How Will the Cadillac Tax Affect Private Insurance Plans?

描述（由申请人提供）：《平价医疗法案》（ACA）显著改变了美国的医疗保健，其最主要和最有影响力的组成部分之一是在2018年对高保费保险计划征收消费税，通常被称为“凯迪拉克税”。“这项税收的目的是增加医疗保险福利设计的成本分摊，降低医疗成本，并作为主要的资金来源，以应对ACA的保险扩张。然而，令人惊讶的是，与ACA的其他组成部分相比，研究人员对凯迪拉克税的关注相对较少。拟议的研究旨在填补这一空白，在文献中提供理论和实证研究， 凯迪拉克税的影响。 凯迪拉克税的目的是有效地减少或 甚至取消美国税法中对健康保险的税收补贴。雇主和雇员可以用税前美元购买医疗保险，降低医疗保险的成本，促进购买过于慷慨的保险。税收补贴经常被指责为医疗保健的高使用和成本，经济学家将每年总计数十亿美元的福利损失归咎于税收补贴。虽然有一些证据表明，税收补贴促进了“更慷慨”的健康保险的普及，但文献对“更慷慨”意味着什么几乎没有提供指导。如果没有税收补贴，计划会是什么样子？拟议中的项目采用了最近推出的理论模型，该模型将税收补贴与计划特征和成本分摊慷慨度联系起来。该项目将扩展这一模型来解释凯迪拉克税，并提供理论预测和指导的实证工作和未来的实证工作在这一领域的税收补贴的实证研究也是有限的，集中在一些选择的结果。税收补贴是一个特别值得研究的政策，因为它类似于凯迪拉克税，而且税收补贴有许多不同的来源，可以用于实证研究。这项拟议的研究项目将使用这些来源的变化，以了解税收补贴的影响，并预测凯迪拉克税的后果， 2018.该项目将研究对计划特点、医疗利用、总医疗费用、 费用和保险公司付款。我们预计凯迪拉克税应该减少成本分摊，减少保险慷慨，并降低医疗成本。本项目的实证部分将量化这些影响。利用这些结果，该项目将计算2018年及以后凯迪拉克税收补贴的经济福利成本和潜在的福利收益。

DESCRIPTION (provided by applicant): The Affordable Care Act (ACA) significantly changes the United States health care and one of its most major and influential component is the introduction of an excise tax on high premium insurance plans in 2018, commonly referred to as the "Cadillac tax." The tax is designed to increase cost-sharing in health insurance benefit design, decrease medical costs, and act as a primary funding source to counter the insurance expansions in the ACA. Surprisingly, though, the Cadillac tax has received relatively little attention compared to other components of the ACA by researchers. The proposed research aims to fill this gap in the literature by providing both theoretical and empirical research on the implications of the Cadillac tax. A stated purpose of the Cadillac tax is to effectively reduce or even eliminate the tax subsidy for health insurance in the United States tax code. Employers and employees can purchase health insurance in pre-tax dollars, reducing the cost of health insurance and promoting the purchase of overly- generous coverage. The tax subsidy has frequently been blamed for the high use and cost of medical care and economists have attributed annual welfare losses totaling billions of dollars to the tax subsidy. While there is some evidence that the tax subsidy promotes the popularity of "more generous" health insurance, the literature offers little guidance about what "more generous" implies. What would plans look like without the tax subsidy? The proposed project uses a recently-introduced theoretical model which relates the tax subsidy to plan characteristics and cost-sharing generosity. The project will extend this model to account for the Cadillac tax and provide theoretical predictions and guidance for the empirical work and future empirical work in this field The empirical research on the tax subsidy is also limited, focusing on a few select outcomes. The tax subsidy is an especially interesting policy to study because it is similar to the Cadillac tax and there are numerous sources of variation in the tax subsidy which can be exploited for empirical research. This proposed research project will use these sources of variation to understand the implications of the tax subsidy and predict the ramifications of the Cadillac tax in 2018. The project will study the impact on plan characteristics, medical utilization, total medical costs, and insurer payments. We would expect that the Cadillac tax should reduce cost-sharing, reduce insurance generosity, and reduce medical costs. The empirical section of this project will quantify those effects. Using these results, the project will calculate the economic welfare cost of the tax subsidy and potential welfare gains of the Cadillac tax in 2018 and beyond.