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The political roots of health insurance benefit mandates


  • James Bailey
  • Douglas Webber


Purpose - As of 2011, the average US state had 37 health insurance benefit mandates, laws requiring health insurance plans to cover a specific treatment, condition, provider, or person. This number is a massive increase from less than one mandate per state in 1965, and the topic takes on a new significance now, when the federal government is considering many new mandates as part of the “essential health benefits” required by the Affordable Care Act. The paper aims to discuss these issues. Design/methodology/approach - The authors use fixed effects estimation on 1996-2010 data to determine why some states pass more mandates than others. Findings - The authors find that the political strength of health care providers is the strongest determinant of mandates. Originality/value - A large body of literature has attempted to evaluate the effect of mandates on health, health insurance, and the labor market. However, previous papers did not consider the political processes behind the passage of mandates. In fact, when they estimate the laws’ effect, almost all papers on the subject assume that mandates are passed at random. The paper opens the way to estimating the causal effect of mandates on health insurance and the labor market using an instrumental variables strategy that incorporates political information about why mandates get passed.

Suggested Citation

  • James Bailey & Douglas Webber, 2017. "The political roots of health insurance benefit mandates," Journal of Economic Studies, Emerald Group Publishing, vol. 44(2), pages 170-182, May.
  • Handle: RePEc:eme:jespps:jes-07-2015-0137

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    Cited by:

    1. James Bailey, 2014. "Who pays the high health costs of older workers? Evidence from prostate cancer screening mandates," Applied Economics, Taylor & Francis Journals, vol. 46(32), pages 3931-3941, November.
    2. repec:bla:jrinsu:v:85:y:2018:i:2:p:577-595 is not listed on IDEAS
    3. Sarah Hamersma & Johanna Catherine Maclean, 2018. "Insurance Expansions and Children’s Use of Substance Use Disorder Treatment," NBER Working Papers 24499, National Bureau of Economic Research, Inc.
    4. James Bailey & Douglas Webber, 2018. "Health Insurance Benefit Mandates and Firm Size Distribution," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 85(2), pages 577-595, June.

    More about this item


    Health insurance; Interest groups; Benefit mandates; Health providers; D72; I13; I18;

    JEL classification:

    • D72 - Microeconomics - - Analysis of Collective Decision-Making - - - Political Processes: Rent-seeking, Lobbying, Elections, Legislatures, and Voting Behavior
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health


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