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.

中文翻译：

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“选择适合您的计划”：选择权下放作为美国雇主赞助的健康保险中的阶级偏见制度变革

本研究考察了美国雇主努力下放管理雇员医疗保险风险责任的分配后果。消费者选择的逻辑越来越主导保险福利设计，要求员工学会做自己的精算师。我们问，选择的个性化（在具有不同成本分摊水平的保险计划之间）在多大程度上改变了社会经济地位阶层中自费（OOP）医疗支出负担的社会分层？我们的分析借鉴了一家大型多雇主商业保险公司的保险理赔数据库，其中包括 2002 年至 2012 年超过 3700 万人的计划提供信息和实际自营费用支出负担。与预期一致，汇总差异事件研究模型的结果表明，与社会经济地位较高的参与者的增长相比，向下放选择的过渡导致较低社会经济地位参与者的实际 OOP 负担略有增加。然而，从实质上看，阶级间支出负担差距的扩大幅度很小。