Research by Author & Topic

Publications by Leonard E. Burman on Elderly

In this testimony Burman outlines a plan for tax reform that would maintain progressivity, raise enough revenues to finance the government, and dovetail with plans to provide universal access to health insurance. It would combine a value-added tax (VAT) dedicated to pay for a new universal health insurance voucher with a vastly simplified and much flatter income tax. With a new financing source for health care, income tax rates could be cut sharply-the top rates could be cut to 25 percent or less. The health care voucher would also offset the inherent regressivity of a VAT. And, under the simplified system, most Americans would not have to file income tax returns.

In this testimony Burman argues that there are limitations to using tax credits to expand health insurance coverage. A program of health insurance tax credits combined with reforms of the market for nongroup health insurance could significantly expand coverage, but at a very high cost. The testimony summarizes the current tax treatment of health insurance, the effects of tax subsidies on coverage and health care costs, and discusses ways that tax credits might affect health coverage. Burman offers recommendations and adds that the most cost-effective approach to expanding health insurance coverage may not be a tax subsidy at all, but an expansion of an existing public program, such as Medicaid, S-CHIP, or Medicare.

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.

The paper describes the new standard deduction for health insurance, proposed in the FY2008 Budget, and evaluates the extent to which it would meet its stated goals of expanding health insurance coverage and restraining healthcare spending, and its effects on the distribution of tax burdens in the short and long terms. The basic approach would improve the market for health insurance, but inadequate attention was paid to problems in the nongroup market or those facing households with low incomes. In consequence, the plan could actually reduce overall insurance coverage. The paper suggests a variety of ways in which the proposal could be improved so more people would be covered, including those with low incomes or in poor health.

The paper describes the basic features of the President's plan and evaluates the extent to which it would meet its stated goals of expanding health insurance coverage and restraining healthcare spending. The basic approach would improve the market for health insurance, but inadequate attention was paid to problems in the nongroup market or those facing households with low incomes. In consequence, the plan could actually reduce overall insurance coverage. The paper suggests a variety of ways in which the proposal could be improved so more people would be covered, including those with low incomes or in poor health.

This report examines the economic and distributional effects of changes made to retirement tax incentives by the Economic Growth and Tax Relief Reconciliation Act of 2001 (EGTRRA). We augment the Tax Policy Center microsimulation tax model with information about saving from the Survey of Consumer Finances. Based on that model, we estimate that although EGTRRA provided some additional tax benefits for middle-income households, the benefits were skewed in favor of those with high incomes, and there were no benefits for those with low incomes. Better targeted policy options exist. We also estimate that when the effect on the deficit is considered, the policies are likely to reduce national saving by as much as 1 percent of GDP.

Over 40 million Americans under age 65--the overwhelming majority of them in working families--lack health insurance. The public ultimately shoulders the burden of paying for the medical treatment of those lacking insurance, either through higher taxes or higher health care costs. Expanding health coverage through the tax system may not be the most efficient path, but tax subsidies appear the only game in town for expanding the federal role in the provision of health insurance. This policy brief examines implications of major expansions in tax credits for health insurance, starting with the President's refundable tax credit proposal.

Over 40 million Americans under age 65—the overwhelming majority of them in working families—lack health insurance. The public ultimately shoulders the burden of paying for the medical treatment of those lacking insurance, either through higher taxes or higher health care costs. Expanding health coverage through the tax system may not be the most efficient path, but tax subsidies appear the only game in town for expanding the federal role in the provision of health insurance. This paper examines implications of major expansions in tax credits for health insurance, starting with the President's refundable tax credit proposal.

This paper incorporates retirement saving incentives into the Tax Policy Center microsimulation model and analyzes the distributional effects of current tax preferences for saving. As a share of income, tax-preferred saving incentives provide the largest benefits to households with income between $75,000 and $500,000, roughly the 80th to 99th percentile of the income distribution. In 2004, the top 20 percent of tax filing units by income will receive 70 percent of the tax benefits from new contributions to defined contribution plans and almost 60 percent of IRA tax benefits.

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.