New Linked Employee-Employer Data Show Workforce Composition Is Associated With Health Insurance Offers Among Small Employers

Abstract

Decades of research shows that small firms are much less likely to offer health insurance than large firms, but less is known about differences among small employers. We examine this issue using the Medical Expenditure Panel Survey-Insurance Component with Administrative Records (MEPS-ICAR), a unique employer-employee linked data set that is constructed by matching the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) to Internal Revenue Service administrative records and the Decennial Census. Multivariate analyses show that among firms with fewer than 50 workers, the probability that workers receive an insurance offer is positively associated with higher median workforce incomes, and conditional offers of dependent coverage increase when the majority of workers are married or from a family with at least three members. This first application of the MEPS-ICAR highlights the significance of workforce characteristics in shaping small employer insurance benefits and the data’s usefulness for expanding analyses of policy changes, wage-benefit tradeoffs, and health insurance benefits.

Keywords

health insurance employee-employer linked data low income

Get full access to this article

View all access options for this article.

References

Abraham

J. M.

Royalty

A. B.

(2005). Does having two earners in the household matter for understanding how well employer-based health insurance works? Medical Care Research and Review, 62(2), 167–186.

Agency for Healthcare Research and Quality. (2024). Medical expenditure panel survey – Insurance component private sector data. Percent of Employees in Establishments that Offer Health Insurance. Retrieved July 2, 2024, https://datatools.ahrq.gov/meps-ic?tab=private-sector-national&dash=25

Alker

(2021). Low-wage uninsured workers: Who are they and where do they work? Center for Children and Families, Georgetown University.

Banthin

(2022). Trends in small-group market health insurance, 2013-2020. The Urban Institute.

Cha

A. E.

Cohen

R. A.

(2022). Demographic variation in health insurance coverage: United States, 2020. National Health Statistics Reports (No. 169).

Gruber

Lettau

(2004). How elastic is the firm’s demand for health insurance? Journal of Public Economics, 88(7–8 July), 1273–1293.

Hadley

Reschovsky

J. D.

(2002). Small firms’ demand for health insurance: The decision to offer insurance. Inquiry, 39, 118–137.

Hegland

T. A.

Zawacki

Miller

G. E.

(2022). Introducing the medical expenditure panel survey-insurance component with administrative records (MEPS-ICAR): Description, data construction methodology, and quality assessment (Working Paper No. CES-22-29). Center for Economic Studies, U.S. Census Bureau. https://www.census.gov/library/working-papers/2022/adrm/CES-WP-22-29.html

Marquis

M. S.

Long

S. H.

(2001). To offer or not to offer: The role of price in employers’ health insurance decisions. Health Services Research, 36(5), 935–958.

10.

Mendoza

R. L.

(2022). Why do small firms offer health insurance in spite of the employer mandate exemption? Journal of Insurance Regulation, 41(6), 133–152.

11.

Miller

G. E.

Vistnes

J. P.

(2019). The excise tax on high-cost health plans: Potential adjustments by policymakers, employers, and employees. National Tax Journal, 72(1), 139–162.

12.

Miller

G. E.

Vistnes

J. P.

Buettgens

Dubay

(2017). The availability and marginal costs of dependent employer-sponsored health insurance. International Journal of Health Economics and Management, 17, 251–260.

13.

Minicozzi

Molloy

Mortenson

(2019). The decision to offer health insurance: Analyzing small firms using tax data. Proceedings, Annual Conference on Taxation and Minutes of the Annual Meeting of the National Tax Association, 112, 1–16.

14.

Monheit

A. C.

Vistnes

J. P.

(1999). Health insurance availability at the workplace: How important are worker preferences? The Journal of Human Resources, 34(4), 770–785.

15.

Morrisey

Jensen

G. A.

Morlock

R. J.

(1994). Small employers and the health insurance market. Health Affairs, 13(5), 149–161.

16.

Nichols

L. M.

Blumberg

L. J.

Acs

G. P.

Uccello

C. E.

Marsteller

J. A.

(1997). Small employers: Their diversity and health insurance. The Urban Institute.

17.

Paringer

(2007). Hispanic workers and employer sponsored insurance. The American Economist, 51(1), 40–53.

18.

Reschovsky

J. D.

Hadley

Nichols

(2007). Why do Hispanics have so little employer-sponsored health insurance? Inquiry, 44(3), 257–279.

19.

Tolbert

Orgera

Damico

(2021). What does the CPS tell us about health insurance coverage in 2020? Kaiser Family Foundation Data Note.

20.

Vistnes

Monheit

A. C.

(2011). The health insurance status of low-wage workers: The role of workplace composition and marital status. Medical Care Research and Review, 68(5), 607–623.

21.

Zawacki

Taylor

(2005). Contributions to health insurance premiums: When does the employer pay 100 percent? (Working Paper Series CES 05-27). Census Bureau Center for Economic Studies.

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.

0.00 MB

0.06 MB