Coherent Identifier About this item: 20.500.12592/srbwpc

Distributional Effects of Alternative Health Reform Proposals

19 May 2021


In this report we examine two health reform policies, one incremental and the other more comprehensive. Each are financed with two alternative tax strategies, one more progressive than the other. The incremental reform adds coverage for 14.8 million people and the comprehensive reform 27.2 million. The annual federal cost of the incremental reform is $103.6 billion and the comprehensive reform $168.7 billion. Financing reform with an income tax increase is more progressive than financing with the payroll tax increase. People with incomes less than $200,000 pay more under payroll tax financing than with income tax financing; the opposite is true for those with incomes higher than $200,000. Both reforms redistribute towards groups that have lower average incomes. Black non-Hispanic, and Hispanic people are net beneficiaries while white non-Hispanic,and Asian American and Pacific Islander people are net contributors. Those in the South are net beneficiaries while other regions are net contributors. The uninsured benefit from gaining coverage and pay relatively little in new taxes, but only 30 percent of new federal spending is on the uninsured. The remaining 70 percent of new spending improves affordability for large numbers of people who already have health coverage.


John Holahan
Institute Fellow

Michael Simpson
Principal Research Associate

Gordon B. Mermin
Principal Research Associate


health policy center health and health policy income and wealth taxes and budget

Rights Holder
Urban Institute

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