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Abstract

In concentrated labor markets, where workers have fewer employers to choose from, employers may exploit their monopsony power by contributing less to workers’ health benefits. This study examined if labor market concentration was associated with higher worker contributions to health plan premiums. We combined publicly available data from the Census to calculate labor market concentration and the Medical Expenditure Panel Survey Insurance/Employer Component to determine premium contributions from 2010 to 2016 for metropolitan areas. After controlling for year fixed-effects and market characteristics, we found that higher labor market concentration was associated with higher worker contributions to health plan premiums, lower take-home income, and no change in employer contributions to premiums, consistent with the hypothesis that greater labor market concentration is associated with less generous health benefits. When evaluating the effects of mergers and acquisitions on labor markets, regulatory agencies should critically assess worker contributions to health insurance premiums.

Keywords

employer-sponsored insurance labor market concentration health insurance premiums private insurance

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References

Agency for Healthcare Research and Quality. (2020). Medical expenditure panel survey insurance/employer component. https://meps.ahrq.gov/survey_comp/Insurance.jsp

Autor

Dorn

Katz

L. F.

Patterson

Van Reenen

(2017). Concentrating on the fall of the labor share. American Economic Review, 107(5), 180-185. https://doi.org/10.1257/aer.p20171102

Autor

Dorn

Katz

L. F.

Patterson

Van Reenen

(2020). The fall of the labor share and the rise of superstar firms. Quarterly Journal of Economics, 135(2), 645-709. https://doi.org/10.1093/qje/qjaa004

Azar

Marinescu

Steinbaum

M. I.

(2019). Labor market concentration (NBER Working Paper No. 21147). http://www.nber.org/papers/w24147

Azar

J. A.

Marinescu

Steinbaum

M. I.

Taska

(2020). Concentration in US labor markets: Evidence from online vacancy data. Labour Economics, 66(October), Article 101886. https://doi.org/10.1016/j.labeco.2020.101886

Baicker

Chandra

(2006). The labor market effects of rising health insurance premiums. Journal of Labor Economics, 24(3), 609-634. https://doi.org/10.1086/505049

Bartik

A. W.

Rinz

(2018). Moving costs and worker adjustment to changes in labor demand: Evidence from longitudinal census data. https://static1.squarespace.com/static/5a0928c18dd0412bcedaea63/t/5bb291f69140b7394f34e16c/1538429444828/Bartik_2018_movingcosts.pdf

Benmelech

Bergman

Kim

(2018). Strong employers and weak employees: How does employer concentration affect wages? (NBER Working Paper No. 24307). http://www.nber.org/papers/w24307

Bhattacharya

Vogt

W. B.

(2006). Employment and adverse selection in health insurance (NBER Working Paper No. 12430). https://www.nber.org/system/files/working_papers/w12430/w12430.pdf

10.

Bundorf

M. K.

(2002). Employee demand for health insurance and employer health plan choices. Journal of Health Economics, 21(1), 65-88. https://doi.org/10.1016/S0167-6296(01)00127-8

11.

Castaneda

M. A.

Marton

(2013). Employer-provided health insurance and the adverse selection problem. Public Finance Review, 41(1), 3-36. https://doi.org/10.1177/1091142111434594

12.

Clemens

Cutler

D. M.

(2014). Who pays for public employee health costs? Journal of Health Economics, 38(December), 65-76. https://doi.org/10.1016/j.jhealeco.2014.04.008

13.

Crocker

K. J.

Moran

J. R.

(2003). Contracting with limited commitment: Evidence from employment-based health insurance contracts. Rand Journal of Economics, 34(4), 694-718. https://doi.org/10.2307/1593784

14.

Ellis

R. P.

Albert Ma

. (2011). Health insurance, cost expectations, and adverse job turnover. Health Economics, 20(1), 27-44. https://doi.org/10.1002/hec.1571

15.

Federal Trade Commission. (2018). FTC hearing #3: Multi-sided platforms, labor markets, and potential competition. https://www.ftc.gov/news-events/events-calendar/2018/10/ftc-hearing-3-competition-consumer-protection-21st-century

16.

Garfield

Orgera

Damico

(2019). The uninsured and the ACA: A primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act. https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/

17.

Goldstein

G. S.

Pauly

M. V.

(1976). Group health insurance as a local public good. In The role of health insurance in the health services sector (pp. 73-114). National Bureau of Economic Research. https://ideas.repec.org/h/nbr/nberch/3817.html

18.

Gruber

(1994). The incidence of mandated maternity benefits. American Economic Review, 84(3), 622-641. https://www.jstor.org/stable/2118071

19.

Gruber

Madrian

B. C.

(1994). Health insurance and job mobility: The effects of public policy on job-lock. ILR Review, 48(1), 86-102. https://doi.org/10.1177/001979399404800107

20.

Kahn

(1997). Evidence of nominal wage stickiness from microdata. American Economic Review, 87(5), 993-1008. https://www.jstor.org/stable/2951337

21.

Kahneman

Knetsch

J. L.

Thaler

(1986). Fairness as a constraint on profit seeking: Entitlements in the market. American Economic Review, 76(4), 728-741. https://www.jstor.org/stable/1806070

22.

Kaiser Family Foundation. (2020). 2020 Employer health benefits survey. https://www.kff.org/health-costs/report/2020-employer-health-benefits-survey/

23.

Kolstad

J. T.

Kowalski

A. E.

(2016). Mandate-based health reform and the labor market: Evidence from the Massachusetts reform. Journal of Health Economics, 47(May), 81-106. https://doi.org/10.1016/j.jhealeco.2016.01.010

24.

Madrian

(1994). Employment-based health insurance and job mobility: Is there evidence of job-lock? Quarterly Journal of Economics, 109(1), 27-54. https://doi.org/10.2307/2118427

25.

Manning

Petrongolo

(2017). How local are labor markets? evidence from a spatial job search model. American Economic Review, 107(10), 2877-2907. https://doi.org/10.1257/aer.20131026

26.

Molloy

Smith

C. L.

Wozniak

A. K.

(2014). Declining migration within the U.S.: The role of the labor market. NBER Working Paper Series w20065. https://doi.org/10.3386/w20065

27.

Monheit

A. C.

Cooper

P. F.

(1994). Health insurance and job mobility: Theory and evidence. Industrial and Labor Relations Review, 48(1), 68-85. https://doi.org/10.2307/2524627

28.

Moretti

(2013). Real wage inequality. American Economic Journal: Applied Economics, 5(1), 65-103. https://doi.org/10.1257/app.5.1.65

29.

Papanicolas

Woskie

L. R.

Jha

A. K.

(2018). Health care spending in the United States and other high-income countries. Journal of the American Medical Association, 319(10), 1024-1039. https://doi.org/10.1001/jama.2018.1150

30.

Prager

Schmitt

(2021). Employer consolidation and wages: Evidence from hospitals. American Economic Review, 111(2), 397-427. https://doi.org/10.1257/aer.20190690

31.

Selden

T. M.

Karaca

Keenan

White

Kronick

(2015). The growing difference between public and private payment rates for inpatient hospital care. Health Affairs (Project Hope), 34(12), 2147-2150. https://doi.org/10.1377/hlthaff.2015.0706

32.

Sommers

B. D.

(2005). Who really pays for health insurance? The incidence of employer-provided health insurance with sticky nominal wages. International Journal of Health Care Finance and Economics, 5(1), 89-118. https://www.jstor.org/stable/25067716

33.

Summers

L. H.

(1989). Some simple economics of mandated benefits. https://eml.berkeley.edu/~saez/course131/Summers89.pdf

34.

Swartz

(2006). Reinsuring health: Why more middle-class people are uninsured and what government can do. Russell Sage Foundation. https://www.jstor.org/stable/10.7758/9781610445207

35.

U.S. Bureau of Labor Statistics. (2019). Consumer price index: All urban consumers. https://beta.bls.gov/dataViewer/view/timeseries/CUUR0000SA0

36.

U.S. Bureau of Labor Statistics. (2020). Employer costs for employee compensation summary. https://www.bls.gov/news.release/ecec.nr0.htm

37.

U.S. Census Bureau. (n.d.). CBP datasets. https://www.census.gov/programs-surveys/cbp/data/datasets.html

38.

U.S. Department of Justice. (2015). Herfindahl–Hirschman index. https://www.justice.gov/atr/herfindahl-hirschman-index

39.

U.S. Department of Justice & Federal Trade Commission. (2010). Horizontal merger guidelines. https://www.justice.gov/atr/horizontal-merger-guidelines-08192010

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