Date of Award

May 2016

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Economics

Advisor(s)

Leonard E. Burman

Second Advisor

Sarah E. Hamersma

Keywords

group health insurance, group health insurance costs, Health Savings Accounts, mental health parity, SCHIP, tax subsidies

Subject Categories

Social and Behavioral Sciences

Abstract

This dissertation comprises three papers on the impacts of health insurance and taxation policies on individuals’ health care and labor market outcomes. The policy contexts include income tax subsidy reform, group health insurance regulation, and public health insurance expansion. In every chapter, I use state by year policy variation and individual level survey data to provide the effectiveness and efficiency cost analysis of these policies.

My first chapter presents new empirical evidence on the impact of tax subsidies for Health Savings Accounts (HSAs) on group insurance coverage. HSAs are tax-free health care expenditure savings accounts. Coupled with high deductible health insurance plans (HDHPs), they together represent new health insurance options. The tax advantage of HSAs expands the group health insurance market by making health care more affordable. Using individual level data from the Current Population Survey and exploiting policy variation by state and year from 2004 to 2012, I find that HSA tax subsidies increase small-group coverage by a statistically significant 2.5 percentage points, although not coverage in larger firms. Moreover, if the tax price of HSA contribution decreases by 10 cents, small-group insurance coverage increases by almost 2 percentage points. I also find that for older workers or less-educated workers, HSA subsidies are associated with 2-3 percentage point increase in their group insurance coverage.

In the second chapter, I provide new empirical evidence on the impacts of state and federal mental health parity laws on related labor market outcomes, particularly working time. Implemented in the last two decades, these policies aim to eliminate differences in mental and physical health benefits among group health plans. The mandated benefits for mental health drive up the costs of providing health insurance substantially. In response, employers may avoid

hiring more full-time workers, whose compensation includes health insurance, by increasing working time per worker and reliance on part-time employment, and employees have an incentive to increase their labor supply to qualify for the benefits. Using individual level data from the Current Population Survey and exploiting policy variation by state and year, I find state parity laws increase average weeks worked by 1.4%. Since self-insured firms are exempted from state regulations, parity is estimated to have nearly twice as large an effect on small firms as it does on large firms. Moreover, I study two federal parity laws and find the more expansive one is associated with 1.7% more weeks worked. Overall, there is no strong evidence that parity laws affect hours worked and prevalence of coverage significantly.

The third chapter examines the effect of public health insurance expansions during 1997-2002 on the mental and behavioral health of children. Using three waves of the National Survey of America’s Families (NSAF) and legislative State Children’s Health Insurance Program (SCHIP) income eligibility thresholds by state-year-age, we explore the causal impact of SCHIP generosity on participation, general health care utilization, mental health service utilization, and finally children’s mental and behavioral health measures. Our results first show that SCHIP thresholds significantly increased public health insurance coverage and general health care utilization. However, there is almost no statistically significant evidence of increases in mental health care utilization or improvements in general mental health outcomes for the whole sample, When we focus on the Assessing the New Federalism (ANF) “study states” that comprise the bulk of the NSAF sample, we find a bit more evidence that SCHIP expansions may have slightly increased the probability of receiving mental health care as well as a few specific mental health outcomes for some age groups, but overall estimated effects remain small.

Access

Open Access

Download

Share

COinS