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How Elastic is the Firm's Demand for Health Insurance?

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Author Info
Jonathan Gruber
Michael Lettau

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Abstract

We investigate the impact of tax subsidies on the firms decision to offer insurance, and on conditional firm spending on insurance. We do so using the micro-data underlying the Employee Compensation Index, which has a major advantage for this exercise: the matching of very high quality compensation data with information on a sample of workers in the firm. We find that, overall, there is a modest elasticity of insurance offering with respect to after-tax prices (elasticity of -0.31 to -0.41), but a larger elasticity of insurance spending (elasticity of 0.66 to 0.99). We also find that the elasticity of offering is driven solely by small firms, for whom the elasticity is much larger, but that spending is more elastic in large firms. We provide some evidence on how the aggregation of worker preferences determines benefits provision decisions. In particular, we find evidence to support a median voter model of benefits determination, along with some additional influence for the most highly compensated workers in the firm. Our simulation results suggest that major tax reform could lead to an enormous reduction in employer-provided health insurance spending.

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Publisher Info
Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 8021.

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Date of creation: Nov 2000
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Handle: RePEc:nbr:nberwo:8021

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Find related papers by JEL classification:
H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

References listed on IDEAS
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  1. Holmer, Martin, 1984. "Tax policy and the demand for health insurance," Journal of Health Economics, Elsevier, vol. 3(3), pages 203-221, December. [Downloadable!] (restricted)
  2. Jonathan Gruber & James M. Poterba, 1996. "Tax Subsidies to Employer-Provided Health Insurance," NBER Chapters, in: Empirical Foundations of Household Taxation, pages 135-168 National Bureau of Economic Research, Inc. [Downloadable!]
    Other versions:
  3. Jonathan Gruber, 2000. "Tax Subsidies for Health Insurance: Evaluating the Costs and Benefits," NBER Working Papers 7553, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  4. 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. [Downloadable!] (restricted)
  5. Woodbury, Stephen A & Hamermesh, Daniel S, 1992. "Taxes, Fringe Benefits and Faculty," The Review of Economics and Statistics, MIT Press, vol. 74(2), pages 287-96, May. [Downloadable!] (restricted)
    Other versions:
  6. Vroman, Susan & Anderson, Gerard, 1984. "The Effect of Income Taxation on the Demand for Employer-Provided Health Insurance," Applied Economics, Taylor and Francis Journals, vol. 16(1), pages 33-43, February.
  7. 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. [Downloadable!] (restricted)
  8. Gruber, Jonathan, 2000. "Health insurance and the labor market," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 12, pages 645-706 Elsevier. [Downloadable!] (restricted)
  9. Marquis, M Susan & Phelps, Charles E, 1987. "Price Elasticity and Adverse Selection in the Demand for Supplementary Health Insurance," Economic Inquiry, Oxford University Press, vol. 25(2), pages 299-313, April.
  10. Long, James E & Scott, Frank A, 1982. "The Income Tax and Nonwage Compensation," The Review of Economics and Statistics, MIT Press, vol. 64(2), pages 211-19, May. [Downloadable!] (restricted)
  11. 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. [Downloadable!] (restricted)
  12. William M. Gentry & Eric Peress, 1994. "Taxes and Fringe Benefits Offered by Employers," NBER Working Papers 4764, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  13. Martin Feldstein & James M. Poterba, 1996. "Empirical Foundations of Household Taxation," NBER Books, National Bureau of Economic Research, Inc, number feld96-1.
  14. Jonathan Gruber & Robin McKnight, 2002. "Why Did Employee Health Insurance Contributions Rise?," NBER Working Papers 8878, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  15. Jonathan Gruber, 1998. "Health Insurance and the Labor Market," NBER Working Papers 6762, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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Cited by:
(explanations, Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.)

  1. Steven F. Lehrer & Nuno Sousa Pereira, 2008. "Worker Sorting, Health Insurance and Wages: Further Evidence from Displaced Workers in the United States," CETE Discussion Papers 0804, Universidade do Porto, Faculdade de Economia do Porto. [Downloadable!]
  2. Karsten Jeske & Sagiri Kitao, 2007. "U.S. tax policy and health insurance demand: can a regressive policy improve welfare?," Working Paper 2007-13, Federal Reserve Bank of Atlanta. [Downloadable!]
    Other versions:
  3. Stan McMillen & Kathryn Parr & Xiumei Song & Brian Baird, 2004. "The Kerry-Bush Health Care Proposals: A Characterization and Comparison of their Impacts on Connecticut (Technical Appendix)," CCEA Studies 2004-06, University of Connecticut, Connecticut Center for Economic Analysis. [Downloadable!]
  4. Judith Shinogle & David Salkever, 2005. "Firms' Demand for Employment-Based Mental Health Benefits," NBER Working Papers 11436, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  5. 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. [Downloadable!] (restricted)
  6. Jonathan Gruber, 2004. "Tax Policy for Health Insurance," NBER Working Papers 10977, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
    Other versions:
  7. Marisol Rodriguez & Alexandrina Stoyanova, 2008. "Changes in the demand for private medical insurance following a shift in tax incentives," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 185-202. [Downloadable!]
  8. Steven F. Lehrer & Nuno Sousa Pereira, 2007. "Worker Sorting, Compensating Differentials and Health Insurance: Evidence from Displaced Workers," NBER Working Papers 12951, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
    Other versions:
  9. Laura Bucila, 2008. "Employment-Based Health Insurance and the Minimum Wage," Working Papers 0812, College of the Holy Cross, Department of Economics. [Downloadable!]
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