Association for Public Policy Analysis & Management

Two phases of the Affordable Care Act (ACA) directly effected workers health insurance coverage: the requirement that most U.S. citizens have health insurance coverage on January 1, 2014 (the Individual Shared Responsibility Provision, aka the Individual Mandate) and the requirement for most employers to offer coverage in 2015 (the Employer Shared Responsibility Provision). We examine changes in the type of health insurance coverage for full-time workers by occupation in light of these two provisions of the law. We estimate the effect of the Individual Shared Responsibility Provision from 2013 to 2014 by occupation (using the assumption that employers did not change their offers of health insurance coverage until 2015). Then, we estimate the effect of the Employer Shared Responsibility Provision from 2014 to 2015.

Using the 2014 and 2015 Annual Social and Economic Supplement to the Current Population Survey (CPS), we calculate the offer rate and the take-up rate of insurance coverage for each occupation,  as well as by the type of coverage (we assume that 2014 rates are useful for 2013 and 2014 analysis and the 2015 rates for the 2015 analysis). We impute the CPS information about offer and take-up onto the 2013 through 2015 American Community Survey (ACS) microdata. In addition, we impute the policyholder from the CPS to the ACS.

From these baseline estimates on offer and take-up rates, we use the ACS to measure the impact of changing coverage on working adults. Specifically, we expect working-age adults in low-earning occupations in the 2013 to 2014 period to increase their Medicaid participation and adults in high-earning occupations to continue to be policyholders of Employer Sponsored Insurance (ESI). Within the middle-earning occupations, we expect that both the uninsured rate and the take-up of ESI will go down. In the 2014 to 2015 period, we expect the same patterns.

Further, using ACS we focus on the detailed occupations and repeat the above exercise. Specifically, we will highlight one group for discussion (for example, the Healthcare Practitioners and Technical occupations group category) to take a deep dive into an occupation with a variety of sub-categories.  We will use a regression to determine which occupations are more likely to have Medicaid and less likely to have their own ESI plan in 2014. 

Results. We expect that the regression/s will show Medicaid participation went up because of Medicaid Expansion. We hope to contribute interesting results for the adults in middle-earnings occupations. This abstract builds on work presented at 2016 PAA. 

Policy implications. We expect this to help inform the discussion of how these two phases of the ACA influenced the workforce. Until this stage of the research is complete, we do not know if we are going to find unexpected results.

Key Words.  ACA, Health Insurance, Occupations, American Community Survey, CPS