Tax Incentives and the Decision to Purchase Health Insurance: Evidence from the Self-Employed

The Tax Reform Act of 1986 introduced a new tax subsidy for health insurance purchases by the self-employed. We analyze the changing patterns of insurance demand before and after tax reform to generate new estimates of how the after-tax price of insurance affects the discrete choice of whether to buy insurance. We employ both traditional regression models and difference-in-difference methods that compare changes in insurance coverage across groups around TRA86. The results from our most carefully controlled comparison suggest that a 1 percent increase in the cost of insurance coverage reduces the probability that a self-employed single person will be insured by 1.8 percentage points.