This 2007 study looks at who really benefits from pay or play health insurance mandates. Researchers find that mandates, which required employers to either provide health insurance for their workers or pay a flat tax per hour to offset the cost of health care, are a very blunt instrument for providing health insurance for the working poor.

The authors found that not only do a large number of low income workers fail to receive health coverage from a pay to play mandate, they may lose their job because of it. Researchers also found that a large number of workers effected by mandates already have coverage from other sources and are likely not better off after the switch.

Authors recommend additional study into alternatives to employer mandates, specifically health insurance tax credits modeled after the Earned Income Tax Credit (EITC), as such credits would have no dis-employment effect and would more effectively target the working poor.