Saltzman Evan A, Eibner Christine, Enthoven Alain C
Evan A. Saltzman (
Christine Eibner is a senior economist at the RAND Corporation in Arlington, Virginia.
Health Aff (Millwood). 2015 Dec;34(12):2095-103. doi: 10.1377/hlthaff.2015.0209.
A key challenge of health reform efforts is to make health insurance affordable for individuals and families who lack coverage without harming those with coverage or increasing federal spending. The Affordable Care Act (ACA) addresses this challenge in part by providing tax subsidies to qualified individuals for purchasing individual insurance and retaining tax exemptions for employer and employee contributions to the cost of premiums of employer-sponsored insurance. These tax exemptions cost approximately $250 billion annually in lost tax revenue and have been criticized for favoring higher earners and conferring preferential treatment of employer-sponsored over individual insurance. We analyzed three options for leveling the financial playing field between the two insurance markets by reallocating the value of tax benefits of employer coverage. We found that one option that uses the subsidy formula employed in the insurance Marketplaces under the ACA for both the individual and employer-sponsored insurance markets, and additionally requires the subsidy to be at least $1,250 without an upper income limit on subsidy eligibility imposed, could expand insurance coverage and reduce individual market premiums relative to the ACA with no additional federal spending.
医疗改革努力面临的一个关键挑战是,在不损害已有医保覆盖人群利益或不增加联邦支出的情况下,让缺乏医保覆盖的个人和家庭能够负担得起医疗保险。《平价医疗法案》(ACA)部分地应对了这一挑战,它向符合条件的个人提供税收补贴以购买个人保险,并保留对雇主和雇员为雇主提供的保险保费成本所做贡献的免税政策。这些免税政策每年造成约2500亿美元的税收损失,并且因偏袒高收入者以及给予雇主提供的保险相对于个人保险的优惠待遇而受到批评。我们分析了三种通过重新分配雇主医保税收优惠的价值来平衡两个保险市场之间财务竞争环境的方案。我们发现,其中一种方案是在个人保险市场和雇主提供的保险市场中都采用《平价医疗法案》下保险市场所使用的补贴公式,并且另外要求补贴至少为1250美元,不对补贴资格设置收入上限,这样相对于《平价医疗法案》而言,在不增加额外联邦支出的情况下,可以扩大保险覆盖范围并降低个人市场保费。