How Does Health Insurance Affect Firm Employment and Performance? Evidence from Obamacare

This article discusses how mandating employers to provide health insurance of a minimum quality and the associated increases in health insurance premia affect firm employment and performance. Using firm-level employee health insurance data around the passage of the Patient Protection and Affordable Care Act (PPACA), we show that the PPACA is associated with a significant increase in health insurance premia for employees in company-sponsored health insurance plans. In response, employers with greater exposure to the PPACA reduce employee enrollments in their health insurance plans to a larger extent after the law’s enactment. Our analysis suggests that employers achieve this reduction in enrollment by shifting employment composition from full-time employees to part-time, temporary, or seasonal workers, who are not covered in employer-sponsored health insurance plans. Furthermore, we find no evidence of deterioration in performance at companies more exposed to the increase in health insurance premia. Overall, our findings illustrate how firms adapt to and mitigate cost increases associated with regulatory changes through strategic labor practices. This paper was accepted by Lin William Cong, finance. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2023.03761 .