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The Role of Agents and Brokers in the Market for Health Insurance
December 2013
Working Paper Number:
CES-13-58
Health insurance markets in the United States are characterized by imperfect information, complex products, and substantial search frictions. Insurance agents and brokers play a significant role in helping employers navigate these problems. However, little is known about the relation between the structure of the agent/broker market and access and affordability of insurance. This paper aims to fill this gap by investigating the influence of agents/brokers on health insurance decisions of small firms, which are particularly vulnerable to problems of financing health insurance. Using a unique membership database from the National Association of Health Underwriters together with a nationally representative survey of employers, we find that small firms in more competitive agent/broker markets are more likely to offer health insurance and at lower premiums. Moreover, premiums are less dispersed in more competitive agent/broker markets.
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Every Breath You Take, Every Dollar You'll Make: The Long-Term Consequences of the Clean Air Act of 1970
September 2013
Working Paper Number:
CES-13-52
This paper examines the long-term impacts of in-utero and early childhood exposure to ambient air pollution on adult labor market outcomes. We take advantage of a new administrative data set that is uniquely suited for addressing this question because it combines information on individuals' quarterly earnings together with their counties and dates of birth. We use the sharp changes in ambient air pollution concentrations driven by the implementation of the 1970 Clean Air Act Amendments as a source of identifying variation, and we compare cohorts born in counties that experienced large changes in total suspended particulate (TSP) exposure to cohorts born in counties that had minimal or no changes. We nd a signi cant relationship between TSP exposure in the year of birth and adult labor market outcomes. A 10 unit decrease in TSP in the year of birth is associated with a 1 percent increase in annual earnings for workers aged 29-31. Most, but not all, of this effect is driven by an increase in labor force participation. In present value, the gains from being born into a county affected by the 1970 Clean Air Act amount to about $4,300 in lifetime income for the 1.5 million individuals born into
these counties each year.
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COMPARING METHODS FOR IMPUTING EMPLOYER HEALTH INSURANCE CONTRIBUTIONS IN THE CURRENT POPULATION SURVEY
August 2013
Working Paper Number:
CES-13-41
The degree to which firms contribute to the payment of workers' health insurance premiums is an important consideration in the measurement of income and for understanding the potential impact of the 2010 Affordable Care Act on employment-based health insurance participation. Currently the U.S. Census Bureau imputes employer contributions in the Annual Social and Economic Supplement of the Current Population Survey based on data from the 1977 National Medical Care Expenditure Survey. The goal of this paper is to assess the extent to which this imputation methodology produces estimates reflective of the current distribution of employer contributions. The paper uses recent contributions data from the Medical Expenditure Panel Survey-Insurance Component to estimate a new model to inform the imputation procedure and to compare the resulting distribution of contributions. These new estimates are compared with those produced under current production methods across employee and employer characteristics.
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Long-Run Earnings Volatility and Health Insurance Coverage: Evidence from the SIPP Gold Standard File
October 2011
Working Paper Number:
CES-11-35
Despite the notable increase in earnings volatility and the attention paid to the growing ranks of the uninsured, the relationship between career earnings and short- and mediumrun health insurance status has been ignored due to a lack of data. I use a new dataset, the SIPP Gold Standard File, that merges health insurance status and demographics from the Survey of Income and Program Participation with career earnings records from the Social Security Administration (SSA) and the Internal Revenue Service (IRS) to examine the relationship between long-run family earnings volatility and health insurance coverage. I find that more volatile career earnings are associated with an increased probability of experiencing an uninsured episode, with larger effects for men, young workers, and the unmarried. These findings are consistent with the 'scarring' literature, and suggest the importance of safety-net measures for job losses and health insurance coverage.
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A Guide to the MEPS-IC Government List Sample Microdata
September 2011
Working Paper Number:
CES-11-27
The Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) is conducted to provide nationally representative estimates on employer sponsored health insurance. MEPSIC data are collected from private sector employers, as well as state and local governments. While similar information is gathered from these two sectors, differences in the survey process exist. The goal of this paper is to provide details on the public sector including types of state and local government employers, sample design, general information on the data collected in the MEPS-IC, and additional sources of information.
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Declines in Employer Sponsored Coverage Between 2000 and 2008: Offers, Take-Up, Premium Contributions, and Dependent Options
September 2010
Working Paper Number:
CES-10-23
Even before the current economic downturn, rates of employer-sponsored insurance (ESI) declined substantially, falling six percentage points between 2000 and 2008 for nonelderly Americans. During a previously documented decline in ESI, from 1987 to 1996, the fall was found to be the result of a reduction in enrollment or 'take-up' of offered coverage and not a decline in employer offer/eligibility rates. In this paper, we investigate the components of the more recent decline in ESI coverage by firm size, using data from the MEPS-IC, a large nationally representative survey of employers. We examine changes in offer rates, eligibility rates and take-up rates for coverage, and include a new dimension, the availability of and enrollment in dependent coverage. We investigate how these components changed for employers of different sizes and find that declining coverage rates for small firms were due to declines in both offer and take-up rates while declining rates for large firms were due to declining enrollment in offered coverage. We also find a decrease in the availability of dependent coverage at small employers and a shift towards single coverage across employers of all sizes. Understanding the components of the decline in coverage for small and large firms is important for establishing the baseline for observing the effects of the current economic downturn and the implementation of health insurance reform.
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The Closure Effect: Evidence from Workers Compensation Litigation
January 2010
Working Paper Number:
CES-10-01
Consideration of the "best interests" of Workers Compensation (WC) claimants often involves the assumption that those who receive benefits in a "lump-sum" behave "too myopically" with respect to labor supply. However, many attorneys argue that lump-sum settlements induce a beneficial "sense of closure." In this paper, I provide an empirical context for these ideas using a unique set of linked administrative databases owned by the State of California. Upon receipt of a court-approved lump-sum settlement, WC claimants immediately increase labor supply. No such change is found for claimants who receive a court-approved settlement in which the insurer provides benefits over time, suggesting that the method of litigation settlement is a determinant of labor supply.
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The Effect of Wage Insurance on Labor Supply: A Test for Income Effects
October 2009
Working Paper Number:
CES-09-37
Studies of moral hazard in wage insurance programs such as Unemployment Insurance (UI) or Workers Compensation (WC) have demonstrated that higher benefits discourage work, emphasizing the price distortion inherent in benefit provision. Utilizing administrative data linking WC claim records to wage records from a UI payroll tax database, I find that the effect of WC benefits on the duration of benefit receipt cannot fully account for the effect of these benefits on post-injury unemployment. This indicates that a significant fraction of the effect of WC benefits on employment is due to an income effect rather than a price distortion.
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Health Insurance and Productivity: Evidence from the Manufacturing Sector
September 2009
Working Paper Number:
CES-09-27
This paper examines the relationship between employer-sponsored offers of health insurance and establishments' labor productivity. Our empirical work is based on unique plant level data that links the 1997 and 2002 Medical Expenditure Panel Survey-Insurance Component with the 1992, 1997, and 2002 Census of Manufactures. These linked data provide information on employer-provided insurance and productivity. We find that health insurance offers are positively associated with levels of establishments' labor productivity. These findings hold for all manufacturers as well as those with fewer than 100 employees. Our preliminary results also show a drop in health care costs from the 75th to the 25th percentile would increase the probability of a plant offering insurance by 1.5-2.0 percent in both 1997 and 2002. The results from this paper provide encouraging and new empirical evidence on the benefits employers may reap by offering health insurance to workers.
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Employer Health Benefit Costs and Demand for Part-Time Labor
April 2009
Working Paper Number:
CES-09-08
The link between rising employer costs for health insurance benefits and demand for part-time workers is investigated using non-public data from the Medical Expenditure Panel Survey- Insurance Component (MEPS-IC). The MEPS-IC is a nationally representative, annual establishment survey from the Agency for Healthcare Research and Quality (AHRQ). Pooling the establishment level data from the MEPS-IC from 1996-2004 and matching with the Longitudinal Business Database and supplemental economic data from the Bureau of Labor Statistics, a reduced form model of the percent of total FTE employees working part-time is estimated. This is modeled as a function of the employer health insurance contribution, establishment characteristics, and state-level economic indicators. To account for potential endogeneity, health insurance expenditures are estimated using instrumental variables (IVs). The unit of analysis is establishments that offer health insurance to full-time employees but not part time employees. Conditional on establishments offering health insurance to full-time employees, a 1 percent increase in employer health insurance contributions results in a 3.7 percent increase in part-time employees working at establishments in the U.S.
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