How Do Employers React to A Pay-or-Play Mandate? Early Evidence from San Francisco

Carrie Hoverman Colla, William H. Dow, Arindrajit Dube

NBER Working Paper No. 16179
Issued in July 2010
NBER Program(s):Health Care, Health Economics

In 2006 San Francisco adopted major health reform, becoming the first city to implement a pay-or-play employer health spending mandate. It also created Healthy San Francisco, a "public option" to promote affordable universal access to care. Using the 2008 Bay Area Employer Health Benefits Survey, we find that most employers (75%) had to increase health spending to comply with the law, yet most (64%) are supportive of the law. There is substantial employer demand for the public option, with 21% of firms using Healthy San Francisco for at least some employees, yet there is little evidence of firms dropping existing insurance offerings in the first year after implementation.

download in pdf format
   (270 K)

email paper

The NBER Bulletin on Aging and Health provides summaries of publications like this.  You can sign up to receive the NBER Bulletin on Aging and Health by email.

Machine-readable bibliographic record - MARC, RIS, BibTeX

Document Object Identifier (DOI): 10.3386/w16179

Published: Carrie H. Colla & William H. Dow & Arindrajit Dube, 2011. "How Do Employers React to a Pay-or-Play Mandate? Early Evidence from San Francisco," Forum for Health Economics & Policy, Berkeley Electronic Press, vol. 14(2), pages 4. citation courtesy of

Users who downloaded this paper also downloaded* these:
Colla, Dow, and Dube w17198 The Labor Market Impact of Employer Health Benefit Mandates: Evidence from San Francisco's Health Care Security Ordinance
Harada, Ito, and Takahashi w16182 Is the Distance to Default a Good Measure in Predicting Bank Failures? Case Studies
Ellul and Yerramilli w16178 Stronger Risk Controls, Lower Risk: Evidence from U.S. Bank Holding Companies
Gaynor, Moreno-Serra, and Propper w16164 Death by Market Power: Reform, Competition and Patient Outcomes in the National Health Service
Marshall, McGarry, and Skinner w16170 The Risk of Out-of-Pocket Health Care Expenditure at End of Life
NBER Videos

National Bureau of Economic Research, 1050 Massachusetts Ave., Cambridge, MA 02138; 617-868-3900; email:

Contact Us