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Implicit Budget Deficits: The Case of a Mandated Shift to Community-Rated Health Insurance

In: Tax Policy and the Economy, Volume 11


  • David F. Bradford
  • Derrick A. Max


Since a typical regulatory mandate can be equated in its economic effect to a combination of an expenditure program and a tax program, observers have often suggested that it would serve consistent public policy to bring regulatory decisions into the same budgetary framework. This paper concerns an important example of a regulatory program that would mimic deficit financing in effecting a transfer of fiscal burdens toward younger and future generations, the mandated purchase of (or provision by employers of) health care insurance under a system of community rating, under which the same price is charged for health insurance for all comers, regardless of age, sex, or health condition. Such a shift would result in redistributions of burdens across birth cohorts, in this case from existing, especially middle-aged birth cohorts toward future generations. Using data from a variety of sources we conclude the effect would be substantial. For our central-case assumptions about discount, health care cost, and productivity growth rates, and about the locus of responsibility for paying health care bills, a shift to community rating is estimated to generate gains for people over age 30 in 1994, $16,700 per person aged 50 for example, at the cost to younger cohorts. Those born in 1994 would acquire an extra payment obligation with a discounted value of $7,100 each. The burden passed along to future generations can be described by a $9,300 per capita tax at birth (growing with productivity). The analysis makes clear that the regula- tory policy shift, with no direct budgetary implications, would have an intergenerational transfer effect comparable to what would be considered a major change in on-budget tax or transfer programs.
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  • David F. Bradford & Derrick A. Max, 1997. "Implicit Budget Deficits: The Case of a Mandated Shift to Community-Rated Health Insurance," NBER Chapters,in: Tax Policy and the Economy, Volume 11, pages 129-168 National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberch:10907

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    References listed on IDEAS

    1. Gruber, Jonathan, 1994. "The Incidence of Mandated Maternity Benefits," American Economic Review, American Economic Association, vol. 84(3), pages 622-641, June.
    2. Baumol, William J, 1993. "Health Care, Education and the Cost Disease: A Looming Crisis for Public Choice," Public Choice, Springer, vol. 77(1), pages 17-28, September.
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    Cited by:

    1. David F. Bradford, 2001. "Reforming Budgetary Language," Working Papers 128, Princeton University, Department of Economics, Center for Economic Policy Studies..
    2. Yu, Tiffany Hui-Kuang & Wang, David Han-Min & Wu, Kuo-Lun, 2015. "Reexamining the red herring effect on healthcare expenditures," Journal of Business Research, Elsevier, vol. 68(4), pages 783-787.
    3. Tadashi Fukui & Yasushi Iwamoto, 2006. "Policy Options for Financing the Future Health and Long-term Care Costs in Japan," CIRJE F-Series CIRJE-F-432, CIRJE, Faculty of Economics, University of Tokyo.

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