آیا گزینه های بیشتر بیمه سلامت منجر به دستمزدهای بالاتر می شود؟ مدارک و شواهد از کشورهای پوششی وابسته توسعه یافته
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|25953||2014||14 صفحه PDF||سفارش دهید||11838 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Health Economics, Volume 36, July 2014, Pages 84-97
Little is known about how health insurance affects labor market decisions for young adults. This is despite the fact that expanding coverage for people in their early 20s is an important component of the Affordable Care Act. This paper studies how having an outside source of health insurance affects wages by using variation in health insurance access that comes from states extending dependent coverage to young adults. Using American Community Survey and Census data, I find evidence that extending health insurance to young adults raises their wages. The increases in wages can be explained by increases in human capital and the increased flexibility in the labor market that comes from people no longer having to rely on their own employers for health insurance. The estimates from this paper suggest the Affordable Care Act will lead to wage increases for young adults.
Labor market and human capital decisions made by young adults can have lasting impacts on their careers. Despite this, little is currently known about how the need for health insurance coverage affects young adults’ labor market decisions. Understanding this is particularly important in light of the fact that extending dependent coverage to young adults is a major component of the Affordable Care Act. Economic theory suggests that having access to employer-sponsored health insurance through a source other than one's own employer could lead to wage increases by reducing job-lock, by allowing people to sort into higher paying jobs that do not offer health insurance, and, as this paper finds, by increasing education. Testing this empirically is difficult, however, because having an alternate source of health insurance, whether it is through a spouse or a parent, is often the outcome of a joint decision. This paper avoids this endogeneity issue by using plausibly exogenous variation in access to a parent's employer-sponsored health insurance plan that is induced by states implementing a minimum age until which employers must provide health insurance to employees’ children. Before the Affordable Care Act required all employers to provide health insurance to employees’ children until the age of 26, many states passed reforms that extended dependent coverage to young adults. These reforms gave young adults access to another source of health insurance apart from school or employment and at a price drastically lower than the private market. Although these reforms increased access to employer-sponsored health insurance for young adults, research on the reforms suggests they did not have a dramatic effect on overall health insurance coverage levels. Both Levine et al. (2011) and Monheit et al. (2011) use health insurance data from the Current Population Survey to study how these reforms affected health insurance levels. Levine et al. find that overall health insurance rises by about 3 percentage points for young adults, while Monheit et al. find that the main effect of these reforms was to allow young adults to switch from insurance through their own employers to insurance through their parents’ employers. Increased flexibility in the labor market and being able to gain employer-sponsored health insurance through a source other than one's own employer could lead to changes in labor market decisions in a number of ways. First, it could affect education decisions. Attending college at later ages often means people cannot have employer-sponsored health insurance since employers generally allow employees’ children to stay on their insurance until the age of 22 at the latest in the absence of the reforms. This makes the opportunity cost of attending college after the age of 22 even higher than the forgone wages since employer-sponsored health insurance is typically cheaper and provides more coverage than individual insurance. Additionally, many colleges require students to have health insurance, which essentially raises the price of college for people without easy access to health insurance. Thus, allowing young adults to stay on their parents’ health insurance until later ages could lower both the real and opportunity cost of attending college, which could induce marginal people to attend college and then earn higher wages due to their higher human capital. Second, having a source of health insurance other than through one's own employer could reduce job-lock, which is the loss of job mobility that arises from the non-portability of employer-sponsored health insurance. As Madrian (1994) argues, with job-lock lessened, people are free to leave their current jobs to find better matches and potentially higher wages. This would be particularly important early in people's careers before people gain experience in careers that are not their best matches. Finally, compensating differential theory suggests that receiving health insurance through a job should lower wages. This suggests that extending dependent coverage to young adults would allow them to earn higher wages by sorting into jobs that do not offer health insurance. This study contributes to the literature along a number of dimensions. First, the results of this paper help us understand what extending health insurance to young adults does and suggest the Affordable Care Act could increase education and wages for young adults. Second, knowing what extending dependent coverage does to education levels helps us understand people's education decisions. Increased college attendance at older ages would suggest the U.S. reliance on employer-sponsored health insurance may prevent people from investing in their human capital. To determine how this new avenue for obtaining health insurance affects young adults’ education and wages, I use data from the Census and the American Community Survey. The estimation strategy compares how education and wages change for eligible young adults after the reforms while accounting for state and national trends. The paper primarily focuses on people older than 22, as younger individuals could generally access parental insurance prior to the change in legislation if they were enrolled in college. I begin by estimating a time-flexible specification that allows the effects of the reforms to vary by an individual's age at the time of the reform. Doing this shows that the reforms begin to affect people 18 or younger at the time of passage, likely because people 18 and younger have not yet made their higher education and labor force decisions and have not left their parents’ health insurance. I find that wages increase after the age of 22 for those who were 18 or younger when dependent coverage was extended. Women experience wage increases of about 3.1 percent while they have access to insurance through their parents’ employers. These wage increases largely persist even after young women no longer have access to insurance through their parents’ employers. Young men experience wage increases of about 1.6 percent after they can no longer remain on their parents’ health insurance. For men, this persistent change can be attributed almost entirely to changes in education, which increases by about 0.17 years on average. The education gains for women, which are only about 0.07 years and are statistically insignificant, do not seem to explain much of the wage increase. Labor force participation falls slightly for people in their early twenties as men enroll in college and women take more time before entering the labor force. Once young adults are no longer eligible for insurance through their parents’ employers, labor force participation returns to the pre-reform levels. Scaling the wage estimates to account for the fact that more employers will have to provide coverage under the Affordable Care Act suggests that the Affordable Care Act will increase wages by an average of 3.5 and 4.6 percent for people who were 18 or younger when the act was passed. The paper unfolds as follows. The next section discusses previous work on health insurance and the labor market. Section 3 discusses the extensions in dependent coverage. Section 4 outlines a conceptual framework for how extending dependent coverage could affect labor market outcomes. Section 5 describes the data. Section 6 discusses the empirical strategy and presents the estimates of the effect of defining dependency status on education levels, education timing, and wages. Section 7 provides a discussion of the results, presents estimates of the effects of extended dependent coverage on health insurance, and summarizes the results of a series of placebo regressions. Section 8 concludes.
نتیجه گیری انگلیسی
Understanding what happens when people do not need to be in the labor force to have access to health insurance is important as the United States continues its process of healthcare reform. Although economic theory suggests a number of ways people could earn higher wages, testing this is difficult since people typically only have outside coverage if they are married. Likely because of the empirical challenges, no studies to date have examined the effect of a low-cost outside source of health insurance on wages for young people, an important and unique group. This paper has shown that having an outside source of employer-sponsored health insurance when young leads to increased wages. For men 18 and younger when dependent coverage was extended, wages increase by 1.6 percent after they are no longer eligible for insurance through their parents’ employers, while wages increase by 2.1 percent for women 18 and younger at the time of the reform once they are older than their state's minimum age. For men, wages increase because education increases by an average of 0.17 years. These increases in education arise because extending dependent coverage lowers the cost of being in school at later ages. The opportunity cost of being in school falls since being in school no longer means losing access to cheap and generous health insurance. The real cost of being in school also falls for many people since some colleges require students to have health insurance, which raises the effective price of attending college for people who do not desire health insurance. The estimates from this paper suggest the Affordable Care Act will lead to persistent wage increases for young adults by an average of 3.5–4.6 percent. Knowing that the Affordable Care Act has benefits that go beyond providing more coverage is important in understanding the potential impact of this legislation.