Benjamin D. Sommers (
Mark Shepard is an assistant professor in the John F. Kennedy School of Government, Harvard University, in Cambridge, Massachusetts.
Health Aff (Millwood). 2018 Jul;37(7):1144-1152. doi: 10.1377/hlthaff.2018.0220.
The Affordable Care Act (ACA) attempted to minimize disruptions to employer-sponsored insurance in part by implementing an employer mandate. Research has shown that employer coverage rates have been stable nationally under the ACA. Massachusetts enacted its own employer mandate in 2006 before eliminating it in 2014, in anticipation of the federal mandate. But the ACA's employer mandate was delayed until 2015 and exempted smaller firms that had been covered by the Massachusetts' mandate. In this unique policy environment, we found that the employer-sponsored insurance rate in Massachusetts fell by 2.3 percentage points after the ACA's coverage expansion took effect (2014-16), compared to the rest of the US. Coverage dropped more for middle-income workers than for lower-income workers, which suggests that crowd-out by Medicaid was not the primary factor. Employer surveys show that employer coverage offer rates declined significantly at small firms in Massachusetts beginning in 2014, but not at large firms. Our findings suggest that eliminating Massachusetts's employer mandate may have contributed to falling employer coverage rates in the state, although other policy and economic factors cannot be ruled out. These results may have implications for understanding the effects of the ACA's employer mandate and its potential repeal.
平价医疗法案（ACA）试图通过实施雇主强制令来最大程度地减少对雇主赞助保险的干扰。研究表明，在 ACA 下，全国范围内的雇主保险覆盖率一直保持稳定。马萨诸塞州在 2006 年颁布了自己的雇主强制令，然后在 2014 年取消，以应对联邦强制令。但 ACA 的雇主强制令被推迟到 2015 年，并豁免了之前受马萨诸塞州强制令覆盖的小型企业。在这种独特的政策环境下，我们发现，在 ACA 的覆盖范围扩大生效后（2014-16 年），马萨诸塞州的雇主赞助保险费率下降了 2.3 个百分点，而美国其他地区则没有。中低收入工人的保险覆盖率下降幅度大于低收入工人，这表明医疗补助计划的排挤效应不是主要因素。雇主调查显示，2014 年开始，马萨诸塞州的小型企业雇主提供保险的意愿显著下降，但大型企业没有。我们的研究结果表明，取消马萨诸塞州的雇主强制令可能导致该州雇主保险覆盖率下降，尽管不能排除其他政策和经济因素的影响。这些结果可能对理解 ACA 雇主强制令的影响及其可能的废除具有启示意义。
