The U.S. Health Care System and Labor Markets

This paper provides a broad and general overview of the relationship between the U.S. health care system and the labor market. The paper first describes some of the salient features of and facts about the system of health insurance coverage in the U.S., particularly the role of employers. It then summarizes the empirical evidence on how health insurance impacts labor market outcomes such as wages, labor supply (including retirement, female labor supply, part-time vs. full-time work, and formal vs. informal sector work), labor demand (including hours worked and the composition of employment across full-time, part-time and temporary workers), and job turnover. It then discusses the implications of having a fragmented system of health insurance delivery--in which employers play a central role--on the health care system and health care outcomes.

The U.S. health care system and labor markets

This session will explore the impact of the U.S. health care system on U.S. labor markets. ; Why do employers believe that rising health care costs are a major cause for concern when economists insist that workers are the ones who actually bear the costs? What are the implications of large health care liabilities for the long-run viability of U.S. employers? How do rising health care costs affect employment and compensation decisions and labor mobility? Do behavioral insights shed any light on these issues?Health care reform

Limited Insurance Portability and Job Mobility: The Effects of Public Policy on Job-Lock

The link between health insurance and the workplace in the U.S. has led to concern over the possibility of insurance-induced reductions in job mobility or 'job-lock". Designing health insurance reforms which retain employer-based insurance coverage but mitigate the extent of job-lock requires an understanding of the policy dimensions to which job-lock is most receptive. We study a policy of limited insurance portability which has been adopted by a number of states and the federal government over the last 20 years. These "continuation of coverage' mandates grant individuals the right to continue purchasing health insurance through their former employers for some period of time after leaving their jobs. We find that the passage of these mandates caused a significant increase in the job mobility of prime age male workers. This suggests that a sizeable share of job-lock arises from short run concerns over portability rather than from long run problems.

Health Insurance, Labor Supply, and Job Mobility: A Critical Review of the Literature

This paper provides a critical review of the empirical literature on the relationship between health insurance, labor supply, and job mobility. We review over 50 papers on this topic, almost exclusively written in the last 10 years. We reach five conclusions. First, there is clear and unambiguous evidence that health insurance is a central determinant of retirement decisions. Second, there is fairly clear evidence that health insurance is not a major determinant of the labor supply and welfare exit decisions of low income mothers. Third, there is fairly compelling evidence that health insurance is an important factor in the labor supply decisions of secondary earners. Fourth, while there is some division in the literature, the most convincing evidence suggests that health insurance plays an important role in job mobility decisions. Finally, there is virtually no evidence in the literature on the welfare implications of these results. We present some rudimentary calculations which suggest that the welfare costs of job lock are likely to be modest. Our general conclusion is that health insurance has important effects on both labor force participation and job choice, but that it is not clear whether or not these effects results in large losses of either welfare or efficiency.

A Note on Longitudinally Matching Current Population Survey (CPS) Respondents

In this paper, we propose an approach for evaluating the trade-offs inherent in different approaches used to match Current Population Survey (CPS) respondents across various CPS surveys. Because there is some measurement error in both the variables used to identify individuals over time and in the characteristics of individuals at any point in time, any procedure used to match CPS respondents has the possibility of both generating incorrect matches and failing to generate potentially valid matches. We propose using the information contained in the variable on whether an individual lived in the same house on March 1 of the previous year as a way to gauge these trade-offs. We find that as measured by reported residence one year ago, increasing the fraction of 'invalid' merges that are rejected usually comes at a cost of decreasing the fraction of 'valid' merges that are retained. However, there are clearly some approaches that are superior to others in the sense that they result in both a higher fraction of 'invalid' merges being rejected and a higher fraction of 'valid' merges being retained. The programs to implement CPS matching across years in this paper are available .

Reducing the Complexity Costs of 401(k) Participation Through Quick Enrollment(TM)

The complexity of the retirement savings decision may overwhelm employees, encouraging procrastination and reducing 401(k) enrollment rates. We study a low-cost manipulation designed to simplify the 401(k) enrollment process. Employees are given the option to make a Quick Enrollment(TM) election to enroll in their 401(k) plan at a pre-selected contribution rate and asset allocation. By decoupling the participation decision from the savings rate and asset allocation decisions, the Quick Enrollment(TM) mechanism simplifies the savings plan decision process. We find that at one company, Quick Enrollment(TM) tripled 401(k) participation rates among new employees three months after hire. When Quick Enrollment(TM) was offered to previously hired non-participating employees at two firms, participation increased by 10 to 20 percentage points among those employees affected.

Employee Stock Purchase Plans

Employee stock purchase plans (ESPPs) are designed to promote employee stock ownership broadly within the firm and provide another tax-deferred vehicle for individual capital accumulation in addition to traditional pensions, 401(k)s, and stock options. We outline the individual and corporate tax treatment of ESPPs and the circumstances under which ESPPs will be preferred to cash compensation from a purely tax perspective. We then examine empirically ESPP participation using administrative data from 1997-2001 for a large health services company that employs approximately 30,000 people. The picture that emerges from the analysis of these data suggests that there is substantial non-participation in these plans even though all employees could increase gross compensation through participation. We discuss a number of potential explanations for non-participation.