IDEAS home Printed from https://ideas.repec.org/a/ucp/tpolec/doi10.1086-734959.html
   My bibliography  Save this article

The Distributional Implications of Itemized Medical Deductions

Author

Listed:
  • Gopi Shah Goda
  • Ithai Lurie
  • Priyanka Parikh
  • Chelsea Swete

Abstract

Approximately $76 billion in out-of-pocket medical spending was deducted as an itemized medical deduction in 2021, resulting in about $9 billion in federal forgone tax revenue. We use data from US tax returns to examine how these tax savings are distributed across income and age, how the distributions differ from the mortgage interest deduction, and how the distributions changed with the 2017 Tax Cuts and Jobs Act. Although a given level of medical spending is less likely to be above the income threshold for higher-income households, itemization rates and marginal tax rates increase with income, resulting in tax savings skewed toward higher-income taxpayers: 94% of the tax savings accrue to those in the top half of the income distribution. The tax savings are also highly concentrated at older ages, with 42% accruing to those over age 65. Using rich survey data on out-of-pocket medical spending, we illustrate how the distribution of tax savings varies across policy alternatives. We find that expanding eligibility for the tax subsidy would likely reduce the concentration of tax savings at higher incomes and increase the concentration of tax benefits at older ages.

Suggested Citation

  • Gopi Shah Goda & Ithai Lurie & Priyanka Parikh & Chelsea Swete, 2025. "The Distributional Implications of Itemized Medical Deductions," Tax Policy and the Economy, University of Chicago Press, vol. 39(1), pages 1-28.
  • Handle: RePEc:ucp:tpolec:doi:10.1086/734959
    DOI: 10.1086/734959
    as

    Download full text from publisher

    File URL: http://dx.doi.org/10.1086/734959
    Download Restriction: Access to the online full text or PDF requires a subscription.

    File URL: http://dx.doi.org/10.1086/734959
    Download Restriction: Access to the online full text or PDF requires a subscription.

    File URL: https://libkey.io/10.1086/734959?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Gopi Shah Goda, 2024. "Subsidizing Medical Spending through the Tax Code: Take-Up, Targeting and the Cost of Claiming," NBER Working Papers 33213, National Bureau of Economic Research, Inc.
    2. Daniel Feenberg & Elisabeth Coutts, 1993. "An introduction to the TAXSIM model," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 12(1), pages 189-194.
    3. Feenberg, Daniel & Skinner, Jonathan, 1994. "The Risk and Duration of Catastrophic Health Care Expenditures," The Review of Economics and Statistics, MIT Press, vol. 76(4), pages 633-647, November.
    4. Dawkins, Casey J., 2023. "The geography of US homeownership tax expenditures," Journal of Housing Economics, Elsevier, vol. 59(PA).
    5. Blouri, Yashar & Büchler, Simon & Schöni, Olivier, 2023. "The geography of mortgage interest deductions," Journal of Urban Economics, Elsevier, vol. 138(C).
    6. Wenli Li & Edison Yu, 2020. "Real Estate Taxes and Home Value: Winners and Losers of TCJA," Working Papers 20-12, Federal Reserve Bank of Philadelphia.
    7. David Splinter, 2019. "The Mortgage Interest Deduction: Causes of Fluctuations in a Procyclical Tax Expenditure," Public Finance Review, , vol. 47(5), pages 807-827, September.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Brent W. Ambrose & Patric H. Hendershott & David C. Ling & Gary A. McGill, 2022. "Homeownership and taxes: How the TCJA altered the tax code's treatment of housing," Real Estate Economics, American Real Estate and Urban Economics Association, vol. 50(5), pages 1167-1200, September.
    2. Maxence Valentin, 2024. "Subsidizing housing with deductions," Journal of Economic Surveys, Wiley Blackwell, vol. 38(4), pages 1490-1515, September.
    3. David Rodríguez-Guerrero, 2019. "Política fiscal, pobreza y desigualdad: un modelo de microsimulación para Colombia," Ensayos de Economía 17544, Universidad Nacional de Colombia Sede Medellín.
    4. Elira Kuka, 2020. "Quantifying the Benefits of Social Insurance: Unemployment Insurance and Health," The Review of Economics and Statistics, MIT Press, vol. 102(3), pages 490-505, July.
    5. Sayeh S. Nikpay, 2020. "Entrepreneurship And Job Lock: The Interaction Between Tax Subsidies And Health Insurance Regulations," Contemporary Economic Policy, Western Economic Association International, vol. 38(1), pages 30-47, January.
    6. Colas, Mark & Saulnier, Emmett, 2023. "Vertical migration externalities," Regional Science and Urban Economics, Elsevier, vol. 101(C).
    7. Mariacristina De Nardi & Eric French & John B. Jones, 2010. "Why Do the Elderly Save? The Role of Medical Expenses," Journal of Political Economy, University of Chicago Press, vol. 118(1), pages 39-75, February.
    8. Khorunzhina, Natalia, 2013. "Structural estimation of stock market participation costs," Journal of Economic Dynamics and Control, Elsevier, vol. 37(12), pages 2928-2942.
    9. James M. Poterba & Arturo Ramirez Verdugo, 2008. "Portfolio Substitution and the Revenue Cost of Exempting State and Local Government Interest Payments from Federal Income Tax," NBER Working Papers 14439, National Bureau of Economic Research, Inc.
    10. Charles Grant & Christos Koulovatianos & Alexander Michaelides & Mario Padula, 2010. "Evidence on the Insurance Effect of Redistributive Taxation," The Review of Economics and Statistics, MIT Press, vol. 92(4), pages 965-973, November.
    11. Bruch, Sarah K. & van der Naald, Joseph & Gornick, Janet C., 2022. "Poverty Reduction through Federal and State Policy Mechanisms: Variation Over Time and Across the U.S. States," SocArXiv jz5xp, Center for Open Science.
    12. East, Chloe N. & Kuka, Elira, 2015. "Reexamining the consumption smoothing benefits of Unemployment Insurance," Journal of Public Economics, Elsevier, vol. 132(C), pages 32-50.
    13. Haurin, Donald R. & Gill, H. Leroy, 2002. "The Impact of Transaction Costs and the Expected Length of Stay on Homeownership," Journal of Urban Economics, Elsevier, vol. 51(3), pages 563-584, May.
    14. Antonia Diaz & Maria Jose Luengo Prado, 2008. "On the User Cost and Homeownership," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 11(3), pages 584-613, July.
    15. Richard G. Newell & Juha Siikamäki, 2014. "Nudging Energy Efficiency Behavior: The Role of Information Labels," Journal of the Association of Environmental and Resource Economists, University of Chicago Press, vol. 1(4), pages 555-598.
    16. Ed Westerhout & Kees Folmer, 2007. "Co-payment systems in health care; between moral hazard and risk reduction," CPB Discussion Paper 78.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
    17. Anagnostopoulos, Alexis & Cárceles-Poveda, Eva & Lin, Danmo, 2012. "Dividend and capital gains taxation under incomplete markets," Journal of Monetary Economics, Elsevier, vol. 59(7), pages 599-611.
    18. Bruno Lanz & Sebastian Rausch, 2016. "Emissions Trading in the Presence of Price-Regulated Polluting Firms: How Costly Are Free Allowances?," The Energy Journal, , vol. 37(1), pages 195-232, January.
    19. Dr. Belkacem Laabas , Dr. Weshah Razzak, "undated". "Taxes, Natural Resource Endowment, and the Supply of Labor: New Evidence," API-Working Paper Series 1005, Arab Planning Institute - Kuwait, Information Center.
    20. Galasso, Alberto & Schankerman, Mark & Serrano, Carlos J., 2011. "Trading and enforcing patent rights," LSE Research Online Documents on Economics 121732, London School of Economics and Political Science, LSE Library.

    More about this item

    JEL classification:

    • H22 - Public Economics - - Taxation, Subsidies, and Revenue - - - Incidence
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:ucp:tpolec:doi:10.1086/734959. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Journals Division (email available below). General contact details of provider: https://www.journals.uchicago.edu/TPE .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.