Marquis M S, Buchanan J L
RAND, Washington, DC 20037-1270.
JAMA. 1994;271(12):939-44.
To understand how changes in federal taxation of and employer contributions to health insurance benefits affect the decisions of firms to offer insurance, the willingness of households to purchase different health plans, and the resultant health expenditures.
Economic policy simulation.
Secondary data analysis.
A total of 18,343 sampled families (representing 77 million total families throughout the United States) with a working household head from the 1988 Current Population Survey who were not covered by either Medicare, Medicaid, or CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) insurance.
One intervention limits the amounts of tax-free employer contributions to health insurance premiums to 80% of our estimate of the base plan in the market and assumes that employer contributions will also be limited to this maximum. A second intervention eliminates the favorable tax treatment of employer-paid premiums altogether and assumes that employees will pay the full price of insurance.
Change in the number of working families offered employment-based insurance, change in insurance plan choice, and change in medical spending.
Capping the favorable tax treatment and employer contributions decreases the number of families offered employment-based insurance by approximately 91,000, increases the number of families selecting the least generous insurance plan from 20% under the current situation to 33%, and reduces overall health spending by less than 2%. By eliminating the tax exemption altogether, the number of families offered employment-based insurance decreases by approximately half a million families, the number of families selecting the least generous plan goes from 20% to 40%, and overall spending falls by about $16 billion.
Eliminating the tax subsidy and limiting employer-paid contributions to the low-cost plan substantially increases the number of low-income uninsured under a voluntary insurance system, decreases overall spending only modestly, but would raise tax revenues by $36 billion. These tax revenues could be used to assist low-income families to obtain insurance coverage.
了解联邦对医疗保险福利征税的变化以及雇主对医疗保险福利的贡献如何影响公司提供保险的决策、家庭购买不同健康计划的意愿以及由此产生的医疗支出。
经济政策模拟。
二次数据分析。
来自1988年《当前人口调查》的18343个抽样家庭（代表美国7700万个家庭），户主有工作，且未参加医疗保险、医疗补助或军队医疗保健计划（统一服务的平民健康和医疗计划）。
一项干预措施将雇主对医疗保险费的免税贡献额限制在我们对市场基本计划估计值的80%，并假设雇主贡献也将限制在这一最大值。第二项干预措施完全取消雇主支付保费的优惠税收待遇，并假设员工将支付保险的全部费用。
提供基于就业的保险的在职家庭数量变化、保险计划选择变化和医疗支出变化。
限制优惠税收待遇和雇主贡献使获得基于就业的保险的家庭数量减少约91000个，选择最不慷慨保险计划的家庭数量从当前的20%增加到33%，总体医疗支出减少不到2%。完全取消免税后，获得基于就业的保险的家庭数量减少约50万个，选择最不慷慨计划的家庭数量从20%增至40%，总体支出下降约160亿美元。
在自愿保险制度下，取消税收补贴并将雇主支付的贡献限制在低成本计划上，会大幅增加低收入未参保者的数量，仅适度降低总体支出，但会增加360亿美元的税收收入。这些税收收入可用于帮助低收入家庭获得保险覆盖。
