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Externalities and Taxation of Supplemental Insurance: A Study of Medicare and Medigap

  • Marika Cabral
  • Neale Mahoney
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    Most health insurance uses cost-sharing to reduce excess utilization. Supplemental insurance can blunt the impact of this cost-sharing, increasing utilization and exerting a negative externality on the primary insurer. This paper estimates the effect of private Medigap supplemental insurance on public Medicare spending using Medigap premium discontinuities in local medical markets that span state boundaries. Using administrative data on the universe of Medicare beneficiaries, we estimate that Medigap increases an individual’s Medicare spending by 22.2%. We calculate that a 15% tax on Medigap premiums generates savings of $12.9 billion annually. A Pigouvian tax generates annual savings of $31.6 billion.

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    Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 19787.

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    Date of creation: Jan 2014
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    Handle: RePEc:nbr:nberwo:19787
    Note: AG HC HE PE
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    1. M. Kate Bundorf & Jonathan D. Levin & Neale Mahoney, 2008. "Pricing and Welfare in Health Plan Choice," NBER Working Papers 14153, National Bureau of Economic Research, Inc.
    2. Wolfe, John R. & Goddeeris, John H., 1991. "Adverse selection, moral hazard, and wealth effects in the medigap insurance market," Journal of Health Economics, Elsevier, vol. 10(4), pages 433-459.
    3. Chetty, Raj & Friedman, John Norton & Hilger, Nathanial & Saez, Emmanuel & Schanzenbach, Dianne Whitmore & Yagan, Danny, 2011. "How Does Your Kindergarten Classroom Affect Your Earnings? Evidence from Project Star," Scholarly Articles 9639983, Harvard Kennedy School of Government.
    4. Hanming Fang & Michael P. Keane & Dan Silverman, 2006. "Sources of Advantageous Selection: Evidence from the Medigap Insurance Market," NBER Working Papers 12289, National Bureau of Economic Research, Inc.
    5. Jeffrey Clemens & Joshua D. Gottlieb, 2012. "Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?," Discussion Papers 11-017, Stanford Institute for Economic Policy Research.
    6. Amanda E. Kowalski, 2009. "Censored Quantile Instrumental Variable Estimates of the Price Elasticity of Expenditure on Medical Care," NBER Working Papers 15085, National Bureau of Economic Research, Inc.
    7. Chandra, Amitabh & Gruber, Jonathan & McKnight, Robin, 2009. "Patient Cost-Sharing and Hospitalization Offsets in the Elderly," Scholarly Articles 8058412, Harvard Kennedy School of Government.
    8. Ettner, Susan L., 1997. "Adverse selection and the purchase of Medigap insurance by the elderly," Journal of Health Economics, Elsevier, vol. 16(5), pages 543-562, October.
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