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Where Do The Sick Go? Health Insurance and Employment in Small and Large Firms

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Author Info
Kanika Kapur () (School of Economics, University College Dublin, Belfield, Dublin 4, Ireland)
José J. Escarce () (Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA)
M Susan Marquis () (RAND, 1200 South Hayes Street, Arlington, VA 22202, USA)
Kosali I. Simon () (Department of Policy Analysis and Management, Cornell University, Ithaca, NY 14853, USA)

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Abstract

Small firms that offer health insurance to their employees may face variable premiums if the firm hires an employee with high-expected health costs. To avoid expensive premium variability, a small firm may attempt to maintain a workforce with low-expected health costs. In addition, workers with high-expected health costs may prefer employment in larger firms with health insurance rather than in smaller firms. This results in employment distortions. We examine the magnitude of these employment distortions in hiring, employment, and separations using the Medical Expenditure Panel Survey from 1996 to 2001. We find that workers with high-expected health costs are less likely to be new hires in insured small firms and are less likely to be employed in insured small firms. We find no evidence that state small group health insurance reforms designed to restrict insurers' ability to deny coverage and restrict premium variability have reduced the extent of these distortions.

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Publisher Info
Article provided by Southern Economic Association in its journal Southern Economic Journal.

Volume (Year): 74 (2008)
Issue (Month): 3 (January)
Pages: 644-664
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Handle: RePEc:sej:ancoec:v:74:3:y:2008:p:644-664

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Find related papers by JEL classification:
J21 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Labor Force and Employment, Size, and Structure
J63 - Labor and Demographic Economics - - Mobility, Unemployment, and Vacancies - - - Turnover; Vacancies; Layoffs
I10 - Health, Education, and Welfare - - Health - - - General
I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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  1. David M. Cutler & Brigitte C. Madrian, 1998. "Labor Market Responses to Rising Health Insurance Costs: Evidence on Hours Worked," RAND Journal of Economics, The RAND Corporation, vol. 29(3), pages 509-530, Autumn. [Downloadable!] (restricted)
    Other versions:
  2. Frank A. Scott & John Garen & Mark Berger, 1995. "Do health insurance and pension costs reduce the job opportunities of older workers?," Industrial and Labor Relations Review, ILR Review, ILR School, Cornell University, vol. 48(4), pages 775-791, July.
  3. Davidoff, Amy & Blumberg, Linda & Nichols, Len, 2005. "State health insurance market reforms and access to insurance for high-risk employees," Journal of Health Economics, Elsevier, vol. 24(4), pages 725-750, July. [Downloadable!] (restricted)
  4. Cutler, David M, 1994. "A Guide to Health Care Reform," Journal of Economic Perspectives, American Economic Association, vol. 8(3), pages 13-29, Summer. [Downloadable!] (restricted)
  5. Kanika Kapur, 1998. "The Impact of health on job mobility: A measure of job lock," Industrial and Labor Relations Review, ILR Review, ILR School, Cornell University, vol. 51(2), pages 282-298, January.
  6. Ilayperuma Simon, Kosali, 2005. "Adverse selection in health insurance markets? Evidence from state small-group health insurance reforms," Journal of Public Economics, Elsevier, vol. 89(9-10), pages 1865-1877, September. [Downloadable!] (restricted)
  7. Jayanta Bhattacharya & William B. Vogt, 2006. "Employment and Adverse Selection in Health Insurance," NBER Working Papers 12430, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  8. Robert Kaestner & Kosali Ilayperuma Simon, 2002. "Labor market consequences of state health insurance regulation," Industrial and Labor Relations Review, ILR Review, ILR School, Cornell University, vol. 56(1), pages 136-159, October.
  9. Royalty, Anne Beeson & Abraham, Jean M., 2006. "Health insurance and labor market outcomes: Joint decision-making within households," Journal of Public Economics, Elsevier, vol. 90(8-9), pages 1561-1577, September. [Downloadable!] (restricted)
  10. David Cutler, 1994. "Market Failure in Small Group Health Insurance," NBER Working Papers 4879, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  11. Madrian, Brigitte C, 1994. "Employment-Based Health Insurance and Job Mobility: Is There Evidence of Job-Lock?," The Quarterly Journal of Economics, MIT Press, vol. 109(1), pages 27-54, February. [Downloadable!] (restricted)
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  12. Ai, Chunrong & Norton, Edward C., 2003. "Interaction terms in logit and probit models," Economics Letters, Elsevier, vol. 80(1), pages 123-129, July. [Downloadable!] (restricted)
  13. Kanika Kapur, 2004. "The Impact of the Health Insurance Market on Small Firm Employment," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 71(1), pages 63-90. [Downloadable!] (restricted)
  14. Manning, Willard G. & Mullahy, John, 2001. "Estimating log models: to transform or not to transform?," Journal of Health Economics, Elsevier, vol. 20(4), pages 461-494, July. [Downloadable!] (restricted)
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  15. Thomas Buchmueller & John Dinardo, 2002. "Did Community Rating Induce an Adverse Selection Death Spiral? Evidence from New York, Pennsylvania, and Connecticut," American Economic Review, American Economic Association, vol. 92(1), pages 280-294, March. [Downloadable!]
    Other versions:
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