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Entrepreneurship Lock and the Demand for Health Insurance: Evidence from the US Affordable Care Act

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  • Margaret E. Blume-Kohout

Abstract

Most US workers have health insurance plans sponsored and subsidized by their employers. The US Affordable Care Act (ACA) improved and expanded the availability of non-employer-based health insurance, with protections for pre-existing conditions, guaranteed issue, and community rating in non-group markets. Using National Health Interview Survey data for 2009 to 2018 and a difference-in-differences modeling approach, this study finds that the ACA increased self-employment in 2015 and 2016 among US adults with higher demand for health insurance. The probability of self-employment increased by 1.4 to 1.8 percentage points among adults ages 30 to 64 with at least one pre-ACA declinable condition and no alternative source of health insurance through a spouse’s employer or public programs. However, these effects were short-lived. As uncertainty about the long-term viability of the ACA’s health insurance exchanges increased in 2017 and 2018, the probability of self-employment among individuals with high demand for insurance fell to pre-ACA levels.

Suggested Citation

  • Margaret E. Blume-Kohout, 2024. "Entrepreneurship Lock and the Demand for Health Insurance: Evidence from the US Affordable Care Act," ILR Review, Cornell University, ILR School, vol. 77(2), pages 199-226, March.
    • Handle: RePEc:sae:ilrrev:v:77:y:2024:i:2:p:199-226
    DOI: 10.1177/00197939231211561
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    References listed on IDEAS

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    1. Craig Garthwaite & Tal Gross & Matthew J. Notowidigdo, 2014. "Public Health Insurance, Labor Supply, and Employment Lock," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 129(2), pages 653-696.
    2. David J. G. Slusky & Donna K. Ginther, 2021. "Did Medicaid expansion reduce medical divorce?," Review of Economics of the Household, Springer, vol. 19(4), pages 1139-1174, December.
    3. Fairlie, Robert W. & Kapur, Kanika & Gates, Susan, 2011. "Is employer-based health insurance a barrier to entrepreneurship?," Journal of Health Economics, Elsevier, vol. 30(1), pages 146-162, January.
    4. Joelle Abramowitz, 2016. "Saying, “I Don’t†: The Effect of the Affordable Care Act Young Adult Provision on Marriage," Journal of Human Resources, University of Wisconsin Press, vol. 51(4), pages 933-960.
    5. Thomas C. Buchmueller & Robert G. Valletta, 1996. "The Effects of Employer-Provided Health Insurance on Worker Mobility," ILR Review, Cornell University, ILR School, vol. 49(3), pages 439-455, April.
    6. J Matthew Hampton & Otto Lenhart, 2019. "'Til insurance do us part: the effect of the affordable care act preexisting conditions provision on marriage," Working Papers 1902, University of Strathclyde Business School, Department of Economics.
    7. Brigitte C. Madrian, 1994. "Employment-Based Health Insurance and Job Mobility: Is there Evidence of Job-Lock?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 109(1), pages 27-54.
    8. Youjin Hahn & Hee-Seung Yang, 2016. "Do Work Decisions among Young Adults Respond to Extended Dependent Coverage?," ILR Review, Cornell University, ILR School, vol. 69(3), pages 737-771, May.
    9. Donna B. Gilleskie & Byron F. Lutz, 2002. "The Impact of Employer-Provided Health Insurance on Dynamic Employment Transitions," Journal of Human Resources, University of Wisconsin Press, vol. 37(1), pages 129-162.
    10. Heim, Bradley T. & Lurie, Ithai Z., 2010. "The effect of self-employed health insurance subsidies on self-employment," Journal of Public Economics, Elsevier, vol. 94(11-12), pages 995-1007, December.
    11. Pierre Azoulay & Benjamin F. Jones & J. Daniel Kim & Javier Miranda, 2020. "Age and High-Growth Entrepreneurship," American Economic Review: Insights, American Economic Association, vol. 2(1), pages 65-82, March.
    12. James Bailey & Dhaval Dave, 2019. "The Effect of the Affordable Care Act on Entrepreneurship among Older Adults," Eastern Economic Journal, Palgrave Macmillan;Eastern Economic Association, vol. 45(1), pages 141-159, January.
    13. Ryan Decker & John Haltiwanger & Ron Jarmin & Javier Miranda, 2014. "The Role of Entrepreneurship in US Job Creation and Economic Dynamism," Journal of Economic Perspectives, American Economic Association, vol. 28(3), pages 3-24, Summer.
    14. Bradley T. Heim & Lang Kate Yang, 2017. "The impact of the Affordable Care Act on self‐employment," Health Economics, John Wiley & Sons, Ltd., vol. 26(12), pages 256-273, December.
    15. Adam Seth Litwin & Phillip H. Phan, 2013. "Quality over Quantity: Reexamining the Link between Entrepreneurship and Job Creation," ILR Review, Cornell University, ILR School, vol. 66(4), pages 833-873, July.
    16. Holtz-Eakin, Douglas & Penrod, John R. & Rosen, Harvey S., 1996. "Health insurance and the supply of entrepreneurs," Journal of Public Economics, Elsevier, vol. 62(1-2), pages 209-235, October.
    17. Simon Condliffe & Matt B. Saboe & Sabrina Terrizzi, 2017. "Did the ACA reduce job-lock and spur entrepreneurship?," Journal of Entrepreneurship and Public Policy, Emerald Group Publishing Limited, vol. 6(2), pages 150-163, August.
    18. James Bailey, 2017. "Health insurance and the supply of entrepreneurs: new evidence from the affordable care act," Small Business Economics, Springer, vol. 49(3), pages 627-646, October.
    19. Hamersma, Sarah & Kim, Matthew, 2009. "The effect of parental Medicaid expansions on job mobility," Journal of Health Economics, Elsevier, vol. 28(4), pages 761-770, July.
    20. H. Peters & Kosali Simon & Jamie Taber, 2014. "Marital Disruption and Health Insurance," Demography, Springer;Population Association of America (PAA), vol. 51(4), pages 1397-1421, August.
    21. Kanika Kapur, 1998. "The Impact of Health on Job Mobility: A Measure of Job Lock," ILR Review, Cornell University, ILR School, vol. 51(2), pages 282-298, January.
    22. H. Elizabeth Peters & Kosali Simon & Jamie Rubenstein Taber, 2014. "Marital Disruption and Health Insurance," NBER Working Papers 20233, National Bureau of Economic Research, Inc.
    23. Katharine G. Abraham & John C. Haltiwanger & Claire Hou & Kristin Sandusky & James R. Spletzer, 2021. "Reconciling Survey and Administrative Measures of Self-Employment," Journal of Labor Economics, University of Chicago Press, vol. 39(4), pages 825-860.
    24. Matt Hampton & Otto Lenhart, 2022. "The effect of the Affordable Care Act Medicaid expansion on marriage," Economic Inquiry, Western Economic Association International, vol. 60(2), pages 568-591, April.
    25. John Haltiwanger & Ron S. Jarmin & Javier Miranda, 2013. "Who Creates Jobs? Small versus Large versus Young," The Review of Economics and Statistics, MIT Press, vol. 95(2), pages 347-361, May.
    26. Matt Hampton & Otto Lenhart, 2019. "The effect of the Affordable Care Act preexisting conditions provision on marriage," Health Economics, John Wiley & Sons, Ltd., vol. 28(11), pages 1345-1355, November.
    27. Yu-Chen Kuo & Jia-Huey Lin, 2020. "Picking the lock: how universal healthcare programs influence entrepreneurial activities," Small Business Economics, Springer, vol. 54(1), pages 3-24, January.
    28. Daeho Kim, 2022. "The Effect of the Affordable Care Act Dependent Coverage Mandate on Health Insurance and Labor Supply: Evidence from Alternative Research Designs," ILR Review, Cornell University, ILR School, vol. 75(3), pages 769-793, May.
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