Implicit Budget Deficits: The Case of a Mandated Shift to Community-Rated Health Insurance
AbstractSince a typical regulatory mandate can be equated in its economic effect to a combination of an expenditure program and a tax program, observers have often suggested that it would serve consistent public policy to bring regulatory decisions into the same budgetary framework. This paper concerns an important example of a regulatory program that would mimic deficit financing in effecting a transfer of fiscal burdens toward younger and future generations, the mandated purchase of (or provision by employers of) health care insurance under a system of community rating, under which the same price is charged for health insurance for all comers, regardless of age, sex, or health condition. Such a shift would result in redistributions of burdens across birth cohorts, in this case from existing, especially middle-aged birth cohorts toward future generations. Using data from a variety of sources we conclude the effect would be substantial. For our central-case assumptions about discount, health care cost, and productivity growth rates, and about the locus of responsibility for paying health care bills, a shift to community rating is estimated to generate gains for people over age 30 in 1994, $16,700 per person aged 50 for example, at the cost to younger cohorts. Those born in 1994 would acquire an extra payment obligation with a discounted value of $7,100 each. The burden passed along to future generations can be described by a $9,300 per capita tax at birth (growing with productivity). The analysis makes clear that the regula- tory policy shift, with no direct budgetary implications, would have an intergenerational transfer effect comparable to what would be considered a major change in on-budget tax or transfer programs.
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Bibliographic InfoPaper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 5514.
Date of creation: Mar 1996
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Publication status: published as David F. Bradford, Derrick A. Max. "Implicit Budget Deficits: The Case of a Mandated Shift to Community-Rated Health Insurance," in James M. Poterba, editor, "Tax Policy and the Economy, Volume 11" MIT Press (1997)
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- David F. Bradford & Derrick A. Max, 1997. "Implicit Budget Deficits: The Case of a Mandated Shift to Community-Rated Health Insurance," NBER Chapters, in: Tax Policy and the Economy, Volume 11, pages 129-168 National Bureau of Economic Research, Inc.
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- Tadashi Fukui & Yasushi Iwamoto, 2006.
"Policy Options for Financing the Future Health and Long-term Care Costs in Japan,"
CIRJE-F-432, CIRJE, Faculty of Economics, University of Tokyo.
- Tadashi Fukui & Yasushi Iwamoto, 2006. "Policy Options for Financing the Future Health and Long-Term Care Costs in Japan," NBER Working Papers 12427, National Bureau of Economic Research, Inc.
- David Bradford, 2001.
"Reforming Budgetary Language,"
CESifo Working Paper Series
619, CESifo Group Munich.
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