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"Choose the Plan That’s Right for You": Choice Devolution as Class-Biased Institutional Change in U.S. Employer-Sponsored Health Insurance

By on May 16, 2022 in Articles

Adam Goldstein, James Franklin Wharam

Sociological Science May 16, 2022
10.15195/v9.a10

Abstract

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This study examines the distributional consequences of U.S. employers’ efforts to devolve responsibility for managing their employees’ medical insurance risk. The logic of consumer choice has increasingly come to dominate insurance benefit design, requiring that employees learn to be their own actuaries. We ask, to what extent does the individuation of choice (between insurance plans with disparate levels of cost-sharing) alter the social stratification of out-of-pocket (OOP) medical expenditure burdens across socioeconomic status class strata? Our analysis draws on an insurance claims database from a large multi-employer commercial insurer, which includes information on plan offerings and realized OOP expenditure burdens for more than 37 million persons from 2002 to 2012. Consistent with expectations, the results of pooled difference-in-difference event study models reveal that transitions to devolved choice result in modestly greater increases in realized OOP burden among lower socioeconomic status enrollees, compared with the growth among higher-status enrollees. However, the magnitude of the increase in the between-class expenditure burden disparity is small in substantive terms.
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Adam Goldstein: Princeton University School of Public and International Affairs
E-mail: amg5@princeton.edu

James Franklin Wharam: Duke University Department of Medicine and Duke-Margolis Center for Health Policy
E-mail: james.wharam@duke.edu

Acknowledgments:This study was generously supported by the Robert Wood Johnson Foundation’s Scholars in Health Policy Research Program. The authors thank Robert LeCates and Fang Zhang for sharing data and assistance with variable derivation. Katherine Swartz, Paul Starr, Jeremy Cohen, and Simone Schneider provided helpful comments on earlier drafts. The study benefited from the feedback of audiences and participants at the Robert Wood Johnson Foundation Scholars in Health Policy Research Annual Meeting, the American Sociological Association Annual Meeting, and Princeton’s Center for the Study of Social Organization Seminar.

  • Citation: Goldstein, Adam, and James Franklin Wharam. 2022. “‘Choose the Plan That’s Right for You’: Choice Devolution as Class-Biased Institutional Change in U.S. Employer-Sponsored Health Insurance.” Sociological Science 9: 221-251.
  • Received: January 3, 2022
  • Accepted: March 21, 2022
  • Editors: Arnout van de Rijt, Cristobal Young
  • DOI: 10.15195/v9.a10


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The Intergenerational Transmission of Family-Income Advantages in the United States

By on May 15, 2019 in Articles

Pablo A. Mitnik, Victoria Bryant, Michael Weber

Sociological Science, May 15, 2019
10.15195/v6.a15

Abstract
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Estimates of economic persistence and mobility in the United States, as measured by the intergenerational elasticity (IGE), cover a very wide range. Nevertheless, careful analyses of the evidence suggested until recently that as much as half, and possibly more, of economic advantages are passed on from parents to children. This “dominant hypothesis” was seriously challenged by the first-ever study of family-income mobility based on tax data (Chetty et al. 2014), which provided estimates of family-income IGEs indicating that only one-third of economic advantages are transmitted across generations and claimed that previous highly influential IGE estimates were upward biased. Using a different tax-based data set, this article provides estimates of family-income IGEs that strongly support the dominant hypothesis. The article also carries out a one-to-one comparison between IGEs estimated with the two tax-based data sets and shows that Chetty et al.’s estimates were driven downward by a combination of attenuation, life-cycle, selection, and functional-form biases. Lastly, the article determines the exact relationship between parental income inequality, economic persistence, and inequality of opportunity for income. This leads to the conclusion that, in the United States, at least half of income inequality among parents is transformed into inequality of opportunity among their children.
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Pablo A. Mitnik: Center on Poverty and Inequality, Stanford University
E-mail: pmitnik@stanford.edu

Victoria Bryant: Statistics of Income Division, Internal Revenue Service
E-mail: victoria.l.bryant@irs.gov

Michael Weber: Statistics of Income Division, Internal Revenue Service
E-mail: michael.e.weber@irs.gov

Acknowledgements: The first author gratefully acknowledges research support from the Russell Sage Foundation and the Pew Charitable Trusts. The editors provided valuable feedback on an earlier version of the article. The opinions expressed in this article are solely those of the authors and do not represent the opinions of the Internal Revenue Service or the Stanford Center on Poverty and Inequality.

Supplemental Material

  • Citation: Mitnik, Pablo A., Victoria Bryant, and Michael Weber. 2019. “The Intergenerational Transmission of Family-Income Advantages in the United States.” Sociological Science 6: 380-415.
  • Received: February 4, 2019
  • Accepted: March 29, 2019
  • Editors: Kim Weeden
  • DOI: 10.15195/v6.a15


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The Sources of Life Chances: Does Education, Class Category, Occupation, or Short-Term Earnings Predict 20-Year Long-Term Earnings?

By on March 21, 2018 in Articles

ChangHwan Kim, Christopher R. Tamborini, Arthur Sakamoto

Sociological Science, March 21, 2018
DOI 10.15195/v5.a9

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In sociological studies of economic stratification and intergenerational mobility, occupation has long been presumed to reflect lifetime earnings better than do short-term earnings. However, few studies have actually tested this critical assumption. In this study, we investigate the cross-sectional determinants of 20-year accumulated earnings using data that match respondents in the Survey of Income and Program Participation to their longitudinal earnings records based on administrative tax information from 1990 to 2009. Fit statistics of regression models are estimated to assess the predictive power of various proxy variables, including occupation, education, and short-term earnings, on cumulative earnings over the 20-year time period. Contrary to the popular assumption in sociology, our results find that cross-sectional earnings have greater predictive power on long-term earnings than occupation-based class classifications, including three-digit detailed occupations for both men and women. The model based on educational attainment, including field of study, has slightly better fit than models based on one-digit occupation or the Erikson, Goldthorpe, and Portocarero class scheme. We discuss the theoretical implications of these findings for the sociology of stratification and intergenerational mobility.

Creative Commons LicenseThis work is licensed under a Creative Commons Attribution 4.0 International License.

ChangHwan Kim: Department of Sociology, University of Kansas
Email: chkim@ku.edu

Christopher R. Tamborini: Office of Retirement Policy, U.S. Social Security Administration
Email: chris.tamborini@ssa.gov

Arthur Sakamoto: Department of Sociology, Texas A&M University
Email: asakamoto@tamu.edu

Acknowledgements: The views expressed in this article are those of the authors and do not represent the views of the Social Security Administration (SSA). Access to SSA data linked to Census Bureau survey data is subject to restrictions imposed by Title 13 of the U.S. Code. The data are accessible at a secured site such as the Federal Statistical Research Data Centers (https://www.census.gov/fsrdc) and must undergo disclosure review before their release. For researchers with access to these data, the computer programs used in this analysis are available upon request.

  • Citation: Kim, ChangHwan, Christopher R. Tamborini, and Arthur Sakamoto. 2018. “The Sources of Life Chances: Does Education, Class Category, Occupation or Short-Term Earnings Predict 20-Year Long-Term Earnings?” Sociological Science 5:206-233.
  • Received: December 19, 2017
  • Accepted: February 6, 2018
  • Editors: Jesper Sørensen, Kim Weeden
  • DOI: 10.15195/v5.a9

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