Implicit Budget Deficits: The Case of a Mandated Shift to Community-Rated Health Insurance
Implicit Budget Deficits: The Case of a Mandated Shift to Community-Rated Health Insurance
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隐性预算赤字：强制转向社区评级健康保险的案例
DOI：
10.1086/tpe.11.20061847
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Derrick A. Max
中科院分区：
文献类型：
--
作者：
D. Bradford;Derrick A. Max
由于一个典型的监管授权在其经济效果上可以等同于一个支出计划和一个税收计划的结合，观察家们经常建议，将监管决策纳入同一预算框架将有助于公共政策的一致性。本文涉及一个重要的例子，监管计划，将模仿赤字融资的财政负担转移到年轻人和后代：强制购买（或由雇主提供）医疗保险的社区评级制度下，在此制度下，相同的价格收取医疗保险的所有人，无论年龄，性别，或健康状况。这种转变将导致负担在出生群体之间的重新分配，在这种情况下，从现有的，特别是中年出生群体，到年轻人和后代。使用来自各种来源的数据，我们得出结论，影响将是巨大的。对于我们关于贴现率、医疗成本、生产率增长率以及支付医疗费用的责任中心的中心案例假设，1994年，向社区评级的转变估计会为30岁以上的人带来收益，例如，50岁的人人均收益16，700美元，而年轻群体的成本则是16，700美元。1994年出生的人将获得额外的付款义务，每个折扣价值为7，100美元。沿着转嫁给后代的负担可以用出生时人均9,300美元的税收来描述（随着生产力的增长而增长）。分析表明，监管政策的转变，没有直接的预算影响，将有代际转移的影响相比，什么会被认为是在预算内税收或转移计划的重大变化。
Since a typical regulatory mandate can be equated in its economic effect to a combination of an expenditure program and a tax program, observers have often suggested that it would serve consistent public policy to bring regulatory decisions into the same budgetary framework. This paper concerns an important example of a regulatory program that would mimic deficit financing in effecting a transfer of fiscal burdens toward younger and future generations: the mandated purchase of (or provision by employers of) health care insurance under a system of community rating, under which the same price is charged for health insurance for all comers, regardless of age, sex, or health condition. Such a shift would result in redistributions of burdens across birth cohorts, in this case from existing, especially middle-aged birth cohorts, toward young and future generations. Using data from a variety of sources, we conclude the effect would be substantial. For our central-case assumptions about discount, health care cost, and productivity growth rates, and about the locus of responsibility for paying health care bills, a shift to community rating is estimated to generate gains for people over age 30 in 1994, $16,700 per person aged 50, for example, at the cost to younger cohorts. Those born in 1994 would acquire an extra payment obligation with a discounted value of $7,100 each. The burden passed along to future generations can be described by a $9,300 per capita tax at birth (growing with productivity). The analysis makes clear that the regulatory policy shift, with no direct budgetary implications, would have an intergenerational transfer effect comparable to what would be considered a major change in on-budget tax or transfer programs.