Small Firm Size and Health Insurance: A Private Enterprise Perspective

Cebula, Richard (2007): Small Firm Size and Health Insurance: A Private Enterprise Perspective. Published in: The Journal of Private Enterprise , Vol. 24, No. 1 (3 June 2008): pp. 51-77.

Abstract

This study has two objectives. First, it proffers and then empirically investigates what is being identified as the "small firm hypothesis," i.e., a hypothesis that the greater the percentage of firms in the U .S. that are "small," the greater the percentage of the population that can be expected to be without health insurance. The study adopts the percentage of private firms with 20 or fewer employees as the measure/ definition of "small firms." The empirical analysis adopts state-level data and finds, after controlling for a variety of other factors, strong empirical support for the small firm hypothesis. Second, with this as the backdrop, this study seeks to critique public policies in the forms of (1) mandated universal health insurance coverage (mandating) and (2) tax-credit incentive policies intended to reduce the percent of the population without health insurance. The study then compares said policies to a private enterprise perspective and finds no compelling evidence of a market failure in the health insurance market. Mandating and tax-credit policies are not only unnecessary but also would create myriad negative economic effects for the economy and jeopardize the private enterprise system.

• Item Type: MPRA Paper
• Language: English
• Keywords: health insurance; small firms hypothesis; mandating policies; tax-credit policies
• Subjects: H - Public Economics > H2 - Taxation, Subsidies, and Revenue > H25 - Business Taxes and Subsidies; H - Public Economics > H3 - Fiscal Policies and Behavior of Economic Agents > H31 - Household; H - Public Economics > H4 - Publicly Provided Goods > H49 - Other; I - Health, Education, and Welfare > I1 - Health > I13 - Health Insurance, Public and Private

References

ACCRA. 2005. The Council for Community and Economic Research. Fairfax, VA: George Mason University Press.

Ali-Saji, A.K. 1993. "Government Budget Deficits, Nominal and Ex Ante Real Long Term Interest Rates in the U.K." Atlantic Economic Journal, 21: 71-77.

Ali, M.M., H.W. Cecil, and J .A. Knoblett. 2001. "The Effects of Tax Rates and Enforcement Policies on Taxpayer Compliance: A Study of Self Employed Taxpayers." Atlantic Economic Journal, 29: 186-202.

Ashby, N.J. 2007. "Economic Freedom and Migration Flows between U.S. States." Southern Economic Journal, 73, 677-697.

Bharmal, M., and J. Thomas. 2005. "Health Insurance Coverage and Health-related Quality of Life: Analysis of 2000 Medical Expenditure Panel Survey Data." Journal of Health Care for the Poor and Underserved, 16: 643-654.

Boskin, M.J. 1987. "Deficits, Public Debt, Interest Rates, and Private Saving: Perspectives and Reflections on the U.S. Experience." International Economics, 45: 158-163.

Burke, M.A., G.M. Fournier, and K. Prasad. 2007. "The Diffusion of a Medical Innovation: Is Success in the Stars?" Southern Economic Journal, 73: 588-603.

Carlson, K.M., and R.W. Spencer. 1975. "Crowding Out and Its Critics." Federal Reserve Bank of St. Louis Review, 60: 1-19.

Cebula, R.J. 1997. "An Empirical Note on the Impact of the Federal Budget Deficit on Ex An the Real Long-Term Interest Rates, 1973-1995." Southern Economic Journal, 73: 1094-1099.

Cebula, R.J. 2006. "A Further Analysis of Determinants of Health Insurance Coverage." International Advances in Economic Research, 12: 1-8.

Cebula, R.J. 1995. "The Impact of Federal Government Budget Deficits on Economic Growth in the United States: An Empirical Investigation,1955-1992."International Review of Economics and Finance, 4: 245-252.

Cebula, R.J. 2005. "Recent Empirical Evidence on the Impact of the Primary Budget Deficit on Nominal Longer Term Treasury Note Interest Rate Yields." Global Business & Economics Review, 17: 47-58.

Cooper, P.F., and B.S. Schone. 1997. "More Offers, Fewer Takers for Employment-Based Health Insurance." Health Affairs, 16, 142-149.

Cutler, D.M. 1994. "A Guide to Health Care Reform." Journal of Economic Perspectives, 8: 13-29.

Cutler, D.M. and J . Gruber . 1996. "Does Public Insurance Crowd Out Private Insurance?" Quarterly Journal of Economics, 111: 391-430.

David, G., and L.A. Helmchen. 2007. "The Choice of Employment Arrangement in the Market for Hospital Services." Southern Economic Journal, 73: 604-622.

Dushi, I., and M. Honig. 2003. "Price and Spouse's Coverage in Employee Demand for Health Insurance." American Economic Review Papers and Proceedings, 93: 252-256.

Ellis, R.P., and T.G. McGuire. 2007. "Predictability and Predictiveness in Health Care Spending." Journal of Health Economics, 26: 25-48.

Frick, K., and Bopp, A. 2005. "Poverty: Insurance Theory and The Medically Uninsured." Atlantic Economic Journal, 33: 271-280.

Fronstin, P., and S.C. Snider. 1996/97. "An Examination of the Decline in Employment-based Health Insurance between 1988 and 1993." Inquiry, 33: 317-325.

Gruber, J. 2003. "Evaluating Alternative Approaches to Incremental Health-Insurance Expansion." American Economic Review Papers and Proceedings, 93: 271-276.

Harris, K.M., and M.P. Keane. 1999. "A Model of Health Plan Choice: Inferring Preferences and Perceptions from a Combination of Revealed Preference and Attitudinal Data." Journal of Econometrics, 89: 131-157.

Holahan, J., L. Nichols, J. Blumberg, and Y.-C. Shen. 2003. "A New Approach to Risk-Spreading via Coverage-Expansion Subsidies." American Economic Review Papers and Proceedings, 69: 277-282.

Kronick, R., and T. Gilmer. 2002. "Insuring Low-income Adults: Does Public Coverage Crowd Out Private?" Health Affairs, 21: 225-39.

Kan, K. 2007. "Cigarette Smoking and Self-Control." Journal of Health Economics, 26: 61-81.

Krueger, A.B. 2003. "Big Federal Deficits, Bigger Risks." The New York Times, March 6, A-10.

Lindrooth, R., G. Bazzoli, and J. Clement. 2007. "The Effect of Reimbursement on the Intensity of Hospital Services." Southern Economic Journal, 73, 575-587.

MacAvoy, P. 2003. "Don't Just Stand There: Treasury Secretary William E. Simon and Fiscal Policy During Stagflation." Atlantic Economic Journal, 31: 231-218.

Moberg, D. 2007. "Universal Health Care for Wisconsin?" http://www.inthesetimes.com/article/3305/universal_health_care_for_wisconsin

Newhouse, J.P. 1994. "Symposium on Health Care Reform." Journal of Economic Perspectives, 8: 3-11.

Nyman, J. 2003. The Theory of Demand for Health Insurance. Stanford, CA: Stanford University Press.

Orcutt, B. 2003. "Expenditure and Deficit Policy: A Retrospective Look at the Simon Agenda." Atlantic Economic Journal, 31: 219-232.

Owings, L. 2007. "Bush's Health Plan: Does It Help You or Hurt You?" http://www.abcnews.go.com/Health/Business/story?id=2817588&page=1

Oxford Analytica. 2007. "States Push 'Universal' Health Insurance." http://www.forbes.com/business/2007/01/23/ universal-health-insurance

Swartz, K. 2001. "Markets for Individual Health Insurance: Can We Make Them Work with Incentives to Purchase Insurance?" Inquiry, 38, 133-145.

Swartz, K. 2003. "Reinsuring Risk to Increase Access to Health Insurance." American Economic Review Papers and Proceedings, 69, 283-287.

Thurston, N. 1997. "An Evaluation of the Impact of Hawaii's Mandatory Employer-provided Health Insurance on the Labor Market." Industrial and Labor Relations Review, 51: 117-135.

Thurston, N.K. 1999. "On the Decline of Employment-based Health Insurance in the U.S." Applied Economics Letters, 6: 683-686.

U.S. Census Bureau. 2008a. http://www.census.gov.

U.S. Census Bureau. 2006. Statistical Abstract of the United States, 2006. Washington, D.C.: U.S. Government Printing Office.

U.S. Census Bureau. 2007. Statistical Abstract of the United States, 2007. Washington, D.C.: U .S. Government Printing Office.

U.S. Census Bureau. 2008b. Statistical Abstract of the United States, 2008. Washington, D.C.: U.S. Government Printing Office.

Wagstaff, A. 2007. "The Economic Consequences of Health Shocks: Evidence from Vietnam." Journal of Health Economics, 26: 82-100.

White, H. 1980. "A Heteroskedasticity-Consistent Covariance Matrix Estimator and a Direct Test for Heteroskedasticity." Econometrica, 48: 817-838.

Wisconsin Policy Research Institute. 2008. "Will Healthy Wisconsin Bust the State Budget?"