Comparing Methods for Imputing Employer Health Insurance Contributions in the Current Population Survey

Janicki, Hubert P.; O’Hara, Brett; Zawacki, Alice

doi:10.2139/ssrn.2318480

Cited by 5 publications

(5 citation statements)

References 6 publications

(1 reference statement)

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“…Our estimates of contributions to Medicare and private insurance rely on straightforward calculations of tax and premium payments (although the CPS data on employer contributions to premiums are imputed by the US Census Bureau based on previous patterns of such contributions). 31 However, our findings regarding contributions to Medicaid are less certain. We calculated individuals’ state and local tax contributions to health care programs for each state assuming uniformity within the state, although taxes paid to local governments vary.…”

Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

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Assessment of Immigrants’ Premium and Tax Payments for Health Care and the Costs of Their Care

et al. 2022

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ImportanceSome worry that immigrants burden the US economy and particularly the health care system. However, no analyses to date have assessed whether immigrants’ payments for premiums and taxes that fund health care programs exceed third-party payers’ expenditures on their behalf.ObjectiveTo assess immigrants’ net financial contributions to US health care programs.Design, Setting, and ParticipantsThis cross-sectional analysis used 2017 data from the Medical Expenditure Panel Survey (MEPS) and the Current Population Survey (CPS) and 2014 to 2018 data from the American Community Survey. The main analyses used data from the calendar year 2017. Data from the calendar years 2012 to 2016 were also reported. Data were analyzed from June 15, 2020, to August 14, 2022. Participants comprised 210 669 community-dwelling respondents to the MEPS and CPS (main analysis) and nursing home residents who were included in the American Community Survey (additional analysis).ExposuresCitizenship and immigration status.Main Outcomes and MeasuresTotal and per capita payments for premiums and taxes that fund health care as well as third-party payers’ expenditures for health care in 2018 US dollars.ResultsAmong 210 669 participants, 51.0% were female, 18.3% were Hispanic, 12.3% were non-Hispanic Black, 60.3% were non-Hispanic White, and 9.2% were of other races and/or ethnicities. A total of 180 084 participants were respondents to the 2018 CPS, and 30 585 were respondents to the 2017 MEPS. Among the 180 084 CPS respondents, immigrants accounted for 14.1% (weighted to be nationally representative), with the subgroup of citizen immigrants accounting for 6.8%, documented noncitizen immigrants accounting for 3.7%, and undocumented immigrants accounting for 3.6%; US-born citizens constituted 85.9% of the population. Relative to US-born citizens, immigrants were more often age 18 to 64 years (79.6% vs 58.3%), of Hispanic ethnicity (45.0% vs 14.0%), and uninsured (16.8% vs 7.4%); similar percentages (51.4% vs 50.9%) were female. US-born citizens vs immigrants paid similar amounts in premiums and taxes ($6269 per capita [95% CI, $6185-$6353 per capita] vs $6345 per capita [95% CI, $6220-$6470 per capita]). However, third-party expenditures for immigrants’ health care ($5061 per capita; 95% CI, $4673-$5448 per capita) were lower than their expenditures for the care of US-born citizens ($6511 per capita; 95% CI, $6275-$6747 per capita). Immigrants, in general, paid significantly more per person (net contribution, $1284; 95% CI, $876-$1691) than was paid on their behalf. Most of this surplus was accounted for by undocumented immigrants, whose contributions exceeded their expenditures by $4418 per person (95% CI, $4047-$4789 per person). US-born citizens collectively paid $67.2 billion (95% CI, −$2.3 to $136.3 billion) less in premiums and taxes than third-party payers paid for their care. This deficit was mostly offset by the $58.3 billion (95% CI, $39.8-$76.8 billion) net surplus of payments from immigrants, 89% of which ($51.9 billion; 95% CI, $47.5-$56.3 billion) was attributable to undocumented immigrants.Conclusions and RelevanceIn this study, immigrants appeared to subsidize the health care of other US residents, suggesting that concerns that immigrants deplete health care resources may be unfounded.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Assessment of Immigrants’ Premium and Tax Payments for Health Care and the Costs of Their Care

et al. 2022

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“…In 2012, spending on OTC health-related items made up 18.8% of nonpremium medical spending. We impute out-of-pocket premium expenses for persons who did not report paying for any premium expenses but reported that their employer paid for some or none of their employer-sponsored insurance or reported directly purchasing their insurance on the market (Janicki, O’Hara, & Zawacki, 2013). Out-of-pocket premium expenses were imputed for 5.7% of observations in the final sample.…”

Section: Methodsmentioning

confidence: 99%

The Financial Burden of Medical Spending

Abramowitz

O’Hara

2014

Med Care Res Rev

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This article uses the 2013 Current Population Survey Annual Social and Economic Supplement to estimate the financial burden of medical out-of-pocket costs by comparing medical out-of-pocket expenditures to income. This measure is important for evaluating the magnitude of burden, better understanding who bears it, and establishing a baseline to assess the impact of the Patient Protection and Affordable Care Act. We examine the distribution of burden and the incidence of high burden across all families and by individuals' health insurance status and demographic and socioeconomic characteristics. We look more closely at one group vulnerable to having high burden: those younger than age 65 with incomes between 138% and 200% of the federal poverty line. We find that 18.5% of these individuals have incomes below the threshold of expansion Medicaid eligibility after accounting for non-over-the-counter medical expenses and examine the characteristics associated with being classified below this threshold.

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“…Employee contributions are the self-reported amount paid by respondents for a health insurance policy in their own name. The Census Bureau imputes the employer contributions based on characteristics of the firm and the worker (see Janicki, O'Hara, and Zawacki, 2013 for details on the imputation approach).…”

Section: Datamentioning

confidence: 99%

How much does health insurance cost? Comparison of premiums in administrative and survey data

Larrimore

Splinter

2019

Economics Letters

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Using newly available administrative data from the Internal Revenue Service, this paper studies the distribution of employer-sponsored health insurance premiums. Previous estimates, in contrast, were almost exclusively from household surveys. After correcting for coverage limitations of the IRS data, we find that average premiums for employer-sponsored plans are roughly $1000 higher in IRS records than in the Current Population Survey. The downward bias in the CPS is largely driven by underestimating of premiums among married workers and topcoding of high premiums. _____________________________________________________________________________The results and opinions expressed in this paper reflect the views of the authors and should not be attributed to the Federal Reserve Board.

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Comparing Methods for Imputing Employer Health Insurance Contributions in the Current Population Survey

Cited by 5 publications

References 6 publications

Assessment of Immigrants’ Premium and Tax Payments for Health Care and the Costs of Their Care

Assessment of Immigrants’ Premium and Tax Payments for Health Care and the Costs of Their Care

The Financial Burden of Medical Spending

How much does health insurance cost? Comparison of premiums in administrative and survey data

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