Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

For the non-elderly population, health insurance is most often obtained through an employer source. However, in the United States a significant proportion of workers do not have access to either employer-sponsored insurance (ESI) or other fringe benefits, including retirement plans, paid sick leave, or paid vacation. Workers who do not have access to these benefits are significantly more likely to be low-income and/or employed at small firms. For these workers, lack of health insurance may adversely affect their ability to access medical care for themselves and their families.

The first two papers in the abstract-driven session provide comprehensive analyses of the set of worker and family characteristics that influence access to ESI and other fringe benefits. The Perry et al. paper focuses on measuring differences in access and utilization of these benefits by low-income families over time, while the Abraham et al. explores how employer size affects the provision of ESI and other benefits. The latter additionally utilizes a difference-in-difference estimation strategy to examine the relative importance of insurance market failures, administrative costs, and worker demand for understanding the gap in ESI offers by firm size.

Several different types of public policies are being proposed to increase access to health insurance for vulnerable populations, including premium subsidies and tax credits. The third paper in the session (Woodbury and Cebi) examines the potential impact of a tax credit on coverage. In particular, the authors estimate a model to measure whether and to what extent the availability of a health insurance tax credit offered under the Omnibus Budget Reconciliation Act of 1990 influenced private health insurance coverage of low-income single women with children.