Employment-based Health Insurance System Research Articles

Late career participation of late retirees in the age of the silver tsunami: understanding the influencing mechanism of health status and employment-based health insurance participation

BackgroundThe delayed retirement initiative and population aging have led to a growing group of late retirees. However, it remains unclear whether the existing employment-based health insurance system can effectively match the recently proposed initiative and support late retirees, especially those with pre-existing function limitations. Thus, this study aims to investigate the influencing mechanism of China’s Urban Employee Basic Medical Insurance (UEBMI), physical functioning limitation (PFL) and difficulty in instrumental activities of daily living (IADLs) on labour participation of late retirees in China.MethodsThis study uses data from the China Health and Retirement Longitudinal Study (CHARLS) survey, which tracks the quality of life among older adults in China (valid sample size = 5560).ResultsEmpirical results show that China’s employment-based health insurance (i.e. UEBMI) and health conditions (i.e. PFL and difficulty in IADLs) are positively associated with late retirees’ withdrawal from late career participation. In addition, a higher level of difficulty in IADLs could strengthen the effect of PFL on late retirees’ withdrawal from late career participation, which could be further buffered by UEBMI beneficiary status.ConclusionIn the formulation of delayed retirement policies, it is necessary to consider the influencing mechanism of the social health insurance system and health conditions on late career participation of older workers to ensure policy effectiveness.

How have recent health insurance expansions affected coverage among artist occupations in the USA?

Most US workers receive their health insurance through employers due to its favorable tax treatment, improved bargaining power, and reduced adverse selection concerns. This institutional structure, however, favors large employers and full-time workers; thus, not all segments of the workforce enjoy the benefits of this system. Artists are especially disadvantaged relative to other sectors in the employment-based health insurance system as they tend to be self-employed workers and/or work on contractual bases. Theory suggests that the Affordable Care Act (ACA), by expanding options for health insurance to those without offers from employers, should represent an improvement, particularly for occupations that favor independent work, such as artists. We use large-scale survey data that identifies occupations and contains sufficient numbers of artists to study the impact of the ACA on the health insurance of these workers. We find that the 2010 Young Adult mandate of the ACA increases employment-related health insurance by 10.7 percentage points (ppts) (and any coverage by 6.6 ppts) for 21–25 year-old artists and that the Medicaid coverage rate of artists below the poverty level increases by 12.4 ppts (although its effects on any coverage are statistically imprecise) due to the state Medicaid expansion component of the ACA in 2014. Both these effects are significantly larger than for other workers. Our results thus indicate that recent health reforms have important and larger effects on artist occupations than other worker populations.

Employment-based health insurance and aggregate labor supply

We study the impact of the U.S. employment-based health insurance system on the employment rate, the shares of full-time/part-time workers, and aggregate hours worked in a general equilibrium life cycle model with incomplete markets and idiosyncratic risks in both income and medical expenses. In contrast to most Europeans, who get universal health insurance from the government, most working-age Americans get health insurance through their employers. We find that the employment-based health insurance system provides Americans with an extra incentive to work and work full-time. In a calibrated version of the model, we assess the extent to which the different health insurance systems account for the differences in employment rate and full-time/part-time shares of workers between the U.S. and European countries. Our quantitative results suggest that the different health insurance systems can account for a significant fraction of the differences in employment rate and full-time/part-time shares of workers between the two regions. In addition, we find that the employment-based health insurance system is one of the reasons why many Americans work more than Europeans.

Financing healthcare in Gulf Cooperation Council countries: a focus on Saudi Arabia.

BackgroundThis paper presents an analysis of the main characteristics of the Gulf Cooperation Council’s (GCC) health financing systems and draws similarities and differences between GCC countries and other high-income and low-income countries, in order to provide recommendations for healthcare policy makers. The paper also illustrates some financial implications of the recent implementation of the Compulsory Employment-based Health Insurance (CEBHI) system in Saudi Arabia.MethodsEmploying a descriptive framework for the country-level analysis of healthcare financing arrangements, we compared expenditure data on healthcare from GCC and other developing and developed countries, mostly using secondary data from the World Health Organization health expenditure database. The analysis was supported by a review of related literature.ResultsThere are three significant characteristics affecting healthcare financing in GCC countries: (i) large expatriate populations relative to the national population, which leads GCC countries to use different strategies to control expatriate healthcare expenditure; (ii) substantial government revenue, with correspondingly high government expenditure on healthcare services in GCC countries; and (iii) underdeveloped healthcare systems, with some GCC countries’ healthcare indicators falling below those of upper-middle-income countries.ConclusionReforming the mode of health financing is vital to achieving equitable and efficient healthcare services. Such reform could assist GCC countries in improving their healthcare indicators and bring about a reduction in out-of-pocket payments for healthcare.

Maximizing Health Care Enrollment Through Seamless Coverage for Families in Transition: Current Trends and Policy Implications

The Affordable Care Act (ACA) builds on the employment-based health insurance system which is the bedrock of health insurance coverage for most Americans. When these Americans experience a change in their work or family lives, they are at risk for losing their job-based health insurance coverage. The health insurance exchanges established by the ACA provide an unprecedented opportunity to address one of the major sources of gaps in health insurance coverage: transitions in life that result in the loss of health insurance. The uninsured population is not static. Many people who are uninsured cycle in and out of coverage over a short period of time. One-half to two-thirds of those who are uninsured in any given year move into or out of coverage in that year. Even short bouts of uninsurance can have important health impacts due to lack of care.Many who are intermittently uninsured are experiencing a work or life transition that also involves a loss of income, divorce or separation, loss of dependent status, disability or death of a family member.These individuals in transition are likely to make up a significant portion of those eligible for the new health insurance exchanges. In Massachusetts, approximately one-quarter of individual market participants in the Massachusetts “Health Connector” the state’s health exchange, enrolled and terminated their coverage within 12 months. How transitional coverage is handled will play a major role in whether the ACA is successful in expanding and stabilizing health coverage. In order to be successful in enrolling the uninsured, the exchange should be designed to maintain continuous coverage for individuals undergoing life transitions. Understanding the triggers to uninsurance provides an important window into how people who are in life transitions can be reached and enrolled into the exchange before or when they lose other sources of coverage.

Health insurance and precautionary saving: A structural analysis

Starr-McCluer (1996) documented an empirical finding showing that US households covered by health insurance saved more than those without coverage, which is inconsistent with the standard consumption–saving theory. This study conducts a structural analysis and suggests that institutional factors, particularly, a social insurance or safety net system and an employment-based health insurance system, can account for this puzzling finding. A dynamic equilibrium model is built that combines these two institutions with heterogeneous agents making endogenous decisions regarding saving, the labor supply and health insurance when they are young. The model, in which agents save in a precautionary manner, can generate Starr-McCluerʼs empirical finding. The result implies that Starr-McCluerʼs results are not inconsistent with the standard theory of saving under uncertainty, but it does indicate that the standard saving regression model is unable to reveal the precautionary saving motive. Counterfactual experiments are performed to provide implications for empirical analyses.

Dynamic Inefficiencies in an Employment-Based Health Insurance System: Theory and Evidence

We investigate the effects of the institutional settings of the U.S. health care system on individuals' life-cycle medical expenditures. We argue that health is a form of human capital that affects labor productivity, and that the employment-based health insurance system may lead to inefficient investment in individuals' health care. The reason is that labor turnover and frictions in the labor market prevent an employer-employee pair from capturing the entire surplus from investment in an employee's health. Thus, the pair underinvests in health capital, and this underinvestment increases medical expenditures during retirement.We provide extensive empirical evidence consistent with the comparative statics predictions of our model using two datasets, the Medical Expenditure Panel Survey (MEPS) and the Health and Retirement Study (HRS). The magnitude of our estimates suggests a significant degree of inefficiency in health investment in the U.S.

The Work/Health Insurance Nexus: A Weak Link for Mexican-origin Men.

OBJECTIVES: The employment based health insurance system of the United States means that those individuals who are disadvantaged in the labor market are also disadvantaged in terms of health insurance coverage. The Mexican-origin population has historically been disadvantaged in both domains. We examine the extent to which low rates of health insurance coverage among Mexican-origin adult male workers are the result of overrepresentation in the types of employment in which coverage is low for everyone. METHODS: We use logistic regression models to analyze data from 80,827 employed Mexican-origin, African American, and non-Hispanic white men in the 2004 and 2006 Current Population Surveys. RESULTS: The results suggest that although such overrepresentation contributes to low rates of coverage among Mexican-origin workers, even within employment sectors, industries, and occupations Mexican-origin workers are less likely to have coverage than non-Hispanic whites or African Americans. CONCLUSIONS: These results make it clear that the health insurance vulnerabilit y of the Mexican-origin population reflects multiple barriers to coverage in addition to those related to employment.

Dynamic Inefficiencies in an Employment-Based Health Insurance System: Theory and Evidence.

We investigate the effects of the institutional settings of the US health care system on individuals' life-cycle medical expenditures. Health is a form of general human capital; labor turnover and labor-market frictions prevent an employer-employee pair from capturing the entire surplus from investment in an employee’s health. Thus, the pair underinvests in health during working years, thereby increasing medical expenditures during retirement. We provide empirical evidence consistent with the comparative statics predictions of our model using the Medical Expenditure Panel Survey (MEPS) and the Health and Retirement Study (HRS). Our estimates suggest significant inefficiencies in health investment in the United States.

Worker preferences, sorting and aggregate patterns of health insurance coverage

To assess the performance of the employment-based health insurance system, it is necessary to understand how well workers sort into jobs that offer their desired mix of cash wages relative to benefits. However, few studies directly measure the extent of sorting. We quantify the prevalence of mismatches between workers' preferences and firms' insurance offerings by considering two types of mismatch: (1) workers who appear to desire coverage through their employer, but work for firms that do not offer coverage, and; (2) workers who appear not to desire coverage through their employer, but work for firms that offer coverage. Most workers (79.6%) enjoy labor market matches that appear consistent with their preferences. The remaining 20.4% of workers appear to be mismatched. For most of these mismatches, the primary consequence is lower wages than would be earned if individuals were better matched in the labor market. However, a minority of the identified mismatches appear to be "involuntarily uninsured" workers who would gain insurance if they were to find a better match. Extrapolating from the analysis sample, these involuntarily uninsured workers and their uninsured dependents may represent up to one in six uninsured individuals in the United States.

The ‘Graying’ Of Group Health Insurance

We examine differential declines in private insurance by income and age. We show that older, higher-income people in working families are more likely to retain private coverage as premiums rise, and we project these effects on future coverage rates. The analysis suggests that trends are leading to the "graying" of the employment-based health insurance system, where older, higher-income people get private health insurance, and others increasingly have public coverage or go without. These changes raise questions about the private health care system's ability to pool health risks. Population aging could interact with rising premiums and place additional pressure on an already strained employment-based health insurance system.

Why we should keep the employment-based health insurance system.

Commentary Health AffairsVol. 18, No. 6 Why We Should Keep The Employment-Based Health Insurance SystemWilliam S. Custer, Charles N. Kahn III, and Thomas F. Wildsmith IV AffiliationsBill Custer is an associate professor in the Department of Risk Management and Insurance, College of Business Administration, Georgia State University in Atlanta. Chip Kahn is president of the Health Insurance Association of America in Washington, D.C., and Tom Wildsmith is a policy research actuary there.PUBLISHED:November/December 1999No Accesshttps://doi.org/10.1377/hlthaff.18.6.115AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleTOPICSPrivate health insuranceMarketsTaxesAccess to careCosts and spendingUninsuredManaged careQuality of careHealth insurance exchangesValue Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 6 History Published online 1 November 1999 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.PDF downloadCited byHealth-Care Reform and ESI: Reconsidering the Relationship Between Employment and Health Insurance31 August 2010 | Business and Society Review, Vol. 115, No. 3The Views of Low-Income Employees Regarding Mandated Comprehensive Employee Benefits for the Sake of Health29 December 2009 | Social Work in Public Health, Vol. 25, No. 1Large Health Savings Accounts: A Step Toward Tax Neutrality for Health CareSSRN Electronic JournalHealth Savings Accounts: Early Estimates Of National Take-UpRoger Feldman, Stephen T. Parente, Jean Abraham, Jon B. Christianson, and Ruth Taylor2 August 2017 | Health Affairs, Vol. 24, No. 6Employer-Sponsored Insurance: How Much Financial Protection does it Provide?18 August 2016 | Medical Care Research and Review, Vol. 59, No. 4Expanding Coverage: Maintain A Role For The Individual Market The individual market protects millions of Americans from unexpected high medical bills, at surprisingly affordable premium prices.Donald A. Young and Thomas F. Wildsmith5 December 2018 | Health Affairs, Vol. 21, No. Suppl1

The Impact of Employer-Provided Health Insurance on Dynamic Employment Transitions

We estimate the impact of employer-provided health insurance (EPHI) on the job mobility of males over time using a dynamic empirical model that accounts for unobserved heterogeneity. Previous studies of job-lock reach different conclusions about possible distortions in labor mobility stemming from an employment-based health insurance system: a few authors find no evidence of job-lock, although most find reductions in the mobility of insured workers of between 20 and 40 percent. We use data from the National Longitudinal Survey of Youth which includes variables describing the health insurance an individual holds, as well as whether he is offered insurance by his employer. This additional information allows us to model the latent individual characteristics that are correlated with the offer of EPHI, the acceptance of EPHI, and employment transitions. Our results provide an estimate of job-lock unbiased through correlation with positive job characteristics and individual specific turnover propensity. We find no evidence of job-lock among married males, and produce small estimates of job-lock among unmarried males of between 10 and 15 percent.

Health System Reform in the Czech Republic

The Czech Republic is among the most aggressive of the former Warsaw Pact countries in encouraging competition and free-market reform. This aggressiveness was extended into the health care sector when, in 1992, a mandatory employment-based health insurance system was introduced. The move from a controlled socialist structure to an insurance-based, fee-for-service model occurred in a short time. Health care spending increased 50% in 2 years and now approaches that of many industrialized nations. Claims for reimbursements are increasing at a rate of 5% to 7% per quarter. Market incentives have changed behaviors within the medical community. Newly privatized physicians generate greater volume and consume more resources than those continuing as state employees. Policy issues requiring further evaluation include supply, distribution, and relative valuation of physician services; clinical resource allocation; and cost containment.

Guaranteed Coverage with Multiple Insurers: Closing Gaps and Easing Transitions

The U.S. health insurance system today rests overwhelmingly on employment-based coverage for children as well as adults. However, gaps in the system make it difficult to ensure adequate and continuous coverage. Because of these gaps, previously insured families may find themselves uninsured or underinsured. Coverage problems result from insurance industry practices such as exclusions and limitations, medical underwriting, waiting periods for people changing jobs, and disputes over coordination of benefits. Although many of these gaps in coverage may affect all people, a few primarily affect children, whose insurance coverage may be particularly sensitive to changes in family status, parental employment, and other factors. In this article, Kevin Haugh of the Institute for Health Policy Solutions and Gary Claxton, formerly with the National Association of Insurance Commissioners (NAIC), explore the causes and consequences of a number of the more important gaps in the employment-based health insurance system. They also examine a number of proposals to close these gaps, ranging from insurance reforms aimed at the small-group/small-employer health insurance market to broader and more fundamental reforms intended to restructure the way health care is financed and delivered. This paper grew out of a seminar held for U.S. congressional staff in which Claxton was joined by Mark Peavy, an NAIC actuary, and Kim Bellard of the Prudential Insurance Company. Although a substantial number of uninsured children have ties to the work force, Haugh and Claxton identify some important limitations for expanding coverage based solely on reform of the present employment-based health insurance market. First, because inadequate financial resources are the key reason many children are uninsured or inadequately insured, simply encouraging or requiring employers to offer coverage for employees and their dependents may have limited impact. Subsidies for employers and employees may be required if insurance premiums are to be affordable for low-wage workers disproportionately represented among the uninsured. Second, reforms that seek to expand coverage by restricting insurance company practices which limit coverage for sick people will likely increase the cost of coverage for healthy individuals. This increase in cost may cause some firms and individuals to reduce their coverage, although in the long run the hope is that expanding coverage will help keep costs down. Third, many reform proposals apply only to health insurance provided by small employers. Large employers tend to self-insure and, under federal ERISA legislation, are immune from most insurance regulation, which is the province of state governments. Finally, the movement of employment

Rationing without Justice: Children and the American Health System

Of all the hardships and inequities in the United States caused by the absence of a reasoned approach to health care resource allocation, perhaps none is more stark or poignant than the nation's treatment of children. The United States stands virtually alone among western industrialized democracies in failing to assure at least minimum health care for all pregnant women and children.1 The voluntary employment-based health insurance system, the central health care financing mechanism for working age Americans and their families, leaves out forty percent of all children.2 Medicaid, the largest source of public health care financing for children, covers less than half of all children without employer benefits;3 moreover, the federal government and some states, responding to the growing economic burdens created by the program, frequently aim their budget cutting knives at expenditures on women and children, who are without the political defenses needed to fight back. The United States offers children no floor of health care decency as it does for the elderly through the Medicare program. There is no body of case law, no constitutional guarantee, that assures all children access to comprehensive, basic health care regardless of ability to pay. Instead, children who today are the poorest Americans are also among the most likely to be medically underserved. The consequences of this cumulative, national neglect of children are found in neonatal intensive care wards, hospital emergency clinics, special education programs for disabled

The politics of employment-based insurance in the United States.

Analyses of the corporatization of U.S. health care typically focus on the political struggle between corporations and traditional health care providers, e.g., physicians. A neglected area of study is the struggle between corporations and their employees over the employment-based health insurance system. Yet, since this system is currently the primary mechanism for financing health care in the United States, an analysis of its historical development is critical to any understanding of the corporatization of U.S. health care. It is argued here that the employment-based health insurance system was a part of a political compromise between capital and labor that emerged after World War II. In exchange for control over production and increased worker productivity, corporations agreed to provide workers with steady wage increases and an expanded system of fringe benefits, or "corporate welfare." But, by the late 1970s, rising health care costs created a corporate health care financing crisis that has prompted corporations to cut back employee health insurance coverage. The relative inability of workers to resist such cutbacks reveals the extent to which, by linking health care to wage labor, the "corporate welfare" system has made the U.S. working class more vulnerable to corporate power.