How Do Employers React to A Pay-or-Play Mandate? Early Evidence from San Francisco
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.
We acknowledge funding support from the Robert Wood Johnson Foundation, the University of California Labor and Employment Research Fund, and the California Program on Access to Care. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.
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