TY  - JOUR
AU  - Glied,Sherry
AU  - Stabile,Mark
TI  - Avoiding Health Insurance Crowd-Out: Evidence from the Medicare as Secondary Payer Legislation
JF  - National Bureau of Economic Research Working Paper Series
VL  - No. 6277
PY  - 1997
Y2  - November 1997
UR  - http://www.nber.org/papers/w6277
L1  - http://www.nber.org/papers/w6277.pdf
N1  - Author contact info:
Sherry A. Glied
Mailman School of Public Health
Columbia University
Department of Health Policy and Management
600 West 168th Street, Room 610
New York, NY 10032
Tel: 212/305-0299
Fax: 212/305-3405
E-Mail: sag1@columbia.edu

Mark Stabile
School of Public Policy and Governance
University of Toronto
Canadiana Building, 3rd Floor
14 Queen's Park Cres. W.
Toronto, ON M5S 3K9
CANADA
Tel: 416/978-4329
Fax: 416/978-5079
E-Mail: mark.stabile@utoronto.ca
AB  - The cost of efforts to expand health insurance coverage to the currently uninsured increases when people who would otherwise purchase private insurance obtain subsidized public coverage.  Legislators are increasingly interested in mechanisms that target insurance benefits to those who need them most.  This paper investigates the effects of one of the first such targeting efforts, the 1982 Medicare as Secondary Payer (MSP) provisions. The MSP rules require employers who offer insurance coverage to their employees under 65 to offer coverage on the same terms to their Medicare-eligible employees. This coverage then becomes 'primary' to Medicare.  We examine the incidence of this implicit tax, the magnitude of tax avoidance efforts, and the extent of tax compliance. We find little evidence that the MSP rules affected the wages or employment of affected workers.  We find weak evidence suggesting that the MSP shifted the composition of employment of older workers toward MSP-exempt jobs.  We find strong evidence of low compliance with the MSP rules. Our results cast doubt on the efficacy of provisions designed to reduce crowd-out in new health insurance programs.
ER  -