Damberg C.

AHSR FHSR Annu Meet Abstr Book. 1994; 11: 41-2.

RAND Graduate School of Public Policy Studies, Santa Monica, CA 90407.

PROBLEM AND OBJECTIVES: Employment-based insurance is the primary source of coverage for most working-age adults, yet not all workers are covered by their own employer. Of 26.5 million dual worker households, 45 percent have access to employment-based coverage through only one spouse. Spousal coverage permits married workers to free ride on the insurance offered by other employers, providing them an implicit cross subsidy. Reform measures may eliminate cost subsidies by mandating that all employers and employees pay for coverage (e.g., Clinton Health Security Act). This study examines the cross subsidization issue to understand the potential consequences of a policy change that requires all workers to contribute. DATA AND METHODS: The sample contains 2,886 dual worker households from the 1987 National Medical Expenditure Survey. A multinomial nested logit is used to predict the probability a worker receives a cross subsidy as a function of the worker's and spouse's demographic and employment characteristics (firm size, hours worked, wage rate, union status, self-employed, industry group, age, number of dependents, gender, and education). A hedonic price model is used to calculate the amount of cross subsidy. RESULTS AND CONCLUSIONS: Spousal coverage was reported for 53.9 percent of all couples. Women were more likely than men to gain coverage from their spouse's health plan (74.2 percent of cross subsidized households), except where the wife was employed by a large firm and the husband a small firm. Workers in small firms and the self-employed exhibited a higher probability of receiving spousal coverage than those in large firms. IMPLICATIONS FOR AUDIENCE: The financing burden of an insurance mandate will likely fall on female and small firm workers. Both groups earn less than their male and large firm counterparts and the wage discrepancy may grow larger as employers shift the cost of the mandate to workers.

Publication Types:

• Meeting Abstracts

Keywords:

• Adult
• Budgets
• Costs and Cost Analysis
• Data Collection
• Employment
• Family Characteristics
• Female
• Health
• Health Care Reform
• Humans
• Industry
• Insurance
• Insurance Benefits
• Insurance Coverage
• Male
• Medicare
• National Health Insurance, United States
• Occupations
• Salaries and Fringe Benefits
• economics
• hsrmtgs

Other ID:

• HTX/94910840

UI: 102211988

From Meeting Abstracts