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Impact of health plan reforms in Washington on employment decisions

  • Norma B. Coe (a1)


The State of Washington, as part of a State Innovation Model (SIM) grant, is changing the payment model within state employee health insurance plans. The system is moving away from traditional fee-for-service reimbursement to value-based payment, through insurance design (the creation of accountable care network insurance products) and bundled payment strategies. New plans were rolled out January 2016 (enrollment occurred in late 2015), with the stated goal of getting 80% of state employees covered by plans that contain value-based purchasing within the next 5 years. The goal of payment reform is to improve member experience, member health, and cut costs. However, changing health insurance during employment can directly and indirectly change labor market outcomes. Decreasing costs of insurance could lead people to remain in the state-employment sector longer. However, it could also influence retirement timing, through changing the relative costs of insurance and through improving health.

This paper examines who switches to value-based insurance, where the insurance explicitly decreases premiums without changing out-of-pocket costs. We find that the peak age for switching insurance plans is 35–45, even among the subsample of individuals who would not need to change their usual sources of care. Second, we look at the labor market activity – both leaving the state-employee sector and retiring from state-employment – and find that younger workers with value-based insurance plans are less likely to leave state employment. Further, we find evidence of value-based insurance, available at a reduced cost to both employees and retirees, leads to a shifting downward in the distribution of retirement age. While these findings support the existence of both the price and income effects, the effect sizes are rather small.


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Blau, DM and Gilleskie, DB (2006) Health insurance and retirement of married couples. Journal of Applied Econometrics 21, 935953.
Blau, DM and Gilleskie, DB (2008) The role of retiree health insurance in the employment behavior of older men. International Economic Review 49, 475514.
Boyle, MA and Lahey, JN (2010) Health insurance and the labor supply decisions of older workers: evidence from a US Department of Veterans Affairs expansion. Journal of Public Economics 94, 467478.
Centers for Medicare & Medicaid Services (2014) State Innovation Models Initiative Round Two [accessed on June 30, 2018]. Available at
Choudhry, NK, Fischer, MA, Avorn, J, Schneeweiss, S, Solomon, DH, Berman, C, Jan, S, Liu, J, Lii, J, Brookhart, MA, Mahoney, JJ and Shrank, WH (2010) At Pitney Bowes, value-based insurance design cut copayments and increased drug adherence. Health Affairs (Millwood) 29, 19952001.
Choudhry, NK, Avorn, J, Glynn, RJ, Antman, EM, Schneeweiss, S, Toscano, M, Reisman, L, Fernandes, J, Spettell, C, Lee, JL, Levin, R, Brennan, T and Shrank, WH (2011) Full coverage for preventive medications after myocardial infarction. N Engl J Medicine 365, 20882089.
Cid, C, Ellis, RP, Vargas, V, Wasem, J and Prieto, L (2016) Global risk-adjusted payment models. In Scheffler, RM (ed.), World Scientific Handbook of Global Health Economics and Public Policy, vol. 1. New Jersey: World Scientific, pp. 2026.
Fisher, ES, Shortell, SM, Kreindler, SA, Van Citters, AD and Larson, BK (2012) A framework for evaluating the formation, implementation, and performance of accountable care organizations. Health Affairs 31, 23682378.
Fitzpatrick, MD (2014) Retiree health insurance for public school employees: does it affect retirement? Journal of Health Economics 38, 8898.
Fronstin, P and Roebuck, MC. Health Plan Switching: A Case Study—Implications for Private- and Public-Health-Insurance Exchanges and Increased Health Plan Choice, EBRI Issue Brief, no. 432, (Employee Benefit Research Institute, March 23, 2017).
Gibson, TB, Mahoney, J, Ranghell, K, Cherney, BJ and McElwee, N (2011) Value-based insurance plus disease management increased medication use and produced savings. Health Affairs (Millwood) 30, 100108.
Gruber, J and Madrian, BC (2001) Health insurance, labor supply, and job mobility: A critical review of the literature, presented at the Research Agenda Setting Conference, University of Michigan, July 8–10, 2001.
Health Care Authority (2015) PEBB Enrollment Report for January 2015 Coverage. Accessed 7/31/2018.
Health Care Authority (2016 a) How UMP Plus Compares to UMP Classic. Accessed 7/31/2018.
Health Care Authority (2016 b) What's Changing for UMP in 2016? accessed 7/31/2018.
Health Care Authority (2018) Public Employees Benefits Board Retreat. accessed 9/24/2018.
Johnson, RW, Davidoff, AJ and Perese, K (2003) Health insurance costs and early retirement decisions. ILR Review 56, 716729.
Kaufman, BG, Spivack, BS, Stearns, SC, Song, PH and O'Brien, EC (2017) Impact of accountable care organizations on utilization, care, and outcomes: a systematic review. Medical Care Research and Review.
Madrian, BC (2005) The U.S. health care system and labor markets. Conference Series; [Proceedings], Federal Reserve Bank of Boston 50, 137163.
McClellan, M, Udayakumar, K, Thoumi, A, Gonzalez-Smith, J, Kadakia, K, Kurek, N, Abdulmalik, M and Darzi, AW (2017) Improving care and lowering costs: evidence and lessons from a global analysis of accountable care reforms. Health Affairs 36, 19201927.
Newhouse, JP, Price, M, Huang, J, McWilliams, JM and Hsu, J (2012) Steps to Reduce Favorable Risk Selection in Medicare Advantage largely succeeded, boding well for health insurance exchanges. Health Affairs 12, 26182628.
Nyce, S, Schieber, SJ, Shoven, JB, Slavov, SN and Wise, DA (2013) Does retiree health insurance encourage early retirement? Journal of Public Economics 104, 4051.
Rajkumar, R, Conway, PH and Tavenner, M (2014) CMS — engaging multiple payers in payment reform. JAMA 311, 19671968.
Rogowski, J and Karoly, L (2000) Health insurance and retirement behavior: evidence from the health and retirement survey. Journal of Health Economics 19, 529539.
Shoven, JB and Slavov, SN (2014) The role of retiree health insurance in the early retirement of public sector employees. Journal of Health Economics 38, 99108.
Shrank, W (2013) The center for medicare and medicaid innovation's blueprint for rapid-cycle evaluation of new care and payment models. Health Affairs 32, 807812.
Wertz, D, Hou, L, DeVries, A, Dupclay, L, McGowan, F, Malinowski, B, et al. (2012) Clinical and economic outcomes of the Cincinnati Pharmacy Coaching Program for diabetes and hypertension. Managed Care (Langhorne, PA) 21, 4454.


Impact of health plan reforms in Washington on employment decisions

  • Norma B. Coe (a1)


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