State and Federal Approaches to Health Reform: What Works for the Working Poor?

28 Pages Posted: 30 Jun 2008 Last revised: 7 Aug 2010

See all articles by Ellen Meara

Ellen Meara

Harvard Medical School; National Bureau of Economic Research (NBER)

Meredith B. Rosenthal

Harvard University - T.H. Chan School of Public Health

Anna Sinaiko

Harvard University

Katherine Baicker

Harvard University - Department of Health Policy & Management; National Bureau of Economic Research (NBER)

Date Written: June 2008

Abstract

We compare and contrast the labor market and distributional impact of three common approaches to state and federal health insurance expansion: public insurance expansions, refundable tax credits for low income people, and employer and individual mandates. We draw on existing estimates from the literature and individual-level data on the non-institutionalized population aged 64 and younger from the 2005 Current Population Survey to estimate how each approach affects (1) the number of people insured; (2) private and public health spending; (3) employment and wages; and (4) the distribution of subsidies across families based on income in relation to the federal poverty level and work status of adult family members. Employer mandates expand coverage to the largest number of previously insured relative to public insurance expansions and individual tax credits, but with potentially negative labor market consequences. Medicaid expansions could achieve moderate reductions in the share of the uninsured with neutral labor market consequences, and by definition, they expand coverage to the poorest groups regardless of work status. Tax credits extend coverage to relatively few uninsured, but with neutral effects on the labor market. Both Medicaid expansions and tax credits offer moderate redistribution to previously insured individuals who are poor or near-poor. None of the three policies significantly expand insurance coverage among poor working families. Our findings suggest that no single approach helps the working poor in exactly the ways policy makers might hope. To the extent that states are motivated to help the uninsured in poor working families, health reforms must find ways to include those unlikely to take up optional policies, and states must address the challenge of the many uninsured likely to be excluded from policies based on part-time work status, firm size, or immigration status.

Suggested Citation

Meara, Ellen and Rosenthal, Meredith B. and Sinaiko, Anna and Baicker, Katherine, State and Federal Approaches to Health Reform: What Works for the Working Poor? (June 2008). NBER Working Paper No. w14125, Available at SSRN: https://ssrn.com/abstract=1152667

Ellen Meara (Contact Author)

Harvard Medical School ( email )

Department of Health Care Policy
Boston, MA 02115
United States
617-432-3537 (Phone)
617-432-0173 (Fax)

National Bureau of Economic Research (NBER)

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

Meredith B. Rosenthal

Harvard University - T.H. Chan School of Public Health ( email )

677 Huntington Avenue
Boston, MA MA 02115
United States

Anna Sinaiko

Harvard University ( email )

1875 Cambridge Street
Cambridge, MA 02138
United States

Katherine Baicker

Harvard University - Department of Health Policy & Management ( email )

677 Huntington Avenue
Boston, MA 02115
United States

National Bureau of Economic Research (NBER)

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

Here is the Coronavirus
related research on SSRN

Paper statistics

Downloads
25
Abstract Views
771
PlumX Metrics