Working Paper: NBER ID: w16179
Authors: Carrie Hoverman Colla; William H. Dow; Arindrajit Dube
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.
Keywords: Health Policy; Employer Mandates; Public Health Insurance
JEL Codes: I11; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| HCSO (Y50) | employer health spending (H51) |
| HCSO (Y50) | employer benefit offerings (J32) |
| HCSO (Y50) | use of Healthy San Francisco public option (I13) |
| HCSO (Y50) | employer support for the law (K31) |
| HCSO (Y50) | crowd-out of private insurance (I13) |