How Do Employers React to a Pay-or-Play Mandate? Early Evidence from San Francisco
AbstractIn 2008 San Francisco implemented major health reform, becoming the first city to adopt a pay-or-play employer health spending mandate. It also created Healthy San Francisco, a new “public option” low-cost health access plan for the uninsured. This study evaluates employer-level health benefit offering responses to the pay-or-play mandate in the first year of implementation using the 2008 Bay Area Employer Health Benefits Survey and a difference-in-difference estimator. Although 92% of firms subject to the mandate already offered insurance prior to enactment, we find that 76% of firms had to expand benefits to comply with the minimum hourly spending requirement for each worker. Nevertheless, most surveyed San Francisco employers (61%) were supportive of the law. There is substantial employer demand for the public option, with 18% of firms using Healthy San Francisco for at least some employees, yet there is little evidence of firms dropping or restricting existing insurance offerings in the first year after implementation. A non-trivial portion of firms chose to meet the mandate by paying into health reimbursement accounts (14%). These results confirm that employer mandate details can have crucial effects on employer behavior. While there are important geographic and political characteristics of San Francisco that are important to bear in mind, San Francisco’s early experience suggests that implementation of a strong pay-or-play mandate is indeed feasible.
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Bibliographic InfoArticle provided by De Gruyter in its journal Forum for Health Economics & Policy.
Volume (Year): 14 (2011)
Issue (Month): 2 (April)
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Web page: http://www.degruyter.com
Other versions of this item:
- Colla, Carrie Hoverman & Dow, William H. & Dube, Arindrajit, 2010. "How Do Employers React to a Pay-or-Play Mandate? Early Evidence from San Francisco," Institute for Research on Labor and Employment, Working Paper Series qt2sw0q5dh, Institute of Industrial Relations, UC Berkeley.
- Carrie Hoverman Colla & William H. Dow & Arindrajit Dube, 2010. "How Do Employers React to A Pay-or-Play Mandate? Early Evidence from San Francisco," NBER Working Papers 16179, National Bureau of Economic Research, Inc.
- I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
- I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Gruber, Jonathan & Simon, Kosali, 2008. "Crowd-out 10 years later: Have recent public insurance expansions crowded out private health insurance?," Journal of Health Economics, Elsevier, vol. 27(2), pages 201-217, March.
- Thomas C. Buchmueller & John DiNardo & Robert G. Valletta, 2011.
"The Effect of an Employer Health Insurance Mandate on Health Insurance Coverage and the Demand for Labor: Evidence from Hawaii,"
American Economic Journal: Economic Policy,
American Economic Association, vol. 3(4), pages 25-51, November.
- Buchmueller, Thomas C. & DiNardo, John & Valletta, Robert G., 2009. "The Effect of an Employer Health Insurance Mandate on Health Insurance Coverage and the Demand for Labor: Evidence from Hawaii," IZA Discussion Papers 4152, Institute for the Study of Labor (IZA).
- Thomas C. Buchmueller & John DiNardo & Robert G. Valletta, 2009. "The effect of an employer health insurance mandate on health insurance coverage and the demand for labor: evidence from Hawaii," Working Paper Series 2009-08, Federal Reserve Bank of San Francisco.
- Kate Bundorf, M., 2002. "Employee demand for health insurance and employer health plan choices," Journal of Health Economics, Elsevier, vol. 21(1), pages 65-88, January.
- Arindrajit Dube & T. William Lester & Michael Reich, 2010.
"Minimum Wage Effects Across State Borders: Estimates Using Contiguous Counties,"
The Review of Economics and Statistics,
MIT Press, vol. 92(4), pages 945-964, November.
- Dube, Andrajit & Lester, T. William & Reich, Michael, 2010. "Minimum Wage Effects Across State Borders: Estimates Using Contiguous Counties," Institute for Research on Labor and Employment, Working Paper Series qt86w5m90m, Institute of Industrial Relations, UC Berkeley.
- Dranove, David & Spier, Kathryn E. & Baker, Laurence, 2000. "'Competition' among employers offering health insurance," Journal of Health Economics, Elsevier, vol. 19(1), pages 121-140, January.
- Carrie H. Colla & William H. Dow & Arindrajit Dube, 2011. "The Labor Market Impact of Employer Health Benefit Mandates: Evidence from San Francisco’s Health Care Security Ordinance," NBER Working Papers 17198, National Bureau of Economic Research, Inc.
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