University of Louisville, United States.
Econ Hum Biol. 2021 May;41:100995. doi: 10.1016/j.ehb.2021.100995. Epub 2021 Mar 2.
Because employer-sponsored health insurance (ESI) is experience rated, employers have an incentive to try to offset its cost by paying lower wages to employees who have greater medical expenditures. The existing evidence on this topic, however, illustrates only that ESI is associated with lower wages for groups of workers who are costlier to cover. In contrast, I use the variation provided by the Affordable Care Act's employer mandate to examine if differences in medical expenditures are passed on to workers at the individual level. My estimates rely on Medical Expenditure Panel Survey data in a dose response difference-in-difference framework that examines how wages change for workers with varying medical expenditures when they must soon be offered ESI. I find that each $1 difference in medical expenditures is associated with a $0.35 to $0.51 wage offset after the employer mandate's announcement wherever ESI must soon be offered to workers. Placebo analyses, focusing on workers whose employers are not affected by the mandate, provide support for a causal interpretation. I also show that my findings are not sensitive to sample selection or data reliability issues and that they cannot be explained by the effects of the Great Recession, demographic characteristics that correlate with medical expenditures, or location- or industry-specific idiosyncratic shocks.
由于雇主赞助的健康保险（ESI）是根据经验进行评级的，因此雇主有动机通过向医疗支出较高的员工支付较低的工资来抵消其成本。然而，关于这个主题的现有证据仅表明，ESI 与覆盖成本较高的工人群体的工资较低有关。相比之下，我利用《平价医疗法案》（Affordable Care Act）雇主强制规定所提供的变化，来检验医疗支出的差异是否会在个人层面上转嫁给工人。我的估计数依赖于医疗支出调查数据，采用剂量反应差异中的差异框架，考察了当工人即将获得 ESI 时，医疗支出不同的工人的工资会如何变化。我发现，在雇主强制规定宣布后，医疗支出每增加 1 美元，工资就会减少 0.35 到 0.51 美元，无论 ESI 何时必须提供给工人。针对不受强制规定影响的工人的安慰剂分析为因果关系解释提供了支持。我还表明，我的发现不受样本选择或数据可靠性问题的影响，也不能用大衰退的影响、与医疗支出相关的人口特征或特定地点或行业的特有冲击来解释。
