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Union Effects on Health Insurance Provision and Coverage in the United States


  • Thomas C. Buchmueller
  • John DiNardo


During the past two decades, union density has declined in the United States and employer provision of health benefits has undergone substantial changes in extent and form. Using individual data spanning the years 1983-1997, combined with establishment data for 1993, we update and extend previous analyses of private-sector union effects on employer-provided health benefits. We find that the union effect on health insurance coverage rates has fallen somewhat but remains large, due to an increase over time in the union effect on employee 'take-up' of offered insurance, and that declining unionization explains 20-35 percent of the decline in employee health coverage. The increasing union take-up effect is linked to union effects on employees' direct costs for health insurance and the availability of retiree coverage.

Suggested Citation

  • Thomas C. Buchmueller & John DiNardo, 2001. "Union Effects on Health Insurance Provision and Coverage in the United States," NBER Working Papers 8238, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:8238
    Note: HE LS

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    Cited by:

    1. Haile, Getinet & Bryson, Alex & White, Michael, 2015. "Spillover effects of unionisation on non-members' wellbeing," Labour Economics, Elsevier, vol. 35(C), pages 108-122.
    2. Hutchens, R & Nolen, PJ, 2006. "Will The Real Family-Friendly Employer Please Stand Up: Who Permits Parents To Reduce Working Hours For Purposes of Childcare?," Economics Discussion Papers 2905, University of Essex, Department of Economics.
    3. Helen Levy, 2004. "Employer-Sponsored Disability Insurance: Where are the Gaps in Coverage?," NBER Working Papers 10382, National Bureau of Economic Research, Inc.
    4. Lu, Yi & Tao, Zhigang & Wang, Yijiang, 2010. "Union effects on performance and employment relations: Evidence from China," China Economic Review, Elsevier, vol. 21(1), pages 202-210, March.
    5. 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.
    6. Baker, Laurence C. & Bundorf, M. Kate & Kessler, Daniel P., 2015. "Does health plan generosity enhance hospital market power?," Journal of Health Economics, Elsevier, vol. 44(C), pages 54-62.
    7. Jennifer Feenstra Schultz & David Doorn, 2009. "Employer Health Benefit Costs and Demand for Part-Time Labor," Working Papers 09-08, Center for Economic Studies, U.S. Census Bureau.
    8. Xuguang Guo & Ran Tao, 2015. "Health Benefit Downward Rigidity: Employers’ Responses to Rising Insurance Costs," Risk Management and Insurance Review, American Risk and Insurance Association, vol. 18(2), pages 217-241, September.
    9. Laurence C. Baker & M. Kate Bundorf & Daniel P. Kessler, 2015. "Does Health Plan Generosity Enhance Hospital Market Power?," NBER Working Papers 21513, National Bureau of Economic Research, Inc.
    10. Richard N. Block & Sheldon Friedman & Michelle Kaminski & Andy Levin (ed.), 2006. "Justice on the Job: Perspectives on the Erosion of Collective Bargaining in the United States," Books from Upjohn Press, W.E. Upjohn Institute for Employment Research, number joj, November.
    11. Patricia H Born & Alice M Zawacki, 2003. "Manufacturing Firms' Decisions Regarding Retiree Health Insurance," Working Papers 03-14, Center for Economic Studies, U.S. Census Bureau.
    12. Jorge Davalos & Monica Puoma Lambon-Quayefio & Samuel B. Manu, 2017. "An empirical assessment of the union facilitation effect in the Ghanaian labor market Author-Name: Nkechi S. Owoo," Working Papers PMMA 2017-08, PEP-PMMA.

    More about this item

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • J3 - Labor and Demographic Economics - - Wages, Compensation, and Labor Costs


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