Ithai Z. Lurie

Do increased premium subsidies affect how much health insurance is purchased? Evidence from the self-employed

This paper estimates the effect of recent federal and state level increases in the deductibility of health insurance premiums for self-employed individuals, which reduced the after-tax price of health insurance, on both the take-up of coverage and the amount of insurance purchased. Using a panel of tax returns filed by self-employed taxpayers from 1999 to 2004, we estimate a take-up elasticity of -0.316 overall, with significantly higher elasticities for single taxpayers. On the intensive margin, we find an elasticity of -0.733 overall.

Medicaid as an Investment in Children: What is the Long-Term Impact on Tax Receipts?

We examine the long-term impact of expansions to Medicaid and the State Childrens Health Insurance Program that occurred in the 1980s and 1990s. With administrative data from the IRS, we calculate longitudinal health insurance eligibility from birth to age 18 for children in cohorts affected by these expansions, and we observe their longitudinal outcomes as adults. Using a simulated instrument that relies on variation in eligibility by cohort and state, we find that children whose eligibility increased paid more in cumulative taxes by age 28. These children collected less in EITC payments, and the women had higher cumulative wages by age 28. Incorporating additional data from the Medicaid Statistical Information System (MSIS), we find that the government spent

DID REFORM OF THE NON‐GROUP HEALTH INSURANCE MARKET AFFECT THE DECISION TO BE SELF‐EMPLOYED? EVIDENCE FROM STATE REFORMS IN THE 1990s

872 in 2011 dollars for each additional year of Medicaid eligibility induced by the expansions. Putting this together with the estimated increase in tax payments discounted at a 3% rate, assuming that tax impacts are persistent in percentage terms, the government will recoup 56 cents of each dollar spent on childhood Medicaid by the time these children reach age 60. This return on investment does not take into account other benefits that accrue directly to the children, including estimated decreases in mortality and increases in college attendance. Moreover, using the MSIS data, we find that each additional year of Medicaid eligibility from birth to age 18 results in approximately 0.58 additional years of Medicaid receipt. Therefore, if we scale our results by the ratio of beneficiaries to eligibles, then all of our results are almost twice as large.

Differential effect of the state children's health insurance program expansions by children's age.

This paper estimates whether state-level implementation of community rating and guaranteed issue regulations in the non-group health insurance market during the 1990s affected the decision of taxpayers to be self-employed. Using a panel of tax returns that span 1987-2000, we find no statistically significant effect of the reforms on the propensity to be self-employed overall, although we find evidence of an increase in self-employment among older taxpayers and weaker evidence of decreases among younger cohorts.

Welfare reform and the decline in the health-insurance coverage of children of non-permanent residents.

RESEARCH OBJECTIVEnThis paper tests for differences in the effect of State Childrens Health Insurance Program (SCHIP) on childrens insurance coverage and physician visits across three age groups: pre-elementary school-aged children (pre-ESA), ESA children, and post-ESA children.nnnDATA SOURCEnThe study uses two cross sections of the Survey of Income and Program Participation (SIPP) from the 1996 and 2001 panels.nnnSTUDY DESIGNnA difference-in-differences approach is used to estimate the effect of SCHIP on coverage and physician visits of newly eligible children of different age groups.nnnDATA COLLECTIONnDemographic, insurance, and physician visit information for children in families with income below 300 percent of federal poverty line were extracted from the SIPP.nnnPRINCIPAL FINDINGSnUninsurance rates for post-ESA children declined due to SCHIP while public coverage and the likelihood of visiting a physician increased. Estimates of cross-age differences show that post-ESA children experienced a larger decline in uninsurance rates compared with pre-ESA and ESA children and a larger increase in physician visits compared with ESA children.nnnCONCLUSIONSnThe higher rate of physician visits for post-ESA children due to SCHIP demonstrates the importance of extending insurance coverage to teens as well as young children.

Millionaire Migration and Taxation of the Elite: Evidence from Administrative Data

The 1996 Welfare Reform Act tightened public health-insurance coverage restrictions for non-permanent residents (NPRs) and altered the eligibility of newly permanent residents (PRs). By drawing on data from the SIPP, this paper explores to what extent welfare reform led to a decline in health-insurance coverage for children of NPRs. This paper proposes that the proportion of uninsured children of NPRs with low social economic status (SES) increased by approximately 10 percentage points relative to their PR counterparts. Furthermore, although eligible for Medicaid, citizen children of NPRs of low SES lost approximately 17 percentage points in coverage.

The Impact of Health Reform on Job Mobility: Evidence from Massachusetts

A growing number of U.S. states have adopted “millionaire taxes” on top income-earners. This increases the progressivity of state tax systems, but it raises concerns about tax flight: elites migrating from high-tax to low-tax states, draining state revenues, and undermining redistributive social policies. Are top income-earners “transitory millionaires” searching for lower-tax places to live? Or are they “embedded elites” who are reluctant to migrate away from places where they have been highly successful? This question is central to understanding the social consequences of progressive taxation. We draw on administrative tax returns for all million-dollar income-earners in the United States over 13 years, tracking the states from which millionaires file their taxes. Our dataset contains 45 million tax records and provides census-scale panel data on top income-earners. We advance two core analyses: (1) state-to-state migration of millionaires over the long-term, and (2) a sharply-focused discontinuity analysis of millionaire population along state borders. We find that millionaire tax flight is occurring, but only at the margins of statistical and socioeconomic significance.

The Impact of the Affordable Care Act Young Adult Provision on Labor Market Outcomes: Evidence from Tax Data

This paper estimates the impact of the implementation of the 2006 Massachusetts health reform on job mobility. Theoretically, the effect is ambiguous, as the public health insurance expansion and low-income subsidies would be expected to increase mobility, but the employer mandate and price effects could either increase or decrease mobility depending on the relative impacts on an individuals current job and the attractiveness of other modes of employment or retirement. Utilizing data from tax returns that span 2002–10, in which job changes are identified using employer information reported on W-2 forms, we estimate the impact of the Massachusetts reform using a difference-in-differences approach, comparing the prevalence of job changes in Massachusetts to those of a comparison group, while controlling for individual fixed effects. The estimates suggest the Massachusetts reform generally did not have a significant impact on job separations overall, though it may have increased separations from primary jobs among married women. There is evidence, however, that mobility increased among low-income married couples, young married men, and older married women.

Health Savings Accounts: Growth Concentrated Among High-Income Households And Large Employers

We use a panel data set of US tax records spanning 2008–2012 to study the impact of the Affordable Care Act (ACA) requirement to allow young adult dependents to be covered by their parents’ insurance policies on labor market-related outcomes. How health insurance expansions affect young adults through employment and education have important implications for public finance. Since tax data record access to employer-provided fringe benefits on W-2 forms, we are able to examine the impact of this coverage expansion by comparing young adults whose parents have access to benefits to other similar-aged young adults, before and after the law, and to young adults who are slightly older than the age threshold of the law. The use of tax data to identify families who have fringe benefits through their employer is an important advantage because the law was implemented during a labor market recovery in which outcomes could differ by age, even absent the law. Despite sizable increases documented elsewhere in insurance coverage resulting from this law, we find no meaningful changes in labor market-related outcomes. We examine a comprehensive set of outcomes (including measures of employment status, job characteristics, and postsecondary education), and are the first to use a triple-difference strategy to examine labor market effects of this law; we are also the first we know of to use tax data to examine the impact of the ACA on labor market outcomes. Although it is possible that labor market outcomes have changed in ways not captured by tax data (e.g., a change in hours of work while holding total wages constant, or a change in nonreported self-employment), our evidence suggests that the extension of health insurance to young adults did not substantially alter their labor market outcomes thus far.

Trends in out-of-pocket medical care expenditures for Medicare-age adults with arthritis between 1998 and 2004.

Between 2005 and 2012, the share of employers whose employees had health savings accounts (HSAs) and the share of employees working at these employers grew more than tenfold. High-income and older tax filers both established HSAs and fully funded their HSAs at least four times as often as did low-income and younger filers.