Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

Over the past twenty years, the prevalence of obesity has increased dramatically throughout the United States. Public health officials and policymakers have become increasingly alarmed by these trends since obesity is associated with severe health conditions. One might expect that the demand for health insurance is relatively high for obese individuals due to higher expected health care costs. Demand for employment-based health insurance, in particular, may be especially strong since the workplace pools individuals with different health care risks. For the same reasons, employers may be less inclined to hire and insure obese persons. Although evidence to date suggests that employers have been able to pass on the higher expected health care costs to obese workers, it is plausible that obese individuals may have a harder time getting access to employment-based health insurance.

In this paper, we analyze the pathways through which individuals acquire employment-based health insurance. Specifically, we consider access to insurance that comes from the labor market (i.e., through one's own job) and access that arises through marriage (i.e., through the employment of one's spouse). Our contention is that obesity can affect employment in jobs that offer insurance and the likelihood of being married to an individual who has access to insurance. Moreover, we expect that the results will differ for men and women.

We pool data from the 2000 ? 2004 Medical Expenditure Panel Survey for our analysis. Our sample consists of 77,796 adults between 21 and 64 years of age. We consider the relationship between body weight and the probability of: 1) being employed; 2) being married; 3) having health insurance offers from one's own job; 4) having a working spouse if married; 5) having health insurance offers from job of the spouse for those with a working spouse; 6) having access to employment-based insurance in general; 7) being covered by employment-based insurance; and 8) being uninsured or on public insurance.

Our results suggest that obesity has not hindered an individual's access to employment-based insurance. However, it may have affected the paths used to obtain coverage. Although women are generally more likely to be dependents on employment-based insurance plans, we find that obese women have lower rates of marriage and somewhat lower quality of marriage. Yet the overall rates of employment-based coverage for obese women are slightly higher than those of the normal weight group. Interestingly, normal weight individuals, particularly normal weight men, have lower rates of employment-based health insurance coverage. This may suggest that at least for some of them, the insurance through their jobs might not be such a good deal, particularly when their share of the premium is large. This is more likely to occur if the median worker is increasingly becoming an overweight worker, and insurance is priced accordingly.