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

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  • Colla, Carrie Hoverman
  • Dow, William H.
  • Dube, Arindrajit

Abstract

In 2006 San Francisco adopted major health reform, becoming the first city to implement a pay-or-play employer-health spending mandate. It also created Healthy San Francisco, a "public option" to promote affordable universal access to care. Using the 2008 Bay Area Employer Health Benefits Survey, we find that most employers (75%) had to increase health spending to comply with the law, yet most (64%) are supportive of the law. There is substantial employer demand for the public option, with 21% of firms using Healthy San Francisco for at least some employees, yet there is little evidence of firms dropping existing insurance offerings in the first year after implementation.

Suggested Citation

  • Colla, Carrie Hoverman & Dow, William H. & Dube, Arindrajit, 2010. "How Do Employers React to a Pay-or-Play Mandate? Early Evidence from San Francisco," Institute for Research on Labor and Employment, Working Paper Series qt2sw0q5dh, Institute of Industrial Relations, UC Berkeley.
    • Handle: RePEc:cdl:indrel:qt2sw0q5dh
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    References listed on IDEAS

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    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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    6. Gruber, Jonathan & Simon, Kosali, 2008. "Crowd-out 10 years later: Have recent public insurance expansions crowded out private health insurance?," Journal of Health Economics, Elsevier, vol. 27(2), pages 201-217, March.
    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.
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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

    Medicine and Health Sciences;

    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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