Most US workers have health insurance plans sponsored and subsidized by their employers. The US Affordable Care Act (ACA) improved and expanded the availability of non-employer-based health insurance, with protections for pre-existing conditions, guaranteed issue, and community rating in non-group markets. Using National Health Interview Survey data for 2009 to 2018 and a difference-in-differences modeling approach, this study finds that the ACA increased self-employment in 2015 and 2016 among US adults with higher demand for health insurance. The probability of self-employment increased by 1.4 to 1.8 percentage points among adults ages 30 to 64 with at least one pre-ACA declinable condition and no alternative source of health insurance through a spouse’s employer or public programs. However, these effects were short-lived. As uncertainty about the long-term viability of the ACA’s health insurance exchanges increased in 2017 and 2018, the probability of self-employment among individuals with high demand for insurance fell to pre-ACA levels.
AbrahamKatharine G.HaltiwangerJohn C.HouClaireSanduskyKristinSpletzerJames R.2021. Reconciling survey and administrative measures of self-employment. Journal of Labor Economics39(4):825–60.
2.
AbramowitzJoelle. 2016. Saying “I don’t”: The effect of the Affordable Care Act young adult provision on marriage. Journal of Human Resources51(4):933–60.
3.
[AHRQ] Agency for Healthcare Research and Quality. 2015. MEPS Insurance Component Chartbook 2014. Rockville, MD: Agency for Healthcare Research and Quality. Accessed May 2023, https://meps.ahrq.gov/data_stats/MEPSICChartbook.pdf
4.
[AHRQ] Agency for Healthcare Research and Quality. 2022. Medical Expenditure Panel Survey Insurance Component 2021 Chartbook. Rockville, MD: Agency for Healthcare Research and Quality. Accessed May 2023, https://meps.ahrq.gov/data_files/publications/cb26/cb26.shtml
AzoulayPierreJonesBenjamin F.KimJ. DanielMirandaJavier. 2020. Age and high-growth entrepreneurship. AER: Insights2(1):65–82.
7.
BaeHannahMeckelKatherine. 2022. Dependent coverage and parental “job lock”: Evidence from the Affordable Care Act. NBER Working Paper No. 30200. Cambridge, MA: National Bureau of Economic Research. Accessed July 2022, https://www.nber.org/papers/w30200
8.
BaileyJames. 2017. Health insurance and the supply of entrepreneurs: New evidence from the Affordable Care Act. Small Business Economics49(3):627–46.
9.
BaileyJamesDaveDhaval. 2019. The effect of the Affordable Care Act on entrepreneurship among older adults. Eastern Economic Journal45(1):141–59.
10.
BlewettLynn A.DrewJulia A. RiveraKingMiriam L.WilliamsKari C. W.2019. IPUMS Health Surveys: National Health Interview Survey. Minneapolis, MN: IPUMS.
11.
Blume-KohoutMargaret E.2023. The Affordable Care Act and women’s self-employment in the United States. Feminist Economics29(1):174–204.
12.
BuchmuellerThomas C.VallettaRobert G.1996. The effects of employer-provided health insurance on worker mobility. Industrial and Labor Relations Review49(3):439–55.
CondliffeSimonSaboeMatt B.TerrizziSabrina. 2017. Did the ACA reduce job-lock and spur entrepreneurship?Journal of Entrepreneurship and Public Policy6(2):150–63.
15.
DeCiccaPhilip. 2010. Health Insurance Availability and Entrepreneurship. Kalamazoo, MI: W.E. Upjohn Institute for Employment Research.
16.
DeckerRyanHaltiwangerJohnJarminRon S.MirandaJavier. 2014. The role of entrepreneurship in US job creation and economic dynamism. Journal of Economic Perspectives28(3):3–24.
17.
FairlieRobert W.KapurKanikaGatesSusan. 2011. Is employer-based health insurance a barrier to entrepreneurship?Journal of Health Economics30(1):146–62.
GarthwaiteCraigGrossTalNotowidigdoMatthew J.2014. Public health insurance, labor supply, and employment lock. Quarterly Journal of Economics129(2):653–96.
21.
GilleskieDonna B.LutzByron F.2002. The impact of employer-provided health insurance on dynamic employment transitions. Journal of Human Resources28(4):761–70.
22.
HahnYoujinYangHee-Seung. 2016. Do work decisions among young adults respond to extended dependent coverage?ILR Review68(3):737–71.
23.
HaltiwangerJohn. 2022. Entrepreneurship in the twenty-first century. Small Business Economics58:27–40.
24.
HaltiwangerJohnJarminRon S.MirandaJavier. 2013. Who creates jobs? Small versus large versus young. Review of Economics and Statistics95(2):347–61.
25.
HamersmaSarahKimMatthew. 2009. The effect of parental Medicaid expansions on job mobility. Journal of Health Economics28(4):761–70.
26.
HamptonMattLenhartOtto. 2019. The effect of the Affordable Care Act preexisting conditions provision on marriage. Health Economics28(11):1345–55.
27.
HamptonMattLenhartOtto. 2022. The effect of the Affordable Care Act Medicaid expansion on marriage. Economic Inquiry60(2):568–91.
28.
HeimBradley T.LurieIthai Z.2010. The effect of self-employed health insurance subsidies on self-employment. Journal of Public Economics94(11-12):995–1007.
29.
HeimBradley T.YangLang Kate. 2017. The impact of the Affordable Care Act on self-employment. Health Economics26(12):e256–73.
30.
Holtz-EakinDouglasPenrodJohn R.RosenHarvey S. 1996. Health insurance and the supply of entrepreneurs. Journal of Public Economics62(1-2):209–35.
31.
KapurKanika. 1998. The impact of health on job mobility: A measure of job lock. Industrial and Labor Relations Review51(2):282–98.
32.
KimDaeho. 2022. The effect of the Affordable Care Act dependent coverage mandate on health insurance and labor supply: Evidence from alternative research designs. ILR Review75(3):769–93.
33.
KuoYu-ChenLinJia-Huey. 2020. Picking the lock: How universal healthcare programs influence entrepreneurial activities. Small Business Economics54(1):3–24.
34.
LavelleBridgetSmockPamela J.2012. Divorce and women’s risk of health insurance loss. Journal of Health and Social Behavior53(4):413–31.
35.
LitwinAdam SethPhanPhillip H.2013. Quality over quantity: Reexamining the link between entrepreneurship and job creation. ILR Review66(4):833–73.
36.
MadrianBrigitte C.1994. Employment-based health insurance and job mobility: Is there evidence of job-lock?Quarterly Journal of Economics109(1):27–54.
37.
[NCHS] National Center for Health Statistics. 2014. Design and estimation for the National Health Interview Survey, 2006–2015. Vital and Health Statistics Series 2(165).
38.
NiuXiaotong. 2014. Health insurance and self-employment: Evidence from Massachusetts. ILR Review67(4):1235–73.
PetersH. ElizabethSimonKosaliTaberJamie Rubenstein. 2014. Marital disruption and health insurance. Demography51(4):1397–421.
41.
SimpsonJessica L.CohenRobin A.2017. The association of marital status and offers of employer-based health insurance for employed women aged 27–64: United States, 2014–2015. NCHS Data Brief. Washington, DC: National Center for Health Statistics.
42.
SluskyDavid J. G.GintherDonna K.2021. Did Medicaid expansion reduce medical divorce?Review of Economics of the Household19:1139–74.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
