Cover

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Table of Contents

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pp. v-vi

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Acknowledgments

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p. vii

We thank Robert Faherty and the staff of Brookings Institution Press for their efforts in publishing the volume and are grateful to Diane Hammond and Anthony Nathe for expert editing. ...

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1. Introduction

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pp. 1-12

Following the collapse of President Bill Clinton’s health reform proposal in 1994, most elected officials became unwilling to talk about major government action to change private health insurance arrangements. Democrats were shell-shocked by the political fallout from the Clinton debacle, ...

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2. Tax Policy and the History of the Health Insurance Industry

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pp. 13-35

For the last six decades, health insurance coverage has been provided primarily through policies offered to workers at their place of employment. In 2006 employer-based insurance covered 161.7 million people, approximately 62.2 percent of the nonelderly population.2 ...

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3. The Tax Code, Employer-Sponsored Insurance, and the Distribution of Tax Subsides

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pp. 36-66

About 46 million Americans under age sixty-five, including 9 million children, lack health insurance. They receive less preventive care when healthy and poorer care when sick than do the insured. Furthermore, the public ultimately shoulders much of the burden of paying for the medical treatment of the uninsured, ...

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4. Health Savings Accounts: Recent Trends and Potential Effects on Coverage and Health Insurance Markets

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pp. 67-91

In 2003 the Medicare Prescription Drug, Improvement, and Modernization Act (also called the Medicare Modernization Act or MMA) established health savings accounts (HSAs), which allow tax benefits for out-of-pocket health spending when paired with a high-deductible health insurance plan (HDHP).1 ...

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5. What's in a Name? Are Health Savings Accounts Really Health Savings Accounts?

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pp. 92-118

Health savings accounts (HSAs) are tax-sheltered savings instruments available to people under the age of 65 who buy high-deductible (HD) health insurance. Chapter 4, by Lisa Clemans-Cope, describes the origin of and rules governing HSAs. Together with high-deductible health insurance, HSAs compose ...

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6. Tax Subsidies for Out-of-Pocket Health Care Costs

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pp. 119-146

Each year, around the time employers have open enrollment for their benefits plans, newspapers publish stories headlining that employer-provided health insurance is becoming less generous. A 2003 New York Times story observed that “employers are shifting a growing share (of costs) onto people who make the heaviest use ...

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7. Administrative Issues: Challenges of the Current System

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pp. 147-170

Many of the major health care reform proposals would assign a key administrative role to the IRS. To those who would rely heavily on IRS involvement, we say: Beware! The IRS’s track record in administering the existing, relatively simple tax rules governing health care is not heartening. ...

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8. The Challenges of Implementing Health Reform thorough the Tax System

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pp. 171-210

Designers of fundamental health reform proposals often use the income tax system to achieve their goals. These goals include expanding health insurance coverage while containing the growth of medical costs. Health reform proposals may use the Internal Revenue Service (IRS) to enforce mandates requiring individuals ...

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9. Reforming the Tax Treatment of Health Care: Right Ways and Wrong Ways

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pp. 211-229

Health care in America faces three fundamental problems. First, according to census estimates 47 million Americans are uninsured.1 Second, America spends an enormous amount on health care for the insured while often getting little or no benefit at the margin.2 And third, health care is the largest source of the long-run fiscal gap.3 ...

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10.Simple Humans, Complex Insurance, Subtle Subsities

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pp. 230-262

The behavioral revolution in economics tells us that human beings often have difficulty making wise choices. The most widely chronicled difficulties in decisionmaking occur in conjunction with decisions made under conditions of uncertainty, decisions that involve significant elements of time, ...

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11. Taxes and Health Insurance

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pp. 263-270

The single most important factor influencing the federal government’s long-term fiscal balance is the rate of growth in health care costs. Without any changes in federal law, the Congressional Budget Office projects that total spending on health care will rise from 16 percent of the GDP in 2007 to 25 percent in 2025 ...

Contributors

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pp. 271-272

Index

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pp. 273-282