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Fiscal difficulties of cities, the labor market, and health care

Published online by Cambridge University Press:  19 December 2018

John Hsu
Affiliation:
Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
Joseph Newhouse*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA Harvard Kennedy School, Cambridge, Massachusetts, USA Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA National Bureau of Economic Research, Cambridge, Massachusetts, USA
Lindsay Nicole Overhage
Affiliation:
Program in Clinical Economics and Policy Analysis, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, Massachusetts, USA
Samuel Zuvekas
Affiliation:
Agency for Healthcare Research and Quality, Rockville, Maryland, USA
*
*Corresponding author. E-mail: newhouse@hcp.med.harvard.edu
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Abstract

We investigated labor force and health outcomes in cities experiencing fiscal difficulties to assess how those difficulties might impact their employees. We matched 23 cities with bond downgrades and 31 cities with stable bond ratings to sampling units in the Medical Expenditure Panel Survey. Starting the year before the downgrade and for the four subsequent years, the rate of separation from local public employment fell in the cities with downgrades relative to the comparison group. Self-reported health may have worsened, but there were no statistically significant effects on health care use or spending.

Figure 0

Table 1. Control vs. Distressed group – public employees and retirees

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Figure 1. No longer a public employee (retire, resign, or lose job). Source: Authors’ Analysis of Medical Expenditure Panel Survey.

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Table 2. No longer a public employee1 years −2, −3, −4 vs. years +2, +3, +4

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Figure 2. Detroit MI local government employees. Dashed lines represent years of downgrade or default: 2008: downgrade; 2009: downgrade. 2011: default. 2012: downgrade. 2013: default. Source: Authors’ calculations from United States Census Bureau/American FactFinder. ‘Class of Worker by Sex and Median Earnings in the Past 12 Months for the Civilian Employed Population 16 Years and Over.’ 2008–2014 American Community Survey and United States Census Bureau/American FactFinder. ‘Class of Worker by Sex for the Civilian Employed Population.’ 2015–2016 American Community Survey.

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Figure 3. Proportion of population who are public employees. Source: Authors’ Analysis of Medical Expenditure Panel Survey.

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Figure 4. Any uninsured spell during the year. Source: Authors’ Analysis of Medical Expenditure Panel Survey.

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Table 3. Uninsured at any time during the year, years −2, −3, −4 vs. years +2, +3, +41

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Figure 5. Poor/fair self-reported health during the year. Source: Authors’ Analysis of Medical Expenditure Panel Survey.

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Table 4. In poor or fair health at any time during the year1