essays in public finance and industrial organization a dissertation ...

More documents

Recommendations

Info

CHAPTER 3. MEDIGAP 137 from the baseline and restricted sample. The full model estimates are slightly lower (0.42 versus 0.57) although the ratio of full model to OLS estimates is very similar across samples. A possible reason for the lower full model and OLS estimates in the restricted sample is that the excluded states, which include states notorious for the overuse of medical services (e.g., FL, NY, TX), are states where the moral hazard from Medigap may be the largest. The premium semi-elasticity of demand estimates, which are potentially the most susceptible to bias from within-state premium variation, are almost identical across the restricted and baseline samples. 3.7 Policy Counterfactuals Having shown that private Medigap insurance increases medical utilization and thus Medicare costs by as much as 59 percent, it seems natural to consider corrective tax- ation. The idea of taxing Medigap premiums is not new. In their 2008 chapter of budget options for health care, for example, the Congressional Budget Office (CBO) considered a 5 percent excise tax on Medigap premiums as a mechanism to reduce the federal deficit. As CBO pointed out, an excise tax on Medigap premiums would reduce the deficit through two main channels: it would raise revenue from individuals who maintained their Medigap coverage while at the same time reducing Medicare costs for people who gave up their supplemental coverage. Yet the CBOs calculations of the taxs impact were likely based on a downwardly biased estimate of the effect of supplemental insurance, meaning the CBO estimates of the effect of a tax underes- timated the budgetary effect. 21 In contrast, the parameters estimated here leverage plausibly exogenous variation in Medigap premiums, accounting not only for selec- tion on unobservable individual characteristics but also for potentially heterogeneous effects on individuals marginal to a change in premiums. We use our estimated parameters to produce back-of-the-envelope budgetary estimates in the follow manner: First, the counterfactual Medigap market share is 21 In another section (Option 82) of their budget options volume, CBO cites studies claiming that Medigap coverage increases utilization by 25 percent versus individuals without supplementary coverage.
CHAPTER 3. MEDIGAP 138 calculated using the estimated premium semi-elasticity of 0.475 (Table 3.6, specification 3) and assuming the tax is completely passed through. 22 We estimate tax revenue by applying the tax to the resulting share of Medigap enrollees. Cost savings are calculated by reducing the medical costs of individuals who drop Medigap by 37.0 percent, the factor implied by the estimated parameter of 0.588 from specification 3 of Table 3.7 (i.e., 0.370 =1 - 1/(1+0.588)). Medicare cost savings are calculated as 80 percent of this number, consistent with Medicare paying 80 percent on the margin for care. The total budgetary impact is simply the sum of the revenue and Medicare cost effects. Table 3.9 presents these revenue and cost savings estimates for the standard sample of individuals with Medigap, Medicare Advantage, and no supplemental coverage. In this sample, baseline Medigap enrollment is 35.8 percent, and Medical costs for Medigap enrollees average $9,458 per annum. The results are presented in dollars per beneficiary and as a percentage of Medicare costs of $5,528 on average for Medigap enrollees. A 20 percent tax would reduce coverage by 9.5 percentage points, raising 1.3 percent of total costs in tax revenue and 4.8 percent of total costs in reduced utilization for total budgetary savings of 6.2 percent. A 40 and 60 percent tax would save 11.4 and 15.6 percent of costs respectively. And a 76 percent tax, which would increase Medigap premiums by $1,076, or about 50.5 percent of the implied $2,802 (=0.37 x $9,458 x 0.80) externality, would reduce the Medigap market share to zero, savings 18.1 percent of total costs entirely though decreased medical utilization. Although it probably goes without saying, we remind the reader that the parameters are estimated using local variation in premiums and the projected effects of larger taxes and subsidies should be viewed with appropriate caution. It is also worth mentioning that under current law, a tax that reduces FFS Medicare costs would reduce minimum Medicare Advantage payments. This is not taken into account in our simple tax simulations, and would likely magnify the cost savings we project. Last but not least, we want to call attention to the fact that a uniform tax on Medigap premiums is a blunt instrument for controlling Medicare costs. Chandra et 22 In the case of incomplete pass-though, one can think of the counterfactuals as simulating the impact of tax that would give rise to the full pass-though increase in premiums.
Page 1 and 2:
ESSAYS IN PUBLIC FINANCE AND INDUST
Page 3 and 4:
I certify that I have read this dis
Page 5 and 6:
insurance choice. Among other thing
Page 7 and 8:
Acknowledgements I am deeply thankf
Page 9 and 10:
Contents Preface iv Acknowledgement
Page 11 and 12:
2.5.3 The Value of Plan Choice ....
Page 13 and 14:
List of Tables 1.1 Asset Exemption
Page 15 and 16:
4.9 First Week Contract Spending fo
Page 17 and 18:
4.3 I.T. Contracting by Week ......
Page 19 and 20:
CHAPTER 1. BANKRUPTCY 2 of the dead
Page 21 and 22:
CHAPTER 1. BANKRUPTCY 4 relevant le
Page 23 and 24:
CHAPTER 1. BANKRUPTCY 6 superficial
Page 25:
CHAPTER 1. BANKRUPTCY 8 After treat
Page 29:
CHAPTER 1. BANKRUPTCY 12 newly edit
Page 32:
CHAPTER 1. BANKRUPTCY 15 bound of t
Page 37 and 38:
CHAPTER 1. BANKRUPTCY 20 or coverag
Page 39 and 40:
CHAPTER 1. BANKRUPTCY 22 homestead
Page 41 and 42:
CHAPTER 1. BANKRUPTCY 24 log seizab
Page 43 and 44:
CHAPTER 1. BANKRUPTCY 26 on the bas
Page 45 and 46:
CHAPTER 1. BANKRUPTCY 28 to seizabl
Page 48 and 49:
CHAPTER 1. BANKRUPTCY 31 CARA utili
Page 50 and 51:
CHAPTER 1. BANKRUPTCY 33 Puzzle 3:
Page 52:
CHAPTER 1. BANKRUPTCY 35 of income
Page 57 and 58:
CHAPTER 1. BANKRUPTCY 40 TaxSim pro
Page 59 and 60:
Payments CHAPTER 1. BANKRUPTCY 42 $
Page 61 and 62:
OOP payments CHAPTER 1. BANKRUPTCY
Page 63 and 64:
ln(seizable sssets) CHAPTER 1. BANK
Page 65 and 66:
50 60 70 80 90 100 Insurance covera
Page 67 and 68:
Pr(WTP > premium) CHAPTER 1. BANKRU
Page 69 and 70:
CHAPTER 1. BANKRUPTCY 52 Table 1.1:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
CHAPTER 1. BANKRUPTCY 62 Table 1.11
Page 81 and 82:
CHAPTER 1. BANKRUPTCY 64 Table 1.14
Page 83 and 84:
CHAPTER 2. HEALTH PLAN CHOICE 66 pl
Page 85 and 86:
CHAPTER 2. HEALTH PLAN CHOICE 68 ar
Page 87:
CHAPTER 2. HEALTH PLAN CHOICE 70 pl
Page 90 and 91:
CHAPTER 2. HEALTH PLAN CHOICE 73 va
Page 92 and 93:
CHAPTER 2. HEALTH PLAN CHOICE 75 An
Page 94 and 95:
CHAPTER 2. HEALTH PLAN CHOICE 77 2.
Page 98 and 99:
CHAPTER 2. HEALTH PLAN CHOICE 81 wh
Page 100 and 101:
CHAPTER 2. HEALTH PLAN CHOICE 83 cr
Page 105 and 106: CHAPTER 2. HEALTH PLAN CHOICE 88 2.
Page 107 and 108: CHAPTER 2. HEALTH PLAN CHOICE 90 av
Page 109 and 110: CHAPTER 2. HEALTH PLAN CHOICE 92 ar
Page 111 and 112: CHAPTER 2. HEALTH PLAN CHOICE 94 le
Page 113 and 114: CHAPTER 2. HEALTH PLAN CHOICE 96
Page 115 and 116: CHAPTER 2. HEALTH PLAN CHOICE 98 ef
Page 117 and 118: CHAPTER 2. HEALTH PLAN CHOICE 100 2
Page 119 and 120: CHAPTER 2. HEALTH PLAN CHOICE 102 T
Page 121: CHAPTER 2. HEALTH PLAN CHOICE 104 T
Page 128 and 129: CHAPTER 2. HEALTH PLAN CHOICE 111 F
Page 130 and 131: CHAPTER 2. HEALTH PLAN CHOICE 113 6
Page 134 and 135: Chapter 3 Private Coverage and Publ
Page 136 and 137: CHAPTER 3. MEDIGAP 119 be of intere
Page 138 and 139: CHAPTER 3. MEDIGAP 121 hazard for i
Page 140 and 141: CHAPTER 3. MEDIGAP 123 have benefit
Page 145 and 146: CHAPTER 3. MEDIGAP 128 We use boots
Page 147 and 148: CHAPTER 3. MEDIGAP 130 of costs and
Page 149 and 150: CHAPTER 3. MEDIGAP 132 policy that
Page 151 and 152: CHAPTER 3. MEDIGAP 134 3.6.2 Causal
Page 153: CHAPTER 3. MEDIGAP 136 3.6.3 Robust
Page 157 and 158: CHAPTER 3. MEDIGAP 140 (10000,11000
Page 159 and 160: CHAPTER 3. MEDIGAP 142 Table 3.2: S
Page 161 and 162: CHAPTER 3. MEDIGAP 144 Table 3.4: H
Page 163 and 164: CHAPTER 3. MEDIGAP 146 Table 3.6: S
Page 165 and 166: CHAPTER 3. MEDIGAP 148 Table 3.8: R
Page 167 and 168: CHAPTER 3. MEDIGAP 150 Table 3.10:
Page 169 and 170: CHAPTER 3. MEDIGAP 152 Table 3.12:
Page 171 and 172: CHAPTER 4. YEAR-END SPENDING 154 bu
Page 173 and 174: CHAPTER 4. YEAR-END SPENDING 156 in
Page 176: CHAPTER 4. YEAR-END SPENDING 159 To
Page 180 and 181: CHAPTER 4. YEAR-END SPENDING 163 4.
Page 182 and 183: CHAPTER 4. YEAR-END SPENDING 165 or
Page 184 and 185: CHAPTER 4. YEAR-END SPENDING 167 ha
Page 186 and 187: CHAPTER 4. YEAR-END SPENDING 169 It
Page 189: CHAPTER 4. YEAR-END SPENDING 172 To
Page 192 and 193: CHAPTER 4. YEAR-END SPENDING 175 0.
Page 194 and 195: CHAPTER 4. YEAR-END SPENDING 177 Th
Page 196 and 197: CHAPTER 4. YEAR-END SPENDING 179 to
Page 198 and 199: CHAPTER 4. YEAR-END SPENDING 181 Co
Page 200 and 201: CHAPTER 4. YEAR-END SPENDING 183 Fi
Page 202 and 203: CHAPTER 4. YEAR-END SPENDING 185 Sp
Page 204 and 205:
CHAPTER 4. YEAR-END SPENDING 187 Ta
Page 206 and 207:
Page 208 and 209:
Page 210 and 211:
Page 212 and 213:
Page 214 and 215:
show all

essays in public finance and industrial organization a dissertation ...

Create successful ePaper yourself

Delete template?

Save as template?