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The impact of state tax subsidies for private long-term care insurance on coverage and Medicaid expenditures

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  • Goda, Gopi Shah

Abstract

In spite of the large expected costs of needing long-term care, only 10–12% of the elderly population has private insurance coverage. Medicaid, which provides means-tested public assistance and pays for almost half of long-term care costs, spends more than $100billion annually on long-term care. In this paper, I exploit variation in the adoption and generosity of state tax subsidies for private long-term care insurance to determine whether tax subsidies increase private coverage and reduce Medicaid's costs for long-term care. The results indicate that the average tax subsidy raises coverage rates by 2.7 percentage points, or 28%. However, the response is concentrated among high income and asset-rich individuals, populations with low probabilities of relying on Medicaid. Simulations suggest each dollar of state tax expenditure produces approximately $0.84 in Medicaid savings, over half of which funnels to the federal government.

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  • Goda, Gopi Shah, 2011. "The impact of state tax subsidies for private long-term care insurance on coverage and Medicaid expenditures," Journal of Public Economics, Elsevier, vol. 95(7), pages 744-757.
  • Handle: RePEc:eee:pubeco:v:95:y:2011:i:7:p:744-757
    DOI: 10.1016/j.jpubeco.2010.11.001
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    Cited by:

    1. Martin Boyer & Philippe De Donder & Claude Fluet & Marie-Louise Leroux & Pierre-Carl Michaud, 2017. "Long-Term Care Insurance: Knowledge Barriers, Risk Perception and Adverse Selection," NBER Working Papers 23918, National Bureau of Economic Research, Inc.
    2. Jeffrey R. Brown & Amy Finkelstein, 2011. "Insuring Long-Term Care in the United States," Journal of Economic Perspectives, American Economic Association, vol. 25(4), pages 119-142, Fall.
    3. Savannah Bergquist & Joan Costa-i-Font & Katherine Swartz, 2015. "Long Term Care Partnerships: Are they 'Fit for Purpose'?," CESifo Working Paper Series 5155, CESifo Group Munich.
    4. Anirban Basu & Norma Coe & Cole G. Chapman, 2017. "Comparing 2SLS vs 2SRI for Binary Outcomes and Binary Exposures," NBER Working Papers 23840, National Bureau of Economic Research, Inc.
    5. Lin, Haizhen & Prince, Jeffrey, 2013. "The impact of the partnership long-term care insurance program on private coverage," Journal of Health Economics, Elsevier, vol. 32(6), pages 1205-1213.
    6. Norma B. Coe & Gopi Shah Goda & Courtney Harold Van Houtven, 2015. "Family Spillovers of Long-Term Care Insurance," NBER Working Papers 21483, National Bureau of Economic Research, Inc.
    7. Haizhen Lin & Jeffrey T. Prince, 2012. "The Impact of the Partnership Long-term Care Insurance Program on Private Coverage and Medicaid Expenditures," Working Papers 2012-01, Indiana University, Kelley School of Business, Department of Business Economics and Public Policy.
    8. Lee M. Lockwood, 2014. "Incidental Bequests and the Choice to Self-Insure Late-Life Risks," NBER Working Papers 20745, National Bureau of Economic Research, Inc.
    9. Martín Caruso & Sebastian Galiani & Pablo Ibarrarán, 2017. "Long-Term Care in Latin America and the Caribbean? Theory and Policy Considerations," NBER Working Papers 23797, National Bureau of Economic Research, Inc.
    10. Coe, Norma B. & Skira, Meghan M. & Van Houtven, Courtney Harold, 2015. "Long-term care insurance: Does experience matter?," Journal of Health Economics, Elsevier, vol. 40(C), pages 122-131.
    11. John Ameriks & Joseph Briggs & Andrew Caplin & Matthew D. Shapiro & Christopher Tonetti, 2016. "Late-in-Life Risks and the Under-Insurance Puzzle," NBER Working Papers 22726, National Bureau of Economic Research, Inc.
    12. Jaspersen, Johannes G. & Richter, Andreas, 2015. "The wealth effects of premium subsidies on moral hazard in insurance markets," European Economic Review, Elsevier, vol. 77(C), pages 139-153.
    13. Thomas Buchmueller & John C. Ham & Lara D. Shore-Sheppard, 2015. "The Medicaid Program," NBER Chapters,in: Economics of Means-Tested Transfer Programs in the United States, volume 1, pages 21-136 National Bureau of Economic Research, Inc.
    14. Agustin Redonda, 2016. "Tax Expenditures and Sustainability. An Overview," Discussion Notes 1603, Council on Economic Policies.
    15. Unruh Mark A. & Stevenson David G. & Frank Richard G. & Cohen Marc A. & Grabowski David C., 2016. "Demand-Side Factors Associated with the Purchase of Long-Term Care Insurance," Forum for Health Economics & Policy, De Gruyter, vol. 19(1), pages 23-43, June.
    16. Jeffrey Brown & Amy Finkelstein, 2011. "Insuring Long Term Care In the US," NBER Working Papers 17451, National Bureau of Economic Research, Inc.

    More about this item

    Keywords

    Long-term care insurance; Tax incentives; Medicaid; Price elasticity; Fiscal impact;

    JEL classification:

    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • H31 - Public Economics - - Fiscal Policies and Behavior of Economic Agents - - - Household
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H71 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Taxation, Subsidies, and Revenue
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs
    • J14 - Labor and Demographic Economics - - Demographic Economics - - - Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination

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