A new survey from the National Bureau of Economic Research finds that making it mandatory for employers to provide health care resulted in higher health spending in most companies, but also wide-ranging support for universal employer coverage.
In 2006 San Francisco became the first U.S. city to require employers to provide health coverage or pay a penalty. It also created a "public option" to promote affordable universal access to care, which is called "Healthy San Francisco." Using the 2008 Bay Area Employer Health Benefits Survey, economists Carrie Hoverman Colla, Bill Dow, and Arindrajit Dube find that three quarters of employers had to increase health spending to comply with the law, but that 64 percent of employers were nonetheless supportive of the law. Furthermore, 21 percent of firms used Healthy San Francisco for at least some employees, although there was little evidence of firms dropping existing insurance offerings, at least in the first year after implementation of the mandate.

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