A growing fraction of U.S. workers face a dual system of medical insurance, with
generous coverage through the Workers’ Compensation system for work-related injuries, but
limited or non-existent coverage for off-the-job illnesses or injuries. Uninsured and under-
insured workers have an economic incentive to report off-the-job injuries as work accidents.
Many analysts have interpreted the high rate of Monday injuries -- especially for hard-to-detect
injuries like back sprains -- as evidence of this incentive. We combine administrative data on
workplace injury claims with Current Population Survey data on medical insurance coverage to
compute the fraction of Monday injury claims for workers who are more and less likely to have
medical insurance. We find that workers with lower medical coverage rates are no more likely
to report a Monday injury than other workers.
health insurance
This paper provides several observations on the impact of employment-based
government mandates on job characteristics, wages, and employment. Special attention is
devoted to evaluating the effects of mandated health insurance because health care is the largest
government mandate potentially on the horizon. In some situations, mandates may be useful
to solve adverse selection problems, and to compel firms to internalize the social costs, of
production. Moreover, in a world with pre-existing distortions, mandates may reduce other inefficiencies. However, it is concluded that in many situations the optimal way for a
government to assure that services are provided is probably not through employment-based
mandates. In many situations, mandates are utilized because alternative schemes are politically
infeasible. Nevertheless, since the labor supply curve is widely believed to be fairly inelastic,
in the long run employers’ costs of meeting government mandates are likely to be shifted to
employees in the form of lower wages. Cost shifting to employees is expected to moderate
the reduction in jobs due to government mandates.
Federal legislation passed in the late 1980s greatly expanded the potential coverage of the Medicaid
program to include children in families with incomes at and slightly above the poverty threshold,
including families with two parents and working parents. Prior to these expansions, the
distribution of health insurance coverage in the population of children was distinctly U-shaped,
with children in the second and third income deciles having the lowest levels of coverage. In this
paper I evaluate the impact of the expansions on the distribution of coverage both by income class
and by region. I find that the expansions served to reduce the variation in insurance coverage,
raising coverage levels substantially for low-income children and children in historically low-
coverage regions. Using the fact that the impact of the legislation varied regionally and by income
decile, I explore whether the fall in private coverage that occurred in the late 1980s and early
1990s could be attributed to the expansions. I conclude that the decline in private coverage was
unlikely to have arisen as a result of the expansions.
This paper investigates the impact of plant closings and permanent layoffs on the
group health insurance coverage for a random sample of workers displaced from
1979-1988. Using data from the 198A, 1986 and 1988 CPS Displaced Worker Surveys
and the March 1989 CPS, I find displaced workers that were re—employed at the
time of the surveys were significantly less likely to have health insurance on
their new job. For all married displaced workers I estimate the overall
probability of HI coverage declined l9 percentage points from .88 to .69. The
probability a married white male lggg health insurance after displacement was
.20. For single displaced workers the probability of health insurance coverage
declined 25 percent from .64 to .48. Single white male workers that had HI
benefits on their displaced job had a .38 probability of losing these benefits
after displacement. Comparable effects were found for females. Less educated
workers and minorities were more likely to lose coverage than white and college
educated workers. I find no evidence that workers who lost health insurance
benefits received higher wages on their new jobs to compensate for the loss. In
fact, a displaced worker that lost health benefits suffered a greater wage loss
than a comparable worker who gained health benefits.