Effectiveness of tax credits for health insurance premium: Evidence from the health insurance tax credit

With the push to repeal the Affordable Care Act, there is renewed interest in using tax credits to increase health insurance coverage. Another tax credit‐driven policy, the Health Insurance Tax Credit (HITC), was implemented during 1991–1993. To date, only one paper has analyzed the effectiveness of the HITC on coverage rates. In this paper, I reexamine the effectiveness of the HITC by using the Survey of Income Program Participation and provide the first estimates of its effects on utilization and self‐reported health status. Despite using the different data set, I find a similar result regarding coverage as the previous paper—the effect of the HITC was about 5.8 percentage points. I also find that self‐reported health was significantly improved because of the HITC. I conclude by discussing the implications of these findings on the larger debate regarding current health care reform.     

The impact of the tax system on health insurance coverage

A central question in health economics is the extent to which this tax subsidization matters for the health insurance coverage of the U.S. population. I assess the impact of taxes on health insurance by using the considerable existing variation in tax subsidies, both at a point in time and across time. I do so by putting together data from more than a decade of Current Population Survey (CPS) data sets, and matching to workers in those data sets their tax subsidies to health insurance coverage. I find that the elasticity of insurance eligibility of workers is at least –0.6, and that the elasticity of own insurance coverage is roughly similar; the results imply that most of the impact of taxes on insurance coverage arise through firm offering and eligibility decisions. I also find that higher tax rates induce more private coverage through other sources, but less public coverage, so that overall there is a reduction in the rate of uninsurance that is comparable to the change in own employer-provided insurance coverage.     

Health insurance theory: the case of the missing welfare gain

An important source of value is missing from the conventional welfare analysis of moral hazard, namely, the effect of income transfers (from those who purchase insurance and remain healthy to those who become ill) on purchases of medical care. Income transfers are contained within the price reduction that is associated with standard health insurance. However, in contrast to the income effects contained within an exogenous price decrease, these income transfers act to shift out the demand for medical care. As a result, the consumer’s willingness to pay for medical care increases and the resulting additional consumption is welfare increasing.     

Alternative health insurance schemes: a welfare comparison

In this paper, we present a simple model of health insurance with asymmetric information, where we compare two alternative ways of organizing the insurance market. Either as a competitive insurance market, where some risks remain uninsured, or as a compulsory scheme, where however, the level of reimbursement of loss is to be determined by majority decision. In a simple welfare comparison, the compulsory scheme may in certain environments yield a solution which is inferior to that obtained in the market. We further consider the situation where the compulsory scheme may be supplemented by voluntary competitive insurance; this situation turns out to be at least as good as either of the alternatives.     

The dynamics of health insurance coverage: identifying trigger events for insurance loss and gain

By linking consecutive years of the 1996–2004 Current Population Survey (CPS), we create new estimates of annual transitions into and out of health insurance coverage. Using the matched CPS panel data, we explore the dynamic factors—including job loss, changes in hours or weeks worked, and movement between firm sizes—associated with health insurance loss and gain. Job loss is strongly associated with losing insurance, whereas becoming reemployed is only weakly associated with gaining insurance. Movement down (up) in employment size is associated with insurance loss (gain), but movement to employers with fewer than 10 employees is associated with especially high rates of loss. Changes in hours or weeks worked and employment type are also strongly associated with insurance transitions.

医疗保险总额预付制对医院的影响及对策

分析了上海市医疗保险局自2009年在三级医院开始"医疗保险总额预付制"试点工作以来,总额预付制对医院的影响,提出了医院应及时转变观念,从提高医疗质量、加强成本核算、实现医疗保险管理信息化及精细化等方面着手,科学合理地控制费用,主动适应和推进医疗改革的进程.

Abstract：

The paper analyzed the impact of the trial for "lump-sum prepayment practice of medical insurance" on tertiary hospitals in Shanghai initiated by Shanghai Medical Insurance Bureau since 2009. Based on the analysis, the authors recommended that the hospitals should adapt to the changes by raising quality of care, improving cost accounting, informationizing and refining medical insurance information management, as well as controlling expenses on a rational basis. These approaches will help them adapt to and promote the ongoing health reform in China.     

State welfare reform policies and declines in health insurance

OBJECTIVES: This study sought to determine whether there is a relationship between state policies on Temporary Assistance to Needy Families (TANF), declines in both TANF and Medicaid caseloads, and the rise in the number of uninsured. METHODS: Extant data sources of state TANF policies, TANF and Medicaid participation, and uninsurance rates were analyzed, with the state as the unit of analysis. The independent variables included state TANF policies that directly address receipt of benefits or relate to health; dependent variables included changes in state TANF enrollment, Medicaid enrollment, and health insurance status since the enactment of the law. RESULTS: In the bivariate analysis, declines in Medicaid were associated with sanction for work noncompliance, lack of a child care guarantee, and strategies to deter TANF enrollment; this last factor was also associated with increased uninsurance. In the multivariate analysis, lack of a child care guarantee and deterrent strategies predicted TANF declines; deterrent strategies predicted Medicaid decline and uninsurance increases. CONCLUSIONS: This analysis suggests that policies deterring TANF enrollment may contribute to declines in Medicaid and increased uninsurance. To maintain health insurance for the poor, policymakers should consider revising policies that deter TANF enrollment.     

医保总额预付制对医院的影响和对策

总额预付制在我国医疗保险领域普遍推行是一个不可避免的大趋势,其实推行带给医院的影响和变化是巨大的,医院要改革管理,积极应对,以实现医、保、患共赢。     

“营改增”对公立医院的实际税负影响实证分析

通过对实际税负率的计算,测算公立医院的税负水平。结果发现公立医院增值税税负率上下波动,节税效果不理想。建议公立医院应多方面努力,抑制不减反增情况,做好税收筹划工作。     

Planning for and securing health insurance in the context of welfare reform

Previous research indicates that 25% to 50% of former Temporary Assistance to Needy Families (TANF) recipients and approximately 15% to 30% of their children become uninsured after the expiration of the one-year transitional Medicaid coverage they receive when leaving welfare. Using data from 90 face-to-face interviews, this paper explores the expectations, plans, and coping strategies of TANF leavers in Oregon who are in the middle of this year of transitional coverage. The paper examines (1) the information available to these individuals, (2) their planning and expectations about securing health insurance, and (3) their perceptions of opportunities for obtaining jobs that provide insurance. The paper shows that while TANF leavers often assume their Medicaid coverage will continue after the transitional year, many lack complete information about this. Many respondents have no active plans for securing health insurance. Even those who do have sufficient information to plan for the end of the transitional year may find themselves having to make stark choices (e.g., sacrificing income in order to keep coverage). Policy recommendations are presented.     

The effects of state‐level earned income tax credits on suicides

This study examines the relationship between state‐level earned income tax credit (EITC) laws in the United States on suicides. Following findings in previous work showing that the EITC is associated with lower depression rates and reduced number of risky biomarkers, I estimated the effects of state EITC generosity on suicide rates. Using data for the years 1996 to 2016, a period with 74 state‐level EITC policy changes, I find that introducing a high state EITC rate reduces suicide rates for adults aged 25 or above by 3.91%. The results are consistent across four different measures of EITC generosity.     

Relationships between welfare status,health insurance status,and health and medical care among children with asthma

OBJECTIVES: This study evaluated the relationships between health insurance and welfare status and the health and medical care of children with asthma. METHODS: Parents of children with asthma aged 2 to 12 years were interviewed at 6 urban clinical sites and 2 welfare offices. RESULTS: Children whose families had applied for but were denied welfare had more asthma symptoms than did children whose families had had no contact with the welfare system. Poorer mental health in parents was associated with more asthma symptoms and higher rates of health care use in their children. Parents of uninsured and transiently insured children identified more barriers to health care than did parents whose children were insured. CONCLUSIONS: Children whose families have applied for welfare and children who are uninsured are at high risk medically and may require additional services to improve health outcomes.     

The influence of health insurance towards accessing essential medicines: The experience from Shenzhen labor health insurance

ObjectivesDue to major problems of accessing essential medicines, this paper will evaluate the impact of the new Shenzhen labor health insurance on accessing essential medicines among migrant workers.MethodsMedicines data and revenues–expenditures reports from 19 community health service centers in Shenzhen city were collected. Insurance indicators within two periods before and after 1st June 2006 were compared. Paired t-tests using month-values of indicators were performed. P value <0.05 considered statistically significant.ResultsThe proportion of EMs in Medicine List of Shenzhen Labor health insurance is 88.5%. For each period, percentage costs of EM procured (P_eem) was 43.1% and increased to 46.1%; costs of medicines per outpatient visit (E_mpv) was 24.94 RMB and decreased to 22.20 RMB; percentage costs of medicine per outpatient visit (P_e) were 49.1% and decreased to 45.9%; number of outpatient visits (N_ov) was 428,328 and increased to 490,305. Values of t for differences in P_eem, E_mpv, P_e and N_ov between the two periods were −1.125 (P = 0.285), 3.096 (P = 0.010), 1.458 (P = 0.173) and −2.069 (P = 0.063), respectively.ConclusionsShenzhen labor health insurance had improved accessibility to EMs for migrant workers, and ensured for them basic health services. Popularization of this insurance will benefit more people.