As the cost of benefits increases, workers may choose to receive wages instead by changing jobs. Similarly, employers may restrict wage increases if health care benefits are mandated. Economist Jonathan Gruber of the Massachusetts Institute of Technology has found, for example, that wages are on average 5.4 percent lower for women in states that have mandated insurance coverage for maternity compared to states without that mandate. Two economists with the federal Agency for Health Care Policy and Research found that even as more employers offered health benefits, the percentage of employees choosing health benefits fell, from 88.3 percent in 1987 to 80.1 percent in 1996. They attributed the decline largely to health insurance premium increases.
Mandates have a significant effect on insurance premium costs.
Gruber reports that mandates account for 22 percent of premium costs in Virginia and Maryland and 18 percent in Massachusetts. He finds that the additional cost of adding a mental health mandate ranges from 4.2 percent to 7.8 percent. Children are also high-cost users. Those who would likely be hurt by a mental health parity mandate have dramatically different demographics. Furthermore, their research also shows that following the loss of their health insurance, these individuals were more likely to delay medical care within four months after visiting an emergency department, were more likely to report no primary care provider, and were less likely to have recommended follow-up care within the four month period.