mount and may be underappreciated.

Racial-Ethnic Poverty Gaps in Later Life: A Role for Late Career Employment Quality?

Abstract Racial-ethnic disparities in poverty are an important form of inequality in older age. Recent scholarship on racial-ethnic poverty gaps demonstrates that, beyond individual characteristics and behaviors, racialized structural factors like employment contribute to such gaps. Yet surprisingly little is known about the role of employment quality, despite observed racial-ethnic disparities in employment quality and the role of employment history in shaping later life well-being. Using data from the 2002–2018 waves of the Health and Retirement Study (HRS) and three poverty measures, we decompose the proportions of the Black-white and Hispanic-white poverty gaps among households led by 65-year-olds that are attributable to disparities in late career employment quality. We find that racial-ethnic disparities in late career employment quality account for 17–28 percent of the observed Black-white and 18–32 percent of the observed Hispanic-white poverty gaps, thus explaining a greater proportion of such gaps than many common individual or behavioral explanations. Disaggregating employment quality into its component measures, we find racial-ethnic disparities in access to employer-provided health insurance and hourly wages account for the largest proportion of racial-ethnic poverty gaps. Our findings suggest that employment quality captures important racialized dimensions of labor market context that help account for racial-ethnic inequalities in later life poverty in the United States.

Socioeconomic and geographic variation in coverage of health insurance across India.

In India, regular monitoring of health insurance at district levels (the most essential administrative unit) is important for its effective uptake to contain the high out of pocket health expenditures. Given that the last individual data on health insurance coverage at district levels in India was in 2016, we update the evidence using the latest round of the National Family Health Survey conducted in 2019-2021. We use the unit records of households from the latest round (2021) of the nationally representative National Family Health Survey to calculate the weighted percentage (and 95% CI) of households with at least one member covered by any form of health insurance and its types across socio-economic characteristics and geographies of India. Further, we used a random intercept logistic regression to measure the variation in coverage across communities, district and state. Such household level study of coverage is helpful as it represents awareness and outreach for at least one member, which can percolate easily to the entire household with further interventions. We found that only 2/5th of households in India had insurance coverage for at least one of its members, with vast geographic variation emphasizing need for aggressive expansion. About 15.5% were covered by national schemes, 47.1% by state health scheme, 13.2% by employer provided health insurance, 3.3% had purchased health insurance privately and 25.6% were covered by other health insurance schemes (not covered above). About 30.5% of the total variation in coverage was attributable to state, 2.7% to districts and 9.5% to clusters. Household size, gender, marital status and education of household head show weak gradient for coverage under "any" insurance. Despite substantial increase in population eligible for state sponsored health insurance and rise in private health insurance companies, nearly 60% of families do not have a single person covered under any health insurance scheme. Further, the existing coverage is fragmented, with significant rural/urban and geographic variation within districts. It is essential to consider these disparities and adopt rigorous place-based interventions for improving health insurance coverage.

The Health Wedge and Labor Market Inequality

ABSTRACT: Over half of the US population receives health insurance through an employer with premium contributions creating a flat "head tax" per worker, independent of their earnings. This paper develops and calibrates a stylized model of the labor market to explore how this uniquely American approach to financing health insurance contributes to labor market inequality. We consider a partial-equilibrium counterfactual in which employer-provided health insurance is instead financed by a statutory payroll tax on firms. We find that, under this counterfactual financing, in 2019 the college wage premium would have been 11 percent lower, noncollege annual earnings would have been $1,700 (3 percent) higher, and noncollege employment would have been nearly 500,000 higher. These calibrated labor market effects of switching from head tax to payroll tax financing are in the same ballpark as estimates of the impact of other leading drivers of labor market inequality, including changes in outsourcing, robot adoption, rising trade, unionization, and the real minimum wage. We also consider a separate partial-equilibrium counterfactual in which the current head tax financing is maintained, but 2019 US health care spending as a share of GDP is reduced to the Canadian share; here, we estimate that the 2019 college wage premium would have been 5 percent lower and noncollege annual earnings would have been 5 percent higher. These findings suggest that health care costs and the financing of health insurance warrant greater attention in both public policy and research on US labor market inequality.

The US Supreme Court and Future of Financing Dialysis Care.

The US Supreme Court and Future of Financing Dialysis Care.

Effects of Dependent Health Insurance Coverage Mandates on Fathers’ Job Mobility and Compensation

Due to the low rates of health insurance coverage among young adults, some state governments began mandating health insurance companies to allow adult children to stay on their parents’ health insurance plans. First implemented in 1995, these mandates aimed to increase insurance coverage among young adults. In 2010, the federal government enacted a more comprehensive version of the dependent coverage mandate as part of the Affordable Care Act. These stateand federal-level efforts increased insurance rates for young adults, but they might have also come with unintended consequences for parents. Parents who placed a high value on health insurance for their young adult children might be reluctant to leave jobs with employerprovided health insurance, and employers might offset the mandate-incurred health care costs by reducing other types of employee benefits or earnings. To assess the extent of such consequences, I study the effects of both the state- and federal-dependent health insurance mandates on fathers’ voluntary job separation rates (job-lock and job-push) and changes in their compensation. I observe a significant decrease in the likelihood of voluntary job separation among eligible working fathers aged 45–64 and find weak evidence that the mandates reduced certain fathers’ total monetary compensation.

Effect of employer-provided health insurance on illness-related absence from work

Effect of employer-provided health insurance on illness-related absence from work

Breaking the Silence

Breaking the Silence

Demographic and media factors affecting women’s demand for different types of health insurance: Evidence from a developing country

Background: In the absence of a National Health Insurance Scheme, many Ugandans don’t have access to basic health care because of the high cost of attaining this health care. The problem is even worse among women who are faced with higher rates of morbidity and hospitalization. The objective of the study was to assess demographic and media factors affecting the demand for community, employer provided and private health insurance among women in Uganda. Methods: The study used secondary data from the 2016 Uganda Demographic Health Survey, a nationally representative survey. The sample comprised of 18,506 women aged 15-49 years from a population of 20,880 households. Data were analyzed using STATA version 15. Descriptive statistics, Chi square tests and the Firth logistic regression were used to understand the frequency distribution of different types of health insurance, demographic and media factors, associations between different types of health insurance, demographic and media factors and the demographic and media factors affecting the demand for community, employer provided and private health insurance. Results: The results indicated low demand for different types of health insurance among women. Education and wealth were the demographic factors that affected the demand for community and employer provided health insurance while marital status, age and education were demographic factors that affected the demand for community, employer provided and private health insurance respectively. Watching television, reading newspapers and listening to radio were the media factors that affected the demand for employer provided health insurance while listening to radio was the only media factor that affected the demand for community health insurance. Conclusions: There is a need to expedite the National Health Insurance policy to enhance the uptake of health insurance among women in Uganda.

User Interactions With Health Insurance Decision Aids: User Study With Retrospective Think-Aloud Interviews.

BackgroundTwo barriers to effective enrollment decisions are low health insurance literacy and lack of knowledge about how to choose a plan. To remedy these issues, digital decision aids have been used to increase the knowledge of plan options and to guide the decision process. Previous research has shown that the way information is presented in a decision aid can impact consumer choice, and existing health insurance decision aids vary in their design, content, and layout. Commercial virtual benefits counselors (VBCs) are digital decision aids that provide decision support by mimicking the guidance provided by an in-person human resources (HR) counselor, whereas more traditional HR websites provide information that requires self-directed navigation through the system. However, few studies have compared how decision processes are impacted by these different methods of providing information.ObjectiveThis study aims to examine how individuals interact with two different types of health insurance decision aids (guided VBCs that mimic conversations with a real HR counselor and self-directed HR websites that provide a broad range of detailed information) to make employer-provided health insurance decisions.MethodsIn total, 16 employees from a local state university completed a user study in which they made mock employer-provided health insurance decisions using 1 of 2 systems (VBC vs HR website). Participants took part in a retrospective think-aloud interview, cued using eye-tracking data to understand decision aid interactions. In addition, pre- and postexperiment measures of literacy and knowledge and decision conflict and usability of the system were also examined.ResultsBoth the VBC and HR website had positive benefits for health insurance knowledge and literacy. Previous health insurance knowledge also impacted how individuals used decision aids. Individuals who scored lower on the pre-experiment knowledge test focused on different decision factors and were more conflicted about their final enrollment decisions than those with higher knowledge test scores. Although both decision aids resulted in similar changes in the Health Insurance Literacy Measure and knowledge test scores, perceived usability differed. Website navigation was not intuitive, and it took longer to locate information, although users appreciated that it had more details; the VBC website was easier to use but had limited information. Lower knowledge participants, in particular, found the website to be less useful and harder to use than those with higher health insurance knowledge. Finally, out-of-pocket cost estimation tools can lead to confusion when they do not highlight the factors that contribute to the cost estimate.ConclusionsThis study showed that health insurance decision aids help individuals improve their confidence in selecting and using health insurance plans. However, previous health insurance knowledge plays a significant role in how users interact with and benefit from decision aids, even when information is presented in different formats.

Informed Decision-making for Health Insurance Enrollment: Survey Study.

BackgroundHealth insurance enrollment is a difficult financial decision with large health impacts. Challenges such as low health insurance literacy and lack of knowledge about choosing a plan further complicate this decision-making process. Therefore, to support consumers in their choice of a health insurance plan, it is essential to understand how individuals go about making this decision.ObjectiveThis study aims to understand the sources of information used by individuals to support their employer-provided health insurance enrollment decisions. It seeks to describe how individual descriptive factors lead to choosing a particular type of information source.MethodsAn introduction was presented on health insurance plan selection and the sources of information used to support these decisions from the 1980s to the present. Subsequently, an electronic survey of 151 full-time faculty and staff members was conducted. The survey consisted of four sections: demographics, sources of information, health insurance literacy, and technology acceptance. Descriptive statistics were used to show the demographic characteristics of the 126 eligible respondents and to study the response behaviors in the remaining survey sections. Proportion data analysis was performed using the Cochran-Armitage trend test to understand the strength of the association between our variables and the types of sources used by the respondents.ResultsIn terms of demographics, most of the respondents were women (103/126, 81.7%), represented a small household (1-2 persons; 87/126, 69%), and used their insurance 3-12 times a year (52/126, 41.3%). They assessed themselves as having moderate to high health insurance literacy and high acceptance of technology. The most selected and top-ranked sources were Official employer or state websites and Official Human Resources Virtual Benefits Counselor Alex. From our data analysis, we found that the use of official primary sources was constant across age groups and health insurance use groups. Meanwhile, the use of friends or family as a primary source slightly decreased as age and use increased.ConclusionsIn this exploratory study, we identified the main sources of health insurance information among full-time employees from a large state university and found that most of the respondents needed 2-3 sources to gather all the information that they desired. We also studied and identified the relationships between individual factors (such as age, gender, and literacy) and 2 dependent variables on the types of primary sources of information. We encountered several limitations, which will be addressed in future studies.

An Empirical Model of Medicare Costs: The Role of Health Insurance, Employment, and Delays in Medicare Enrollment

Medicare is one of the largest federal social insurance programs in the United States and the secondary payer for Medicare beneficiaries covered by employer-provided health insurance (EPHI). However, an increasing number of individuals are delaying their Medicare enrollment when they first become eligible at age 65. Using administrative data from the Medicare Current Beneficiary Survey (MCBS), this paper estimates the effects of EPHI, employment, and delays in Medicare enrollment on Medicare costs. Given the administrative nature of the data, we are able to disentangle and estimate the Medicare as secondary payer (MSP) effect and the work effects on Medicare costs, as well as to construct delay enrollment indicators. Using Heckman’s sample selection model, we estimate that MSP and being employed are associated with a lower probability of observing positive Medicare spending and a lower level of Medicare spending. This paper quantifies annual savings of $5.37 billion from MSP and being employed. Delays in Medicare enrollment generate additional annual savings of $10.17 billion. Owing to the links between employment, health insurance coverage, and Medicare costs presented in this research, our findings may be of interest to policy makers who should take into account the consequences of reforms on the Medicare system.

Effect of the COVID-19 pandemic on health insurance coverage among trauma patients: a study of six level I trauma centers

BackgroundIncreased unemployment during the COVID-19 pandemic has likely led to widespread loss of employer-provided health insurance. This study examined trends in health insurance coverage among trauma patients during the COVID-19...

Crushed by COVID-19 Medical Bills, Coronavirus Victims Need Debt Relief Under the Bankruptcy Code and Workers’ Compensation Laws

After the U.S. declared COVID-19 a pandemic, cracks in the U.S.’s fragile privatized healthcare system were exposed. At the start of the pandemic, 74 million U.S. residents were already uninsured or underinsured. To date, over 7.7 million recently terminated employees have lost their employer-provided health insurance, while over 24.6 million individuals have been infected with COVID-19 and 800,000 have been hospitalized. As a result, coronavirus survival often comes with astronomical medical bills like the $1.1 million hospital bill received by Michael Flor, a 70-year-old survivor who spent 62 days in the hospital for treatment.This Article examines how the U.S.’s flawed healthcare system and federal bankruptcy law may work together to unfairly penalize debtors burdened with medical debts arising from treatment for an infectious disease, like COVID-19. The financial fate of many burdened with infectious-disease medical bills will depend on whether a court characterizes such bills as “consumer” debts. Under the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005, individuals with “primarily consumer debts” are subject to a complex calculation known as the “Means Test.” Debtors who have their massive medical bills characterized as non-consumer debts are allowed to wipe out those bills quickly in a Chapter 7 case. Debtors who have such bills characterized as consumer debts and who fail the Means Test are forced into a five-year repayment plan in a Chapter 13 case, where they pay down their unsecured debts, including medical bills. As a result, courts are effectively penalizing debtors who lack adequate health insurance and who involuntarily contract a contagious disease.To prevent such perverse results, this Article proposes that bankruptcy law be amended to exclude infectious-disease medical bills from the definition of consumer debt. Also, to obviate the need for some individuals to file for bankruptcy relief, this Article proposes that workers’ compensation (“workers’ comp”) laws be amended to include COVID-19 as an occupational disease for any “essential worker,” as defined in each state, so that infected essential workers can have their medical bills paid from workers’ comp funds. If a former U.S. president infected with COVID-19 was considered essential for the nation’s survival and, therefore, entitled to taxpayer-funded medical care in state-of-the-art facilities, then front-line employees—who are required to work for the benefit and survival of us all—should absolutely receive COVID-19 treatment at no cost to them. Legislative action is especially needed due to the current spread of new, highly contagious mutations of COVID-19 in the U.S. With the proposed legislative amendments in place, the U.S. would ensure that survivors are protected from financial devastation due to involuntarily contracting an infectious disease.

Occupational Credentials and Job Qualities of Direct Care Workers: Implications for Labor Shortages.

Occupational training and credentialing requirements for direct care workers were in place for consumers’ health and safety, but their effects on job qualities and labor shortages in the direct care industry have been controversial. Using a nationally representative sample of psychiatric, nursing, and home health aides, a series of Average Treatment Effect models were analyzed to examine the effects of occupational credentials on various measures of job qualities. The findings revealed that credential-holding was related to higher annual earnings and increased probability of working full-time, year-round, and having access to employer-provided health insurance and retirement savings plans. The positive effects, however, were modest in size and suggested that, given the current wage and benefit levels for direct care workers, training and credential requirements cannot be the key to resolving job quality and labor shortage issues in the direct care industry. Implications of these findings and alternative ways to address the issues were discussed.

The federal-private wage differential: how has it evolved?

ABSTRACT This paper is the first to document and analyse the variation of the federal-private pay differential over time. We estimate the evolution of the federal-private pay differential from 1995 to 2017 using Current Population Survey data, enabling us to examine the current pay gap and how it has changed. To do so, wage regressions are estimated by year and used to calculate the yearly federal-private wage differential. To deal with unobserved heterogeneity, we adopt control function methods. We also estimate the probability of receiving employer-provided health insurance and a pension plan each year for each sector. The findings imply that the federal pay differential is invariably positive, but has varied substantially. We examine the reasons for this variation and find that the most robust result is the positive effect of federal spending as a share of GDP, ipromplying that a 1 percentage point increase in federal spending as a share of GDP raises the federal pay differential by 1.3 to 1.75 percentage points.

Waiting for care: Chronic illness and health system uncertainties in the United States

Structures of power and inequality shape day-to-day life for individuals who are poor, imposing waiting in multiple forms and for a variety of services, including for healthcare (Andaya, 2018a; Auyero, 2012; Strathmann and Hay, 2009). Constraints, such as the age requirements for Medicare, losing employer-provided health insurance, or the bureaucracy involved in filing for disability often require people to wait to follow recommendations for medical treatments. In 2016–2017, we conducted 52 narrative interviews in St. Louis, a city with significant racial and economic health inequities and without Medicaid expansion. We interviewed people with one or more chronic illnesses for which they were prescribed medication and who identified as having difficulties affording their prescriptions. Throughout the interviews, participants frequently recounted 1) experiences of waiting for care, along with other services, and 2) the range of strategies they utilized to manage the waiting. In this article, we develop the concept of active waiting to describe both the lived experiences of waiting for care and the responses that people devise to navigate, shorten, or otherwise endure waiting. Waiting is structured into healthcare and other social services at various scales in ways that reinforce feelings of marginalization, and also that require work on the part of those who wait. While much medical and public health research focuses on issues of diagnostic or treatment delay, we conclude that this conceptualization of active waiting provides a far more productive frame for accurately understanding the emotional and physical experiences of individuals who are disproportionately poor and made to wait for their care. Only with such understanding can we hope to build more just and compassionate social systems.

Supporting Women in the Workforce: The Importance of Employer-Provided Supplemental Fertility Insurance Benefits [30A

INTRODUCTION: Age-related declines in natural fertility may pose a challenge to women who delay childbirth to pursue careers. Reproductive hormone testing may be critical for addressing workplace gender inequality by enabling women to pursue both professional and reproductive goals. Fertility treatments, when performed before significant fertility declines, can provide additional options. However, these procedures can be expensive and are not typically covered under employer-provided health insurance. We assessed U.S. women's beliefs about supplemental fertility insurance benefits. METHODS: Participants (N=327 women) completed an IRB-approved online survey in 2019. The data were analyzed with descriptive and chi-square analyses. RESULTS: Participants indicated that it is important to them to have insurance cover the cost of annual reproductive hormone testing (77.06%) and fertility treatments (78.28%). Further, they would choose an employer that provides insurance benefits for annual reproductive hormone testing (54.74%) and fertility treatments (59.32%) over one that does not. There were no differences by age, income, geographic region, health insurance, or fertility knowledge; however, infertile women were more likely than fertile women to choose an employer that provides insurance benefits for annual reproductive hormone testing (χ2=7.56*) and fertility treatments (χ2=7.99*). (note: * P<.05). CONCLUSION: Our results suggest that U.S. women believe supplemental fertility insurance benefits are important, and they would choose an employer based on the provisioning of these benefits. Employer-provided insurance that includes supplemental fertility insurance benefits may enable women to achieve both professional and reproductive goals, ultimately contributing to greater workplace gender equality.

Can Employers Solve the Adverse Selection Problem for Insurers?

Establishing the existence of equilibrium in insurance markets has always been a challenging task for economists due to imperfect information. As illustrated by Rothschild and Stiglitz (1976), imperfect information may lead to complete market failure. This paper extends the standard model of adverse selection by introducing employers that choose the set of policies that are offered to consumers. Introducing employers allows for the existence of multiple pooling and a unique separating equilibrium. The key to these results is that the financial incentives of the employers in the model differ from the financial incentives of the insurance companies. Data on age and insurance premiums from the 1987 National Medical Expenditure Survey provides evidence of pooling in the employer-provided health insurance market. JEL classification: D82; I18

Medicare for all or medicare for none? A macroeconomic analysis of healthcare reform

In this study, I develop a novel general equilibrium life cycle model composed of finitely-lived households that differ according to age, skill level, and access to employer-provided health insurance. After introducing a “Medicare for all” health insurance system to the model, I examine how the welfare response to this policy change will differ according to household characteristics. Then, I compare this system to a completely privatized health insurance system that achieves universal health insurance coverage through the creation of utilization-based premium subsidies. In general, both systems tend to improve the welfare of young households at the expense of old households. However, when using average value-of-life as the primary measure of welfare, Medicare for all either benefits unskilled households at the expense of skilled households, or makes both worse off. In contrast, the privatized system improves the average value-of-life of all household groups, regardless of skill level or prior access to employer-provided health insurance.