Health insurance for workers who lose jobs: Implications for various subsidy schemes

Health Affairs

Volumn 22, Issue 3, 2003, Pages 203-213

  Kapur, Kanika ^a   Marquis, M Susan ^a  

^a RAND CORPORATION   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CLASSIFICATION; ECONOMICS; EMPLOYMENT; EPIDEMIOLOGY; FAMILY SIZE; HEALTH INSURANCE; HUMAN; INCOME; LEGAL ASPECT; ORGANIZATION AND MANAGEMENT; PATIENT; PERSONNEL MANAGEMENT; POVERTY; STATISTICS; UNEMPLOYMENT; UNITED STATES;

ELIGIBILITY DETERMINATION; EMPLOYMENT; FAMILY CHARACTERISTICS; HEALTH CARE SURVEYS; HUMANS; INCOME; INSURANCE, HEALTH; MEDICALLY UNINSURED; PERSONNEL DOWNSIZING; POVERTY; UNEMPLOYMENT; UNITED STATES;

EID: 0037711349     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.22.3.203     Document Type: Article

References (28)

1. S.A. Glied, "Challenges and Options for Increasing the Number of Americans with Health Insurance," Inquiry 38, no. 2 (2001): 90-105
2. J.M. Lambrew, How the Slowing U.S. Economy Threatens Employer-Based Health Insurance, Pub. no. 511 (New York: Commonwealth Fund, November 2001).
3. P. Flynn, "COBRA Qualifying Events and Elections, 1987-1991," Inquiry (Summer 1994): 215-220;
4. and M.C. Berger et al., "Health Insurance Coverage of the Unemployed: COBRA and the Potential Effects of Kassebaum-Kennedy," Journal of Policy Analysis and Management 18, no. 3 (1999): 430-448.
5. G. Scandlen, Helping Laid-Off Workers Keep Insurance, Brief Analysis no. 373 (Washington: National Center for Policy Analysis, 4 October 2001);
6. and Lambrew, How the Slowing U.S. Economy Threatens Employer-Based Health Insurance
7. J. Gruber, "Transitional Subsidies for Health Insurance Coverage," Inquiry (Summer 2001): 225-231.
8. See S. Dorn and J.A. Meyer, What Health Coverage Would Laid-Off Workers Obtain under Recent Tax Credit Proposals? (Washington: Economic and Social Research Institute, March 2002).
9. S. Zuckerman, J. Haley, and M. Fragale, Could Subsidizing COBRA Health Insurance Coverage Help Most Low-Income Unemployed? Health Policy Online, no. 2, 17 October 2001, www.urban.org/UploadedPDF/410351_HPOnline_2.pdf (11 March 2003);
10. and L. Duchon et al., Security Matters: How Instability in Health Insurance Puts U.S. Workers at Risk (New York: Commonwealth Fund, December 2001).
11. J.A. Klerman, J.L. Buchanan, and A. Leibowitz, "Labor Turnover and Health Insurance," in Health Benefits and the Workforce (Washington: U.S. Department of Labor, Pension and Welfare Benefits Administration, 1992), 43-54.
12. A. Monheit et al., "Health Insurance for the Unemployed: Is Federal Legislation Needed?" Health Affairs (Spring 1984): 101-111.
13. The Survey of Income and Program Participation (SIPP) is another panel data set that tracks changes in insurance. However, it does not explicitly identify COBRA coverage, so we chose to use MEPS.
14. If a person had more than one job turnover, we examined insurance status following the first job loss.
15. Other reasons given for leaving a job include retired, quit, took unpaid leave, or had illness or injury.
16. We compared the insurance status in the initial month following the job loss for the full sample and these two subsamples to ensure that the patterns were similar and that the change in status we report between the initial month and these later months was not attributable to sample differences.
17. These are based on self-reports of type of coverage. We define COBRA eligibility as holding a job with insurance from a firm with twenty or more employees. A categorical measure for firm size, which groups firms with ten to twenty-five employees in a single category, was used when the continuous measure for firm size was missing. In this case, COBRA eligibility was identified for those with jobs with insurance in firms with more than twenty-five workers. If a person has COBRA coverage and non-COBRA employer coverage from the same employer in the same round, it is not possible to distinguish these two types of coverage in the MEPS data. Therefore, we use the reported job end date to determine the start of COBRA coverage.
18. If the worker reported having coverage from an employer in the month after leaving a job but did not report COBRA coverage in the month, we assume that the employer continued to subsidize the insurance. Workers on temporary layoff are dropped from the analysis.
19. We use the CPS for both years of the contrast, rather than the 1996 MEPS data, to have consistent definitions over time. We defined job leavers in the CPS as all people who were not working but had worked in the past month, and those who had changed jobs within the past month. Involuntary job leavers are those reporting that the reason for unemployment was loss of a job or the end of a temporary job.
20. This is similar to the 8 percent figure for 1977. Monheit et al., "Health Insurance for the Unemployed."
21. In some cases, this is a new job; in others, it is a previously held second job.
22. We calculated uninsurance rates for twelve and eighteen months after job loss by linking the 1996 and 1997 MEPS data. The 1997 MEPS data do not contain information on COBRA.
23. Family income is measured as total income for 1996, so it does not necessarily reflect the family circumstances after the job loss.
24. This estimate is based on the number of people under age sixty-five who reported a lost job in the month preceding the February 2002 CPS. The estimate does not include those who left a job voluntarily. It may also overcount the number of people displaced because we counted lost jobs in a month and multiplied them by 12; that is, we did not correct for multiple job losses. If COBRA subsidies were available to all job leavers including voluntary terminations, the number eligible for the subsidy would increase to 10.6 million.
25. The samples of low-income and involuntary job loss COBRA participants were too small to allow reliable estimates of COBRA durations for these groups.
26. J.R. Baumgardner, "Providing Health Insurance to the Short-Term Unemployed," Inquiry 35, no. 3 (1998): 266-279.
27. Gruber, "Transitional Subsidies."
28. Baumgardner, "Providing Health Insurance to the Short-Term Unemployed."