Research by Author & Topic

Publications by Leonard E. Burman on Health and Health Care

The latest statistics show that 46 million Americans were uninsured in 2007. Health care costs threaten to bankrupt the nation if we can't figure out a way to slow their growth and pay for the government's growing share. Adding to the government's unfunded health care obligations would be reckless and irresponsible. In this statement, I will discuss some issues involved in measuring the impact of health care financing options, discuss an option to pay for universal health care coverage with a value added tax (VAT), and examine several incremental options to pay for all or part of health care coverage expansions.

This paper proposes to expand Medicare to cover comprehensive long-term care services, including home care and custodial nursing home care. These services would be financed by a surcharge on federal income taxes. Unlike the regressive payroll tax that finances Medicare’s hospitalization coverage, the proposed surcharge would not increase tax burdens for low-income people. Beneficiaries would share costs through deductibles and copayments, but the program would include stop loss coverage and special protections for low-income adults. By providing long-term care insurance that protects the assets of older adults, our proposal would eliminate the savings disincentives inherent in the means-tested Medicaid system.

In this testimony before the Senate Finance Committee, Len Burman summarizes the latest data on who has health insurance and who doesn't, outlines the various tax subsidies that exist for health insurance, examines how those subsidies affect the market for health insurance and employment, and briefly comments on some reform options.

The Budget for Fiscal Year 2007 contains a package of new tax incentives for individuals and employees who are covered by high deductible health insurance policies and contribute to Health Savings Accounts (HSAs). The new proposals would make the tax system more complex, less fair, and add to our budget woes, especially over the long run. The proposals would reduce revenues by $156 billion over ten years. Perhaps most problematic, they are likely to exacerbate the problems in the health care market.

The 2003 Medicare prescription drug bill created Health Savings Accounts (HSAs), tax-free savings accounts for people who are covered by a "high-deductible health insurance plan," either purchased directly or on their behalf by an employer. The qualifying health insurance plan must have a deductible of at least $1,000 for single coverage and $2,000 for family coverage. Some preventative care may be covered by insurance, but all elective procedures and medicine is subject to the deductibles.

A bipartisan consensus favors public policy initiatives to expand health insurance coverage. This paper summarizes new CPS data on health insurance coverage for the nonelderly and discusses the issues involved in subsidizing health insurance. We outline a tax credit option designed to diminish many health insurance market flaws. A simple model illustrates that the Administration’s recent proposal for tax credits for nongroup insurance alone is equivalent to a general insurance tax credit (our preferred option) with a tax on ESI. Thus, it runs the risk of doing harm - undermining the insurance that currently covers most nonelderly Americans.