Health Insurance and Labor Markets

by Donald Marron

Tuesday, July 14, 2009 at 12:09 AM EDT

Health insurance is not just a health issue. It’s also a jobs issue. Why? Because about 60% of non-elderly Americans get their health insurance through an employer or a labor union. As a result, health insurance and employment are closely related.

As lawmakers consider changes to our system of health insurance, they should therefore keep an eye on the potential implications for jobs and wages. To help them do so, the Congressional Budget Office yesterday released a very helpful brief (see also the accompanying blog entry) that discusses many of the linkages between health insurance and the labor market.

Among other things, CBO reiterates a point I’ve made previously: that the costs of health insurance are ultimately born by workers through lower wages and salaries:

Although employers directly pay most of the costs of their workers’ health insurance, the available evidence indicates that active workers—as a group—ultimately bear those costs. Employers’ payments for health insurance are one form of compensation, along with wages, pension contributions, and other benefits. Firms decide how much labor to employ on the basis of the total cost of compensation and choose the composition of that compensation on the basis of what their workers generally prefer. Employers who offer to pay for health insurance thus pay less in wages and other forms of compensation than they otherwise would, keeping total compensation about the same.

CBO then goes on to discuss a range of potential policies, including ones that would impose new costs on employers. Such policies might require employers to provide health insurance to their workers (an employer mandate), for example, or might levy a fee on employers who don’t provide health insurance (play or pay). CBO concludes that, consistent with the argument above, employers would generally pass the costs of such measures on to their employees through lower wages and salaries. Such adjustments won’t happen instantly, so there may be some short-term effect on employment, but over time the cost will primarily be born by workers through lower compensation.

One exception, however, would be workers who currently earn low wages. As noted on the blog:

Requiring employers to offer health insurance—or pay a fee if they do not—is likely to reduce employment, although the effect would probably be small. Those who would most likely be affected are currently paid close to or at the minimum wage. They would be more vulnerable to job loss because their wages could not be lowered sufficiently to absorb the cost of health insurance (if their firm decides to offer) or the fee (if their firm does not) without bumping into the minimum wage.

Proposals that imposed surcharges on employers whose workers received subsidies directly from the government could have a larger impact on employment. (Such provisions are sometimes known as free-rider surcharges.) Many of the affected workers would be paid low wages that could not easily adjust to absorb the full cost.