How Do Employers React to A Pay-or-Play Mandate? Early Evidence from San Francisco

Carrie Hoverman Colla, William H. Dow, Arindrajit Dube

NBER Working Paper No. 16179
Issued in July 2010
NBER Program(s):Health Care, Health Economics

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.

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Document Object Identifier (DOI): 10.3386/w16179

Published: 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

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