The primary goals of food assistance programs are to alleviate child hunger and reduce food insecurity; if successful, such programs may have the added benefit of improving child academic outcomes (e.g., test scores, attendance, behavioral outcomes). Some U.S. government programs serve children in the home, such as the Supplemental Nutritional Assistance Program (SNAP), others serve them at school, such as the National School Lunch Program (NSLP) and School Breakfast Program (SBP), and still others fall in-between, such as the Summer Food Service Program (SFSP) and the Child and Adult Care Food Program (CACFP). Most empirical research seeking to identify the causal effect of such programs on child academic outcomes addresses the endogeneity of program participation with a reduced form, intent-to-treat approach. Specifically, such studies estimate the effect of a program’s availability, timing, or other specific feature on the academic outcomes of all potentially affected children. While findings of individual studies and interventions are mixed, some general conclusions emerge. First, increasing the availability of these programs typically has beneficial effects on relatively contemporaneous academic and behavioral outcomes. The magnitudes are modest but still likely pass cost-benefit criteria, even ignoring the fact that the primary objective of such programs is alleviating hunger, not improving academic outcomes. Less is known about the dynamics of the effects, for example, whether such effects are temporary boosts that dissipate or instead accumulate and grow over time. Likewise, the effects of recent innovations to these programs, such as breakfast in the classroom or increases in SNAP benefits to compensate for reduced time in school during the pandemic, yield less clear conclusions (the former) and/or have not been studied (the latter). Finally, many smaller programs that likely target the neediest children remain under- or un-examined. Unstudied government-provided programs include SFSP and CACFP. There are also a growing number of understudied programs provided primarily by charitable organizations. Emerging evidence suggests that one such program, Weekend Feeding or “Backpack” programs, confers substantial benefits. There, too, more work needs to be done, both to confirm these early findings and to explore recent innovations such as providing food pantries or “Kids’ Cafés” on school grounds. Especially in light of the uncertain fate of many pandemic-related program expansions and innovations, current empirical evidence establishes that the additional, beneficial spillover effects to academic outcomes—beyond the primary objective of alleviating food insecurity—deserve to be considered as well.
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Article
The Academic Effects of United States Child Food Assistance Programs—At Home, School, and In-Between
Michael D. Kurtz, Karen Smith Conway, and Robert D. Mohr
Article
Aging and Healthcare Costs
Martin Karlsson, Tor Iversen, and Henning Øien
An open issue in the economics literature is whether healthcare expenditure (HCE) is so concentrated in the last years before death that the age profiles in spending will change when longevity increases. The seminal article “aging of Population and HealthCare Expenditure: A Red Herring?” by Zweifel and colleagues argued that that age is a distraction in explaining growth in HCE. The argument was based on the observation that age did not predict HCE after controlling for time to death (TTD). The authors were soon criticized for the use of a Heckman selection model in this context. Most of the recent literature makes use of variants of a two-part model and seems to give some role to age as well in the explanation. Age seems to matter more for long-term care expenditures (LTCE) than for acute hospital care. When disability is accounted for, the effects of age and TTD diminish. Not many articles validate their approach by comparing properties of different estimation models. In order to evaluate popular models used in the literature and to gain an understanding of the divergent results of previous studies, an empirical analysis based on a claims data set from Germany is conducted. This analysis generates a number of useful insights. There is a significant age gradient in HCE, most for LTCE, and costs of dying are substantial. These “costs of dying” have, however, a limited impact on the age gradient in HCE. These findings are interpreted as evidence against the red herring hypothesis as initially stated. The results indicate that the choice of estimation method makes little difference and if they differ, ordinary least squares regression tends to perform better than the alternatives. When validating the methods out of sample and out of period, there is no evidence that including TTD leads to better predictions of aggregate future HCE. It appears that the literature might benefit from focusing on the predictive power of the estimators instead of their actual fit to the data within the sample.
Article
Anthropometrics: The Intersection of Economics and Human Biology
John Komlos
Anthropometrics is a research program that explores the extent to which economic processes affect human biological processes using height and weight as markers. This agenda differs from health economics in the sense that instead of studying diseases or longevity, macro manifestations of well-being, it focuses on cellular-level processes that determine the extent to which the organism thrives in its socio-economic and epidemiological environment. Thus, anthropometric indicators are used as a proxy measure for the biological standard of living as complements to conventional measures based on monetary units.
Using physical stature as a marker, we enabled the profession to learn about the well-being of children and youth for whom market-generated monetary data are not abundant even in contemporary societies. It is now clear that economic transformations such as the onset of the Industrial Revolution and modern economic growth were accompanied by negative externalities that were hitherto unknown. Moreover, there is plenty of evidence to indicate that the Welfare States of Western and Northern Europe take better care of the biological needs of their citizens than the market-oriented health-care system of the United States.
Obesity has reached pandemic proportions in the United States affecting 40% of the population. It is fostered by a sedentary and harried lifestyle, by the diminution in self-control, the spread of labor-saving technologies, and the rise of instant gratification characteristic of post-industrial society. The spread of television and a fast-food culture in the 1950s were watershed developments in this regard that accelerated the process. Obesity poses a serious health risk including heart disease, stroke, diabetes, and some types of cancer and its cost reaches $150 billion per annum in the United States or about $1,400 per capita. We conclude that the economy influences not only mortality and health but reaches bone-deep into the cellular level of the human organism. In other words, the economy is inextricably intertwined with human biological processes.
Article
Business Cycles and Apprenticeships
Samuel Muehlemann and Stefan Wolter
The economic reasons why firms engage in apprenticeship training are twofold. First, apprenticeship training is a potentially cost-effective strategy for filling a firm’s future vacancies, particularly if skilled labor on the external labor market is scarce. Second, apprentices can be cost-effective substitutes for other types of labor in the current production process. As current and expected business and labor market conditions determine a firm’s expected work volume and thus its future demand for skilled labor, they are potentially important drivers of a firm’s training decisions.
Empirical studies have found that the business cycle affects apprenticeship markets. However, while the economic magnitude of these effects is moderate on average, there is substantial heterogeneity across countries, even among those that at first sight seem very similar in terms of their apprenticeship systems. Moreover, identification of business cycle effects is a difficult task. First, statistics on apprenticeship markets are often less developed than labor market statistics, making empirical analyses of demand and supply impossible in many cases. In particular, data about unfilled apprenticeship vacancies and unsuccessful applicants are paramount for assessing potential market failures and analyzing the extent to which business cycle fluctuations may amplify imbalances in apprenticeship markets. Second, the intensity of business cycle effects on apprenticeship markets is not completely exogenous, as governments typically undertake a variety of measures, which differ across countries and may change over time, to reduce the adverse effects of economic downturns on apprenticeship markets. During the economic crisis related to the COVID-19 global pandemic, many countries took unprecedented actions to support their economies in general and reacted swiftly to introduce measures such as the provision of financial subsidies for training firms or the establishment of apprenticeship task forces. As statistics on apprenticeship markets improve over time, such heterogeneity in policy measures should be exploited to improve our understanding of the business cycle and its relationship with apprenticeships.
Article
The Early Origins of the Civil Rights Movement in the United States: An Analysis of the Growth of the NAACP
Daniel Aaronson, Jala Abner, Mark Borgschulte, and Bhashkar Mazumder
A newly digitized panel of county-level branch activity of the National Association for the Advancement of Colored People (NAACP) is used to describe the potential factors underlying the expansion of political participation in the American South, with a particular emphasis on the short period from the late 1930s through the 1940s. This period has long been recognized for its significant progress in reducing sizable racial gaps in labor market outcomes. But little work in economics has considered the role of political participation in shaping that progress. As the preeminent civil rights organization prior to the 1950s, the NAACP provides a natural lens in which to explore the expansion in political activism during this crucial period. Associative evidence suggests that a few potential channels could be especially worthy of future study, including the role of demographics, increased human capital, expansion in labor demand driven by wartime efforts, reduction in racial violence, latent political activism, and expansions in political and social networks, all of which have been highlighted in a variety of history and social science literatures. However, careful causal empirical work does not currently exist on these factors. Filling in this hole is important for providing compelling evidence on the origins of the 20th century’s most important U.S. political movement, as well as adding to a growing literature in political economy and development economics which examines the role that grassroots activism has played on economic growth and income inequality around the world.
Article
The Economic Effect of Vocational Education on Student Outcomes
Shaun M. Dougherty and Walter G. Ecton
As long as formal education has existed, there has been a clear connection between education and preparation for employment. In much of the world, formal educational systems have come to include vocational education and training (VET) as part of secondary education. In these spaces, individuals can receive continued training in general skills related to reading, writing, and mathematics while also pursuing specific skills in prescribed vocational or technical programs (e.g., skilled trades, culinary arts, information technology, health services). Across all countries and associated educational systems, a tension exists between whether to invest educational dollars in general versus specific skill development. On the one hand, general skills allow for transferability and likely support adaptability across workplace settings and in response to changes in employment conditions. On the other hand, secondary school completion is not universal, even in rich countries, and there are often large penalties or social costs to not completing secondary education. Furthermore, across countries of varying GDP levels, the question about how to best prepare individuals for entry into and success in the workforce is a persistent one. Evidence suggests that the payoff to investments in VET vary considerably, and that context and the characteristics of participants likely inform the expected returns to such investments. For instance, there is strong evidence across contexts that male participants in VET are likely to benefit in the short- to medium-term with respect to employment and earnings, and possibly also engage in less crime. Unresolved, however, is whether these payoffs persist in the longer term. In contrast, for women the estimated returns appear to be more context dependent. Some research shows reduced fertility and greater financial independence of women participating in VET programs in less-developed countries, but evidence is mixed in other settings. All evidence underscores that the payoff to VET is likely tied to the extent to which it adapts to contemporary economic needs, including extending the amount of total formal education that participants might otherwise receive.
Article
Economics and Genetics
Jason M. Fletcher
Two interrelated advances in genetics have occurred which have ushered in the growing field of genoeconomics. The first is a rapid expansion of so-called big data featuring genetic information collected from large population–based samples. The second is enhancements to computational and predictive power to aggregate small genetic effects across the genome into single summary measures called polygenic scores (PGSs). Together, these advances will be incorporated broadly with economic research, with strong possibilities for new insights and methodological techniques.
Article
The Economics of Abortion Policy
Damian Clarke
The economic literature on abortion policy broadly is broad, studying abortion reforms that have occurred over the past two centuries, with a concentration of studies examining policy reform over the 20th and 21st centuries. The literature has examined a range of policies: both those which restrict access and those which legalize elective abortion; but within these two broad classes, the precise nature of policy reform can vary greatly. Policy reforms studied range from specific types of limits or financial barriers restricting access for particular age groups to policies which entirely criminalize or legalize elective abortion. Policies have been studied that restrict or relax individual access as well as impose regulations on abortion providers. The economic literature on abortion reform has illuminated a number of clear links, showing that increased availability of abortion decreases rates of unintended births, and vice versa when access to abortion is limited. These effects have been shown to have downstream impacts in many domains such as family formation, educational attainment, and labor market attachment, as well as impacts on health, empowerment, and broader measures of well-being such as life satisfaction and exposure to intimate partner violence.
There is mixed evidence when examining the impact that abortion reform has on cohorts of children exposed to reform variation. Across contexts abortion reforms have been shown to affect the composition of cohorts of children via differential rates of access to abortion, though this compositional effect is context-dependent, and as such a number of different patterns have been documented. Compositional effects of policies often also have been shown to have a geographic component, given that certain types of individuals are more easily able to travel to access abortion where restrictions are in place in one area but not in another.
Much of what is known in the economic literature on abortion is gleaned from country-level case studies and cohort variation in access, with this evidence generated from a relatively small number of countries in which reforms have occurred and data is available. In general, much of the literature available covers low fertility and industrialized settings. Additional evidence from other settings would allow for a broader understanding of how abortion reform affects well-being.
Article
The Economics of Families and Health
Susan Averett and Jennifer Kohn
An individual’s health is produced in large part by family investments that start before birth and continue to the end of life. The health of an individual is intertwined with practically every economic decision including education, marriage, fertility, labor market, and investments. These outcomes in turn affect income and wealth and hence have implications for intergenerational transfer of economic advantage or disadvantage. A rich body of theoretical and empirical work considers the role of the family in health production over the life cycle and the role of health in household economic decisions. This literature starts by considering family inputs regarding health at birth, then moves through adolescence and midlife, where relationship decisions affect health. After midlife, health, particularly the health of family members, becomes an input into retirement and investment decisions. The literature on family and health showcases economists’ skills in modeling complex family dynamics, deriving theoretical predictions, and using clever econometric strategies to identify causal effects.
Article
The Economics of Informal Care
Courtney Van Houtven, Fiona Carmichael, Josephine Jacobs, and Peter C. Coyte
Across the globe, the most common means of supporting older disabled adults in their homes is through “informal care.” An informal carer is a family member or friend, including children or adults, who help another person because of their illness, frailty, or disability. There is a rich economics literature on the direct benefits of caregiving, including allowing the care recipient to remain at home for longer than if there was no informal care provided. There is also a growing literature outlining the associated costs of care provision. Although informal care helps individuals with disabilities to remain at home and is rewarding to many carers, there are often negative effects such as depression and lost labor market earnings that may offset some of these rewards. Economists have taken several approaches to quantify the net societal benefit of informal care that consider the degree of choice in caregiving decisions and all direct and indirect benefits and costs of informal care.
Article
Education and Social Mobility
Helena Holmlund and Martin Nybom
Family background is a strong determinant of an individual’s educational achievement and labor market success. Using an economics framework, intergenerational persistence in socioeconomic status can be explained by a variety of factors, including parental investment behavior, credit constraints, and the degree of inequality in society. Genetic transmission from parents to children may also play a role. In addition, the skill formation process is governed by dynamics between different stages of a child’s life, such as complementarities between early and late investments or between informal and formal education.
Education policy holds the promise of breaking the strong ties between family background and socioeconomic position by providing publicly accessible education for children of all backgrounds. However, the education system may also perpetuate social inequalities if well-off families are able to protect their children from downward mobility by, for example, moving to neighborhoods with high-quality schools and by providing networks that offer opportunities to succeed.
However, a growing number of studies show that educational interventions can have long-lasting effects on students’ outcomes, in particular for disadvantaged students, and that they can be cost-effective. For example, reducing class size, increasing general education spending, tutoring, and improving teacher quality are policy levers that are shown to be successful in this regard. Shifting from selective to comprehensive school systems is also a policy that enhances equality of opportunity. While the evidence on credit constraints and their role for access to higher education is evolving, but still mostly U.S. focused and largely inconclusive, it is a key domain for shaping social mobility given the life-changing impacts that a university degree can have.
Article
The Effect of Immigration on Education
Giorgio Brunello
Does a higher share of immigrants affect the school performance of both immigrants and natives? Do desegregation policies improve efficiency? The existing evidence suggests that a higher share of immigrants has a negative (and often sizable) effect on the school performance of immigrants and a negative but probably small effect on the performance of natives. When average school performance is considered, this asymmetry generates concave peer effects, a key condition for the efficiency of desegregating policies. The broad message from the empirical literature is that these policies are not only equitable, in that they provide better opportunities to individuals with relatively low parental background, but also efficient.
Article
The Effects of Parental Job Loss on Children’s Outcomes
Jenifer Ruiz-Valenzuela
Severe economic downturns are typically characterized by a high incidence of job losses. The available evidence suggests that job losers suffer short-run earning losses that persist in the long run, are more likely to remain unemployed, suffer negative health impacts, and experience an increased likelihood of divorce. Job losses have therefore the potential to generate spillover effects for other members of the household, including children. This comes about because most of the negative consequences of job loss have a direct effect on variables that enter both the production function of cognitive achievement and the health production function.
Workers who lose their jobs are likely different from those who remain employed in ways that are unobserved to the researcher and that might, in turn, affect child outcomes. Omitted variable bias poses a challenge to obtaining causal estimates of parental job loss. The way the literature has tried to approximate the ideal experiment has mainly depended on whether the child outcome under analysis could be observed both before and after the shock (i.e., both before and after parental job loss), normally relying on job losses coming from plant closures or downsizes and/or individual fixed effects. A survey of the literature shows that father’s job losses seem to have a detrimental impact on outcomes measuring children’s health and school performance. The impact of mother’s job losses on these same outcomes is mixed (including negative, null, and positive impacts). The impact on more long-term outcomes is less clear, with very mixed findings when it comes to the effect of parental job loss on college enrollment, and small impacts on earnings. In many studies, though, average effects mask important differences across subgroups: the negative impact of parental job loss seems to be mostly concentrated on disadvantaged households.
Article
Explaining the Mathematics Gender Gap: The Role of Stereotypes
Pilar Cuevas Ruiz, Ismael Sanz, and Almudena Sevilla
Descriptive stereotypes such as “girls are not good at mathematics” or prescriptive stereotypes, that is, fixed views about women’s societal roles, can explain the persistent gender gap in mathematics. Stereotypes lower girls’ beliefs, expectations, and incentives to put forth effort, and can constrain girls’ choices in male-dominated high-paying careers that are math-intensive and that require strong math skills. This gap slows progress toward gender equality in the labor market and hinders productivity and economic growth.
Policy interventions to alleviate the negative impacts of descriptive stereotypes aim to prevent girls from internalizing socially constructed behaviors aligned with prevalent gender stereotypes regarding the innate mathematical abilities of boys and girls. Boosting girls’ confidence in their math skills includes introducing them to female role models, such as women math teachers, using gender-neutral language, and providing textbooks and other teaching materials that challenge gender stereotypes. A different set of policies focuses on altering the environment in which girls learn, rather than modifying their beliefs. By adjusting the testing methods (such as reducing the level of competition) or adapting the instructional approach to better align with the learning style of girls, it is possible to create an environment that enables more girls to achieve their maximum potential and to accurately assess their math abilities and interests, rather than simply their test-taking or classroom performance.
However, interventions that aim to modify the beliefs and attitudes of girls and women ex post, as well as those that seek to alter the environment, may not work in the long term because they reinforce preexisting stereotypes and operate within the constraints of those stereotypes. For instance, while modifying the testing environment may result in higher grades for girls, it may not necessarily alter the perception that girls are incapable of excelling in math. In some cases, these interventions may even have negative consequences. Encouraging girls to “lean in” and behave like boys, for example, can lead to unequal, unjust, and inefficient outcomes because the benefits (economic returns) of doing so are lower or even negative for girls in light of existing gender stereotypes.
One popular and affordable approach to combating gender stereotypes involves addressing (unconscious) biases among teachers, parents, and peers through initiatives such as unconscious bias training and self-reflection on biases. The underlying premise is that by increasing awareness of their own (unconscious) biases, individuals will engage their more conscious, non-gender-stereotypical thinking processes. However, such behavioral interventions can sometimes have unintended consequences and result in backlash, and their effectiveness may vary significantly depending on the context, so that their external validity is often called into question.
The recognition of the adaptable nature of both conscious and unconscious stereotypes has led to progress in economics, with the development of social learning and information-based theories. Interventions resulting from these models can effectively counteract prescriptive stereotypes that limit girls’ education to certain fields based on societal expectations of gender roles. However, prescriptive gender stereotypes are often based on biased beliefs about the innate abilities of girls and women. Overcoming deeply ingrained descriptive stereotypes about innate abilities of boys and girls is a fruitful avenue for future economics research and can help close the gender performance gap in mathematics.
Article
Gene–Environment Interplay in the Social Sciences
Rita Dias Pereira, Pietro Biroli, Titus Galama, Stephanie von Hinke, Hans van Kippersluis, Cornelius A. Rietveld, and Kevin Thom
Nature (one’s genes) and nurture (one’s environment) jointly contribute to the formation and evolution of health and human capital over the life cycle. This complex interplay between genes and environment can be estimated and quantified using genetic information readily available in a growing number of social science data sets. Using genetic data to improve our understanding of individual decision making, inequality, and to guide public policy is possible and promising, but requires a grounding in essential genetic terminology, knowledge of the literature in economics and social-science genetics, and a careful discussion of the policy implications and prospects of the use of genetic data in the social sciences and economics.
Article
The Growth of Health Spending in the United States From 1776 to 2026
Thomas E. Getzen
During the 18th and 19th centuries, medical spending in the United States rose slowly, on average about .25% faster than gross domestic product (GDP), and varied widely between rural and urban regions. Accumulating scientific advances caused spending to accelerate by 1910. From 1930 to 1955, rapid per-capita income growth accommodated major medical expansion while keeping the health share of GDP almost constant. During the 1950s and 1960s, prosperity and investment in research, the workforce, and hospitals caused a rapid surge in spending and consolidated a truly national health system. Excess growth rates (above GDP growth) were above +5% per year from 1966 to 1970, which would have doubled the health-sector share in fifteen years had it not moderated, falling under +3% in the 1980s, +2% in 1990s, and +1.5% since 2005. The question of when national health expenditure growth can be brought into line with GDP and made sustainable for the long run is still open. A review of historical data over three centuries forces confrontation with issues regarding what to include and how long events continue to effect national health accounting and policy. Empirical analysis at a national scale over multiple decades fails to support a position that many of the commonly discussed variables (obesity, aging, mortality rates, coinsurance) do cause significant shifts in expenditure trends. What does become clear is that there are long and variable lags before macroeconomic and technological events affect spending: three to six years for business cycles and multiple decades for major recessions, scientific discoveries, and organizational change. Health-financing mechanisms, such as employer-based health insurance, Medicare, and the Affordable Care Act (Obamacare) are seen to be both cause and effect, taking years to develop and affecting spending for decades to come.
Article
Happiness and Productivity in the Workplace
Mahnaz Nazneen and Daniel Sgroi
Happiness has become an important concept in economics as a target for government policy at the national level. This is mirrored in an increasing understanding of the microeconomic effects of increased happiness. While correlational studies have for many years documented a relationship between individual-level happiness and productivity, more recent work provides causal evidence that a positive shock to happiness can boost productivity significantly. These studies include three strands of research. The first provides a number of longitudinal surveys that have generated evidence linking happiness to productivity but run the risk of confounding happiness with other related variables that may be driving the relationship. The second includes laboratory experiments that simulate a workplace under tightly controlled conditions, and this strand has established a clear relationship between positive happiness shocks and rises in productivity. The third involves examining experimental field data, which sacrifices the control of laboratory experiments but offers greater realism. However, there is still work to be done generalizing these findings to more complex work environments, especially those that involve cooperative and team-based tasks where increases in happiness may have other consequences.
Article
Health and Economic Growth
David E. Bloom, Michael Kuhn, and Klaus Prettner
The strong observable correlation between health and economic growth is crucial for economic development and sustained well-being, but the underlying causality and mechanisms are difficult to conceptualize. Three issues are of central concern. First, assessing and disentangling causality between health and economic growth are empirically challenging. Second, the relation between health and economic growth changes over the process of economic development. In less developed countries, poor health often reduces labor force participation, particularly among women, and deters investments in education such that fertility stays high and the economy remains trapped in a stagnation equilibrium. By contrast, in more developed countries, health investments primarily lead to rising longevity, which may not significantly affect labor force participation and workforce productivity. Third, different dimensions of health (mortality vs. morbidity, children’s and women’s health, and health at older ages) relate to different economic effects. By changing the duration and riskiness of the life course, mortality affects individual investment choices, whereas morbidity relates more directly to work productivity and education. Children’s health affects their education and has long-lasting implications for labor force participation and productivity later in life. Women’s health is associated with substantial intergenerational spillover effects and influences women’s empowerment and fertility decisions. Finally, health at older ages has implications for retirement and care.
Article
Health Economics of the Workplace: Workplace Accidents and Effects of Job Loss and Retirement
Jan C. van Ours
There are three main topics in research on the effects of work on health.
The first topic is workplace accidents where the main issues are reporting behavior and workplace safety policies. A worker seems to be less inclined to report a workplace accident for fear of job loss when unemployment is high or when the worker has a temporary contract that may not be renewed. Workplace safety legislation has intended to reduce the incidence and severity of workplace accidents but empirical evidence on this result is unclear.
The second topic is employment and health where the focus is on how job characteristics and job loss affect health, in particular mental health. Physically demanding jobs have negative health effects. The effects of working hours vary and the effects of job loss on physical and mental health are not uniform. Job loss seems to increase mortality.
The third topic concerns retirement and health. Retirement seems to have a negative effect on cognitive skills and short-term positive effects on overall health. Other than that, the effects are very inconsistent, that is, even with as clear a measure as mortality, it is not clear whether life expectancy goes up, goes down, or remains constant due to retirement.
Article
Health Insurance and Labor Supply
Gregory Colman, Dhaval Dave, and Otto Lenhart
Health insurance depends on labor market activity more in the U.S. than in any other high-income country. A majority of the population are insured through an employer (known as employer-sponsored insurance or ESI), benefiting from the risk pooling and economies of scale available to group insurance plans. Some workers may therefore be reluctant to leave a job for fear of losing such low-cost insurance, a tendency known as “job lock,” or may switch jobs or work more hours merely to obtain it, known as “job push.” Others obtain insurance through government programs for which eligibility depends on income. They too may adapt their work effort to remain eligible for insurance. Those without access to ESI or who are too young or earn too much to qualify for public coverage (Medicare and Medicaid) can buy insurance only in the individual or nongroup market, where prices are high and variable. Most studies using data from before the passage of the Patient Protection and Affordable Care Act (ACA) in 2010 support the prediction that ESI reduced job mobility, labor-force participation, retirement, and self-employment prior to the ACA, but find little effect on the labor supply of public insurance. The ACA profoundly changed the health insurance market in the U.S., removing restrictions on obtaining insurance from new employers or on the individual market and expanding Medicaid eligibility to previously ineligible adults. Research on the ACA, however, has not found substantial labor supply effects. These results may reflect that the reforms to the individual market mainly affected those who were previously uninsured rather than workers with ESI, that the theoretical labor market effects of expansions in public coverage are ambiguous, and that the effect would be found only among the relatively small number on the fringes of eligibility.
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