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How Do Employers React to a Pay-or-Play Mandate? Early Evidence from San Francisco

Author

Listed:
  • Colla Carrie H

    (Dartmouth Medical School, carrie.colla@gmail.com)

  • Dow William H

    (University of California, Berkeley, wdow@berkeley.edu)

  • Dube Arindrajit

    (University of Massachusetts Amherst, adube@berkeley.edu)

Abstract
In 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.

Suggested Citation

  • Colla Carrie H & Dow William H & Dube Arindrajit, 2011. "How Do Employers React to a Pay-or-Play Mandate? Early Evidence from San Francisco," Forum for Health Economics & Policy, De Gruyter, vol. 14(1), pages 1-43, April.
    • Handle: RePEc:bpj:fhecpo:v:14:y:2011:i:2:n:4
    DOI: 10.2202/1558-9544.1228
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    References listed on IDEAS

    as
    1. Alan C. Monheit & Jessica Primoff Vistnes, 1999. "Health Insurance Availability at the Workplace: How Important are Worker Preferences?," Journal of Human Resources, University of Wisconsin Press, vol. 34(4), pages 770-785.
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    7. Sang-Hyop Lee & Gerard Russo & Lawrence H. Nitz & Abdul Jabbar, 2005. "The Effect of Mandatory Employer-Sponsored Insurance (ESI) on Health Insurance Coverage and Labor Force Utilization in Hawaii: Evidence from the Current Population Survey (CPS) 1994-2004," Working Papers 200512, University of Hawaii at Manoa, Department of Economics.
    8. 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.
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    Cited by:

    1. 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.
    2. Carrie H. Colla & William H. Dow & Arindrajit Dube, 2017. "The Labor-Market Impact of San Francisco's Employer-Benefit Mandate," Industrial Relations: A Journal of Economy and Society, Wiley Blackwell, vol. 56(1), pages 122-160, January.

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    More about this item

    Keywords

    health benefits; employer mandate; pay-or-play;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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