Impact of health plan reforms in Washington on employment decisions

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.

Sorel, Georges (1847–1922)

Georges Sorel was a French social thinker and political theorist. An engineer of modest bourgeois extraction, he was a state employee for twenty-five years. He theorized anarcho-syndicalism: an anti-state, non-party workers’ movement predicated on the threat of general strike (le grand soir, lit. the big night) and nourished by fond memories of the Paris Commune (1871).

Changes in spending and service use after a state autism insurance mandate

Almost all states have insurance coverage mandates for childhood autism spectrum disorder treatment, yet little is known about how mandates affect spending and service use. We evaluated a 2011 Kansas law mandating comprehensive coverage of autism spectrum disorder treatments in the State Employee Health Plan. Data were extracted from the Kansas All-Payer Claims Database from 2009 to 2013 for enrollees of State Employee Health Plan and private health plans. The sample included children aged 0–18 years with >2 claims with an autism spectrum disorder diagnosis insured through State Employee Health Plan or a comparison group enrolled through private health plans. We estimated differences-in-differences regression models to compare trends among State Employee Health Plan to privately insured children. Average annual total spending on autism spectrum disorder services increased by US$912 (95% confidence interval: US$331–US$1492) and average annual out-of-pocket spending on autism spectrum disorder services increased by US$138 (95% confidence interval: US$53–US$223) among diagnosed children in the State Employee Health Plan relative to the comparison group following the mandate, representing 92% and 75% increases over baseline total and out-of-pocket autism spectrum disorder spending, respectively. Average annual quantity of outpatient autism spectrum disorder services increased by 15.0 services (95% confidence interval: 8.4–21.6) among children in the State Employee Health Plan, more than doubling the baseline average. Implementation of a comprehensive autism spectrum disorder mandate in the Kansas State Employee Health Plan was associated with substantial increases in service use and spending for autism spectrum disorder treatment among autism spectrum disorder–diagnosed children.

Exploring determinants of state employee union density in the United States

Purpose – To explore state employee union density, this paper discusses determinants of state sector union density and then empirically examines the linkages of the determinants and state union membership in the USA. Design/methodology/approach – After operationalizing and measuring the indicators of the crucial determinants of state employee union density, this study conducts a cross-sectional analysis on state sector union density. The dependent variable used in this study is state employee union density in the USA. The independent variables used in this study are the presence of a liberal state government, the presence of collective bargaining laws, the size of a budget deficit, and an unemployment rate which could determine state sector union density. Findings – This study finds that state union density is not determined by the size of budget deficits and the presence of liberal governors but by the presence of collective bargaining laws and liberal state legislatures and unemployment rates. Additionally, this study reveals that unified governments can make a difference in state employee union density. For instance, liberal states controlling both the state executive and legislative branches have a positive impact on state employee union density, while conservative states ruling both branches have a negative impact on state union density. Originality/value – This paper analyzed pooled cross-sectional data on state employee union density in the US with regards to crucial legal, political, financial, and economic variables.