Essays on Distortionary Effects of Employer-Sponsored Health Insurance

This dissertation consists of two chapters. Chapter one studies distortionary effects of tax exemption of employer-sponsored health insurance (ESHI) premiums. First, I argue that, in the competitive labor market, tax deductibility of ESHI premiums generates an implicit labor cost subsidy to the employers sponsoring health insurance (HI) which distorts the allocation of labor across employers. Second, I quantify the extent of this misallocation measured as output loss in a general equilibrium model of firm dynamics extended to incorporate tax exemption of ESHI premiums and endogenous provision of HI by the employers. The calibrated model shows that elimination of tax exemption increases aggregate output by 1.73%. About two-thirds of this effect comes from removing the misallocation of labor across existing establishments, and the remaining one-third comes from the increase in the number of operating establishments. Third, I use the model to analyze how tax exemption interacts with the employer mandate of the Affordable Care Act imposing a tax on large employers not sponsoring HI. Quantitative results show that implementing the employer mandate when the tax exemption is present reduces output by 0.13%.

Chapter two studies macroeconomic implications of a higher cost of health services faced by the unemployed which arise because 1) workers lose access to ESHI when they leave their jobs and 2) the uninsured face inflated health care prices. First, I provide evidence suggesting that the cost of health services for the privately insured is about 50% lower than for the uninsured. Second, I quantify the effects of higher cost of health services for the unemployed in the Lucas and Prescott (1974) island model extended to allow the workers to pay an extra cost of health services contingent on their employment status. Calibration procedure uses the differences between costs of health services for the privately insured and uninsured inferred from the data as a gap between costs of health services for the employed and unemployed. Quantitative results show that equalizing these costs across workers increases labor productivity by 1.2% and unemployment rate by 1.5 percentage points. The increased unemployment dominates quantitatively leading to a decrease in aggregate output by 0.26%.