How Will the Cadillac Tax Affect Private Insurance Plans?

描述(由申请人提供)：《平价医疗法案》(ACA)极大地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引入消费税，通常被称为“凯迪拉克税”。这项税收旨在增加医疗保险福利设计中的成本分担，降低医疗成本，并作为主要资金来源，以应对ACA中的保险扩张。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。这项拟议的研究旨在通过提供关于 凯迪拉克税的影响。凯迪拉克税的一个明确目的是有效地降低或 甚至取消了美国税法中对医疗保险的税收补贴。雇主和雇员可以用税前美元购买医疗保险，降低了医疗保险的成本，并促进了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率和高成本，经济学家将每年总计数十亿美元的福利损失归因于税收补贴。虽然有一些证据表明，税收补贴促进了“更慷慨”的医疗保险的流行，但对于“更慷慨”意味着什么，文献几乎没有提供指导。如果没有税收补贴，计划会是什么样子？拟议的项目使用了最近引入的理论模型，该模型将税收补贴与计划特点和费用分担慷慨联系起来。本项目将该模型扩展到凯迪拉克税种，为该领域的实证工作和未来的实证工作提供理论预测和指导。对税收补贴的实证研究也是有限的，主要集中在少数精选结果上。税收补贴是一项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变化来源，可用于实证研究。这项拟议的研究项目将使用这些变异来源来了解税收补贴的影响，并预测#年凯迪拉克税的影响。 2018年。该项目将研究对规划特点、医疗利用、医疗总量 费用，以及保险公司的付款。我们预计，凯迪拉克税应该会减少成本分担，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年及以后税收补贴的经济福利成本和凯迪拉克税收的潜在福利收益。

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.