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Tax Subsidies for Health Insurance: Evaluating the Costs and Benefits

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  • Jonathan Gruber

Abstract

The continued rise in the number of non-elderly Americans without health insurance has led to considerable interest in tax-based policies to raise the level of insurance coverage. This paper describes a detailed microsimulation model that has been developed to evaluate such tax-based polices, and its findings for the impact of polices on government costs and insurance coverage. I find that while tax subsidies could significantly increase insurance coverage, even very generous tax policies could not cover more than a sizable minority of the uninsured population. But there are several design features which can clearly make tax policy more effective: using tax credits rather than deductions; making credits refundable; and addressing the timing mismatch between when insurance purchases are made and tax refunds are received. I also document a clear tradeoff between the scope of tax subsidies and their efficiency.

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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 7553.

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Date of creation: Feb 2000
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Publication status: published as Gruber, Jonathan and Larry Levitt. "Tax Subsidies For Health Insurance: Costs And Benefits," Health Affairs, 2000, v19(1,Feb), 72-85.
Handle: RePEc:nbr:nberwo:7553

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  1. Jonathan Gruber, 1998. "Health Insurance and the Labor Market," NBER Working Papers 6762, National Bureau of Economic Research, Inc.
  2. Marquis, M. Susan & Long, Stephen H., 1995. "Worker demand for health insurance in the non-group market," Journal of Health Economics, Elsevier, vol. 14(1), pages 47-63, May.
  3. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-77, June.
  4. Farber, Henry S. & Levy, Helen, 2000. "Recent trends in employer-sponsored health insurance coverage: are bad jobs getting worse?," Journal of Health Economics, Elsevier, vol. 19(1), pages 93-119, January.
  5. David M. Cutler & Jonathan Gruber, 1995. "Does Public Insurance Crowd Out Private Insurance?," NBER Working Papers 5082, National Bureau of Economic Research, Inc.
  6. Jeffrey B. Liebman, 1998. "The Impact of the Earned Income Tax Credit on Incentives and Income Distribution," NBER Chapters, in: Tax Policy and the Economy, Volume 12, pages 83-120 National Bureau of Economic Research, Inc.
  7. David M. Cutler & Sarah Reber, 1996. "Paying for Health Insurance: The Tradeoff between Competition and Adverse Selection," NBER Working Papers 5796, National Bureau of Economic Research, Inc.
  8. Pauly, Mark V, 1986. "Taxation, Health Insurance, and Market Failure in the Medical Economy," Journal of Economic Literature, American Economic Association, vol. 24(2), pages 629-75, June.
  9. Royalty, Anne Beeson, 2000. "Tax preferences for fringe benefits and workers' eligibility for employer health insurance," Journal of Public Economics, Elsevier, vol. 75(2), pages 209-227, February.
  10. Shore-Sheppard, Lara & Buchmueller, Thomas C. & Jensen, Gail A., 2000. "Medicaid and crowding out of private insurance: a re-examination using firm level data," Journal of Health Economics, Elsevier, vol. 19(1), pages 61-91, January.
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Cited by:
  1. Jonathan Gruber, 2001. "Taxes and Health Insurance," NBER Working Papers 8657, National Bureau of Economic Research, Inc.
  2. McGarry, Kathleen, 2002. "Public Policy and the U.S. Health Insurance Market: Direct and Indirect Provision of Insurance," National Tax Journal, National Tax Association, vol. 55(4), pages 789-827, December.
  3. de Rassenfosse, Gaétan & van Pottelsberghe, Bruno, 2007. "Per un Pugno di Dollari: A first Look at the Price Elasticity of Patents," CEPR Discussion Papers 6499, C.E.P.R. Discussion Papers.
  4. Herring, Bradley, 2005. "The effect of the availability of charity care to the uninsured on the demand for private health insurance," Journal of Health Economics, Elsevier, vol. 24(2), pages 225-252, March.
  5. David W. Emmons & Eva Madly & Stephen A. Woodbury, 2005. "Refundable Tax Credits for Health Insurance: The Sensitivity of Simulated Impacts to Assumed Behavior," Upjohn Working Papers and Journal Articles 05-119, W.E. Upjohn Institute for Employment Research.
  6. Alan C. Monheit & Jessica Primoff Vistnes, 2006. "Health Insurance Enrollment Decisions: Preferences for Coverage, Worker Sorting, and Insurance Take Up," NBER Working Papers 12429, National Bureau of Economic Research, Inc.
  7. Jayanta Bhattacharya & William B. Vogt, 2006. "Employment and Adverse Selection in Health Insurance," NBER Working Papers 12430, National Bureau of Economic Research, Inc.
  8. Jeremiah Hurley & Rhema Vaithianathana & Thomas F. Crossley & Deborah Cobb-Clark, 2001. "Parallel Private Health Insurance in Australia: A Cautionary Tale and Lessons for Canada," Centre for Health Economics and Policy Analysis Working Paper Series 2001-12, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
  9. Jonathan Gruber & Michael Lettau, 2000. "How Elastic is the Firm's Demand for Health Insurance?," NBER Working Papers 8021, National Bureau of Economic Research, Inc.
  10. Jonathan Gruber, 2003. "Evaluating Alternative Approaches to Incremental Health-Insurance Expansion," American Economic Review, American Economic Association, vol. 93(2), pages 271-276, May.

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