The Role of the Safety Net in Employer Health Benefit Decisions

Published in: Medical Care Research and Review, v. 62, no. 4, Aug. 2005, p. 435-457

Posted on RAND.org on December 31, 2004

by M. Susan Marquis

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The potential for sizable crowd-out of private expenditures by public insurance and delivery programs has been demonstrated. However, there is limited evidence about whether this stems from decisions of employers about their health benefit package or by decisions of workers. This study focuses on the role of public programs on employer decisions to offer insurance and the amount the employer contributes to the premium, using data from a large survey of employers and a database describing community characteristics. The study finds that both public insurance and public delivery programs have a significant effect on employer decisions, but the magnitude of the effect is small. Policies to limit crowd-out should focus on incentives to make continued private insurance purchase attractive to workers rather than incentives to employers.

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