Employer Offers, Private Coverage, and the Tax Subsidy for Health Insurance: 1987 and 1996
Tóm tắt
Economists have long been interested in the effect of tax-based subsidies on private health insurance coverage. We examine this relationship using pooled data from the 1987 National Medical Expenditure Survey and the 1996 Medical Expenditure Panel Survey. Our main tax price elasticity estimates for employer offers and for private coverage are near the mid-point of the existing literature. However, these estimates may mask substantial differences in tax-price responsiveness across subsets of workers. Our more disaggregated analysis reveals tax price responsiveness to be significantly above average for low-income workers, workers with low health risks, and workers in small firms—precisely those groups whose continued participation in employment-related risk pooling is of greatest policy concern. In addition, we present family-level elasticities that allow for joint decision-making in two-worker families.
Tài liệu tham khảo
Agency for Healthcare Research and Quality. (2001). “MEPS HC-012: 1996 Full Year Consolidated Data File April 2001 (Documentation).” Rockville, MD.
Amemiya, Y. (1990). “Two-Stage Instrumental Variable Estimators for the Nonlinear Errors-in-Variables Model.” Journal of Econometrics 44, 311–332.
Buchmueller, T. (1995). “Health Risk and Access to Employer-Provided Health Insurance.” Inquiry 32(1), 75–86.
Burman, L. E. and R. Williams. (1994). “Tax Caps on Employment-Based Health Insurance.” National Tax Journal 47(3), 529–545.
Chernick, H. A., M. R. Holmer and D. H. Weinberg. (1987). “Tax Policy toward Health Insurance and the Demand for Medical Services.” Journal of Health Economics 6(1), 1–25.
Cohen, J. W., et al. (1996). “The Medical Expenditure Panel Survey: A National Health Information Resource.” Inquiry 33(4), 373–389.
Cohen, S. B. (1997). “Sample Design of the 1996 Medical Expenditure Panel Survey Household Component.” MEPS Methodology Report No. 2, Pub. No. 97-0027, Agency for Health Care Policy and Research, Rockville, MD.
Cooper, P. F. and B. S. Schone. (1997). “More Offers, Fewer Takers for Employment-Based Health Insurance: 1987 and 1996.” Health Affairs 16(6), 142–149.
Davidson, R. and J. G. MacKinnon. (1993). Estimation and Inference in Econometrics. New York: Oxford University Press, Inc.
Dranove, D., K. Spier and L. Baker. (2000). “‘Competition’ among Employers Offering Health Insurance.” Journal of Health Economics 19(1), 121–140.
Edwards, W. S. and M. Berlin. (1989). Questionnaires and Data Collection Methods for the Household Survey and the Survey of American Indians and Alaska Natives (Pub. No. 89-3450): National Medical Expenditure Survey Methods 2, Agency for Health Care Policy and Research, Public Health Service, Rockville, MD.
Emmons, C. and C. Hill. (1994). Questionnaires and Data Collection Methods for the Health Insurance Plan Survey (Pub. No. 94-0016): National Medical Expenditure Survey Methods 5, Agency for Health Care Policy and Research, Public Health Service, Rockville, MD.
Feenberg, D. and E. Coutts. (1993). “An Introduction to the TAXSIM Model.” Journal of Policy Analysis and Management 12(1), 189–194.
Feldman, R. and B. Dowd. (1991). “A New Estimate of the Welfare Loss of Excess Health Insurance.” American Economic Review 81(1), 297–301.
Feldman, R., M. Finch, B. Dowd and S. Cassou. (1989). “The Demand for Employment-Based Health Insurance Plans.” The Journal of Human Resources 24(1), 115–142.
Feldstein, M. S. (1973). “The Welfare Loss of Excess Health Insurance.” Journal of Political Economy 81(2), 251–280.
Gabel, J. R., J. D. Pickreign, H. H. Whitmore and C. Schoen. (2001). “Embraceable You: HowEmployers Influence Health Plan Enrollment.” Health Affairs 20(4), 196–208.
Goldstein, G. S. and M. V. Pauly. (1976). “Group Health Insurance as a Local Public Good.” In Richard Rosett (ed.), The Role of Health Insurance in the Health Services Sector. National Bureau of Economic Research: New York.
Gruber, J. (2001). “The Impact of the Tax System on Health Insurance Coverage.” Mimeo, Economics Department, Massachusetts Institute of Technology.
Gruber, J. and M. Lettau. (2000). “How Elastic is the Firm's Demand for Health Insurance?” Mimeo, Economics Department, Massachusetts Institute of Technology.
Gruber, J. and J. M. Poterba. (1996a). “Tax Subsidies to Employer-Provided Health Insurance.” In Martin Feldstein and James M. Poterba (eds.), Empirical Foundations of Household Taxation. Chicago: The University of Chicago Press.
Holmer, M. R. (1984). “Tax Policy and the Demand for Health Insurance.” Journal of Health Economics 3(3), 203–221.
Kirby, J. B., S. R. Machlin and J. M. Thorpe. (2001). “Patterns of Ambulatory Care Use: Changes from 1987 to 1996.” Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Research Findings No. 16, AHRQ Pub. No. 01-0026, Rockville, MD.
Levy, H. (1998). “Who Pays for Health Insurance? Employee Contributions to Health Insurance Premiums.” Mimeo, University of California at Berkeley.
Moeller, J. F. (1994). “MEDTAX: An Analyst's Guide.” Center for Cost and Financing Studies Working Paper. Rockville, MD: Agency for Health Care Policy and Research.
Monheit, A. C. (1994). “Underinsured Americans: A Review.” Annual Review of Public Health 15, 461–485.
Monheit, A. C. and P. F. Cooper. (1994). “Health Insurance and Job Mobility: Theory and Evidence.” Industrial and Labor Relations Review 48(1), 68–85.
Newhouse, J. P. (1992). “Medical Care Costs: How MuchWelfare Loss?” Journal of Economic Perspectives 6(3), 2–33.
Pauly, M. V. (1986). “Taxation, Health Insurance, and Market Failure in the Medical Economy.” Journal of Economic Literature 24(2), 629–675.
Royalty, A. B. (2000). “Tax Preferences for Fringe Benefits and Worker's Eligibility for Employer Health Insurance.” Journal of Public Economics 75, 209–227.
Selden, T. M. and D. Bernard. (2002). “What Happens When Workers Fail to Take up Employment-Related Health Insurance? Evidence from 1987 and 1996.” Mimeo, Center for Cost and Financing Studies, Agency for Healthcare Research and Quality, Rockville, MD.
Selden, T. M. and J. F. Moeller. (2000). “Estimates of the Tax Subsidy for Employment-Related Health Insurance.” National Tax Journal 53(4, part 1), 877–887.
Sheiner, L. (1999). “Health Care Costs, Wages, and Aging.” Mimeo, Federal Reserve Board of Governors, Washington, D.C.
Short, P. F. and A. K. Taylor. (1989). “Premiums, Benefits, and Employee Choice of Health Insurance Options.” Journal of Health Economics 8(3), 293–312.
Stabile, M. (2002). “The Role of Tax Subsidies in the Market for Health Insurance.” International Tax and Public Finance 9, 33–50.
Taylor, A. K. and J. S. Banthin. (1994). “Changes in Out-of-Pocket Expenditures for Personal Health Services: 1977 and 1987.” Agency for Health Care Policy and Research, National Medical Expenditure Survey Research Findings No. 21, AHCPR Pub. No. 94-0065, Rockville, MD.
U.S. Bureau of the Census. (1998). State and Metropolitan Area Data Book 1997–1998, Fifth edition. Washington, D.C.: U.S. Department of Commerce.
U.S. Bureau of Labor Statistics. (2001). “Most Requested Statistics” on Employee Benefit Survey internet page, http://www.bls.gov/ncs/ebs/home.htm.
Wilensky, G. R., P. J. Farley and A. K. Taylor. (1984). “Variations in Health Insurance Coverage: Benefits vs. Premiums.” Milbank Memorial Fund Quarterly 62(1), 53–81.
Winter, A. and M. E. Moyer. (1999). “Understanding Estimates of Uninsured Children: Putting the Differences in Context.” ASPE Research Note, Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, Washington, D.C.