By Jacob Goldin, Ithai Z. Lurie, and Janet McCubbin
National Bureau of Economic Research, December 2019
Abstract
We evaluate a randomized pilot study in which the IRS sent informational letters to 3.9 million taxpayers who paid a tax penalty for lacking health insurance coverage under the Affordable Care Act. Drawing on administrative data, we study the effect of the intervention on taxpayersā subsequent health insurance enrollment and mortality. We find the intervention led to increased coverage in the two years following treatment and that this additional coverage reduced mortality among middle-aged adults over the same time period. Our results provide the first experimental evidence that health insurance reduces mortality.
From the Conclusion
Drawing on a randomized pilot intervention, we examined the effect of outreach about tax incentives to enroll in health insurance coverage among taxpayers who had previously paid a penalty for lacking coverage. We found positive effects of the intervention on subsequent enrollment decisions, particularly for taxpayers who were uninsured in the year prior to intervention. We also found that the intervention reduced mortality among middle-aged adults in the subsequent two years, which we attribute to the additional coverage the intervention induced. Our findings thus provide strong empirical support, and the first experimental evidence, for the hypothesis that health insurance coverage reduces mortality.
Comment:
By Don McCanne, M.D.
Health insurance saves lives. Yet our current national policies are projected to leave about ten percent of our population uninsured over the next decade. People will die prematurely merely because they are uninsured.
Although this study showed that tax penalties were effective in increasing coverage and reducing mortality, they certainly did not result in universal coverage, and, besides, the penalties have been eliminated anyway.
Perpetuating our current financing system while adding a public option for purchase will not result in everyone being covered, and the most recent Republican proposal would actually increase the number of uninsured.
Premature deaths due to lack of insurance are preventable. Changing to the single payer model of Medicare for All would automatically include everyone, regardless of personal income or wealth since the financing is totally separated from the coverage. Equitable progressive taxes would make the system affordable for all of us. Considering not only the reduction in deaths but also the reduction in physical suffering and financial hardship, we really can’t afford not to do it.
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