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The Effect of Mandatory Employer-Sponsored Insurance (ESI) on Health Insurance Coverage and Employment in Hawai ` i: Evidence from the Current Population Survey (CPS) 1994-2003. Sang-Hyop Lee, Ph.D. Gerard Russo, Ph.D. Lawrence Nitz, Ph.D. Abdul Jabbar, Ph.D. Candidate - PowerPoint PPT Presentation
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This research is funded in part through a U.S. Health Resources and Services Administration, State Planning Grant to the Hawaii State Department of Health. Sub-Contract Research Corporation of the University of Hawaii. Research conducted by the University of Hawaii, Social Science Research Institute in collaboration with the Hawaii State Department of Health, Hawaii Institute for Public Affairs: Hawaii Uninsured Project and the Hawaii
Health Information Corporation.1
The Effect of MandatoryEmployer-Sponsored Insurance (ESI)
on Health Insurance Coverage and Employment in Hawai`i:
Evidence from the Current Population Survey (CPS) 1994-2003
Sang-Hyop Lee, Ph.D.Gerard Russo, Ph.D.Lawrence Nitz, Ph.D.
Abdul Jabbar, Ph.D. CandidateUniversity of Hawai`i at Mānoa
Hawaii HRSA SPGTechnical Workshop VI
17 September 2004
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 2
Research Questions: PHCA
What is the impact of PHCA on hours worked?
What is the impact of PHCA on insurance coverage?
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 3
Data and Method
Current Population Survey (CPS) March Demographic Supplement 1994-2003
Analyze the performance of Hawaii system after implementation of the PHCA relative to the other states and US
US, Hawaii, Nevada, Michigan, California, and Florida
Counter-factual analysis
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 4
Percent Distribution of Employees by Hours Worked: CPS 1994-2003
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
1-5 6 - 10 11-15 16-19 20 21-25 26-30 31-35 35-39
Hours worked
Pe
rce
nt
dis
trib
uti
on HI
US
NV
MI
CA
FL
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 5
Estimating the effect of PHCA
Methodology: multinomial logit model Three categories: uninsured, employment based
insurance, or other insurance Predictor variables: age, sex, income, working
hours, ethnicity, industry of employment, and collective bargaining.
Predict the effect of hours worked on probability of coverage
Impact of hours worked holding other characteristics constant.
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 6
The effect of PHCA on the percent uninsured: CPS 1994-2003
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
1-5 6-10 11-15 16-19 20 21-25 26-30 31-35 36-39 40 &more
Hours worked
Per
cen
t u
nin
sure
d HI
US
NV
MI
CA
FL
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 7
The effect of PHCA on the percent covered by employment-based insurance: CPS 1994-2003
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
1-5 6-10 11-15 16-19 20 21-25 26-30 31-35 36-39 40 &more
Hours worked
Pe
rce
nt
ins
ure
d
HI
US
NV
MI
CA
FL
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 8
Predicted Probability of ESI by Hours Worked: Hawaii & US
Predicted Probability of Employment-Based Health Insurance by Hours Worked (single hours), 1994-2003 CPS.
0.4
0.5
0.6
0.7
0.8
0.9
1
1 8 15 22 29 36 43 50 57 64 71 78 85
Hawaii
US
hours worked
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 9
Predicted Probability of ESI by Hours Worked: Hawaii & Nevada
Predicted Probability of Employment-Based Health Insurance by Hours Worked (single hours), 1994-2003 CPS.
0.4
0.5
0.6
0.7
0.8
0.9
1
1 8 15 22 29 36 43 50 57 64 71 78 85
Hawaii
Nevada
hours worked
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 10
Predicted Probability of ESI by Hours Worked: Hawaii & Michigan
Predicted Probability of Employment-Based Health Insurance by Hours Worked (single hours), 1994-2003 CPS.
0.4
0.5
0.6
0.7
0.8
0.9
1
1 8 15 22 29 36 43 50 57 64 71 78 85
Hawaii
Michigan
hours worked
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 11
The effect of PHCA on the percent covered by non-employment based insurance: CPS 1994-2003
0.0%
10.0%
20.0%
30.0%
40.0%
1-5 6-10 11-15 16-19 20 21-25 26-30 31-35 36-39 40 &more
Hours worked
Per
cen
t in
sure
d HI
US
NV
MI
CA
FL
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 12
Probability of Non-Employment Based Insurance by Hours Worked: Hawaii & US
Predicted Probabilty of Non-Employment Based Health Insuranceby Hours Worked (single hours), CPS 1994-2003.
-0.05
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
1 8 15 22 29 36 43 50 57 64 71 78 85
Hours Worked
Hawaii
US
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 13
Probability of Non-Employment Based Insurance by Hours Worked: Hawaii & Nevada
Predicted Probabilty of Non-Employment Based Health Insuranceby Hours Worked (single hours), CPS 1994-2003.
-0.05
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
1 8 15 22 29 36 43 50 57 64 71 78 85
Hours Worked
Hawaii
Nevada
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 14
Probability of Non-Employment Based Insurance by Hours Worked: Hawaii & Michigan
Predicted Probabilty of Non-Employment Based Health Insuranceby Hours Worked (single hours), CPS 1994-2003.
-0.05
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
1 8 15 22 29 36 43 50 57 64 71 78 85
Hours Worked
Hawaii
Michigan
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 15
Other Sensitivity Analyses
1) Regression with and without CHAMPUS/TRICARE enrollees
2) Using Hawaii means (vs. US means)
=> Results are qualitatively same.
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 16
The effect of PHCA on the percent covered by employment-based insurance without CHAMPUS/TRICARE: CPS 1994-2003
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
1-5 6-10 11-15 16-19 20 21-25 26-30 31-35 36-39 40+
Hours worked
Per
cen
t in
sure
d
HI
US
NV
MI
CA
FL
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 17
The effect of PHCA on the percent covered by employment-based insurance using Hawaii means: CPS 1994-2003
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
1-5 6-10 11-15 16-19 20 21-25 26-30 31-35 36-39 40+
Hours worked
Per
cen
t in
sure
d
HI
US
NV
MI
CA
FL
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 18
Conclusions: PHCA
1) PHCA has shifted the distribution of employees by hours worked.
2) PHCA has increased the employer-provided health insurance coverage for full-time workers.
3) PHCA has changed the distribution of health insurance by hours worked.
4) Some workers who are unable to find full-time jobs with health insurance might have switched to other types of insurance.
17 September 2004 Preliminary results. Revised September 2004. Subject to further revision. 19
Mahalo!
This research is funded in part by U.S. Department of Health and Human Services
Health Resources & Services Administration State Planning Grant
Hawaii State Department of Health.
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