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Avoiding Health Insurance Crowd-Out: Evidence from the Medicare as Secondary Payer Legislation

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  • Sherry Glied
  • Mark Stabile

Abstract

The cost of efforts to expand health insurance coverage to the currently uninsured increases when people who would otherwise purchase private insurance obtain subsidized public coverage. Legislators are increasingly interested in mechanisms that target insurance benefits to those who need them most. This paper investigates the effects of one of the first such targeting efforts, the 1982 Medicare as Secondary Payer (MSP) provisions. The MSP rules require employers who offer insurance coverage to their employees under 65 to offer coverage on the same terms to their Medicare-eligible employees. This coverage then becomes 'primary' to Medicare. We examine the incidence of this implicit tax, the magnitude of tax avoidance efforts, and the extent of tax compliance. We find little evidence that the MSP rules affected the wages or employment of affected workers. We find weak evidence suggesting that the MSP shifted the composition of employment of older workers toward MSP-exempt jobs. We find strong evidence of low compliance with the MSP rules. Our results cast doubt on the efficacy of provisions designed to reduce crowd-out in new health insurance programs.

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Bibliographic Info

Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 6277.

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Date of creation: Nov 1997
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Publication status: published as Glied, Sherry and Mark Stabile. "Avoiding Health Insurance Crowd-Out: Evidence From The Medicare As Secondary Payer Legislation," Journal of Health Economics, 2001, v20(2,Mar), 239-260.
Handle: RePEc:nbr:nberwo:6277

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  1. Bruce D. Meyer, 1994. "Natural and Quasi- Experiments in Economics," NBER Technical Working Papers 0170, National Bureau of Economic Research, Inc.
  2. Jonathan Gruber & Alan Krueger, 1990. "The Incidence of Mandated Employer-Provided Insurance: Lessons from Workers' Compensations Insurance," Working Papers 659, Princeton University, Department of Economics, Industrial Relations Section..
  3. Orley Ashenfelter & Robert Smith, 1977. "Compliance with the Minimum Wage Law," Working Papers 478, Princeton University, Department of Economics, Industrial Relations Section..
  4. David M. Cutler & Jonathan Gruber, 1995. "Does Public Insurance Crowd Out Private Insurance?," NBER Working Papers 5082, National Bureau of Economic Research, Inc.
  5. David E. Bloom & Gilles Grenier, 1986. "Models of Firm Behavior Under Minimum Wage Legislation," NBER Working Papers 1877, National Bureau of Economic Research, Inc.
  6. Gruber, J. & Madrian, B.C., 1994. "Health Insurance Availability and the Retirement Decision," Working papers 94-04, Massachusetts Institute of Technology (MIT), Department of Economics.
  7. David Card & Alan Krueger, 1993. "Minimum Wages and Employment: A Case Study of the Fast Food Industry in New Jersey and Pennsylvania," Working Papers 694, Princeton University, Department of Economics, Industrial Relations Section..
  8. Poterba, James M & Venti, Steven F & Wise, David A, 1994. "Targeted Retirement Saving and the Net Worth of Elderly Americans," American Economic Review, American Economic Association, vol. 84(2), pages 180-85, May.
  9. Gruber, J., 1992. "State Mandated Benefits and Employer Provided Health Insurance," Working papers 92-18, Massachusetts Institute of Technology (MIT), Department of Economics.
  10. Gruber, Jonathan, 1994. "The Incidence of Mandated Maternity Benefits," American Economic Review, American Economic Association, vol. 84(3), pages 622-41, June.
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Cited by:
  1. Lo Sasso, Anthony T. & Buchmueller, Thomas C., 2004. "The effect of the state children's health insurance program on health insurance coverage," Journal of Health Economics, Elsevier, vol. 23(5), pages 1059-1082, September.
  2. Gopi Shah Goda & John Shoven & Sita Slavov, 2009. "A Tax On Work For The Elderly: Medicare As A Secondary Payer," Discussion Papers 08-60, Stanford Institute for Economic Policy Research.
  3. Amy Finkelstein, 2002. "The Interaction of Partial Public Insurance Programs and Residual Private Insurance Markets: Evidence from the U.S. Medicare Program," NBER Working Papers 9031, National Bureau of Economic Research, Inc.

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