Working Paper: NBER ID: w11315
Authors: William Jack; Arik Levinson; Sjamsu Rahardja
Abstract: Flexible Spending Accounts (FSAs) subsidize out-of-pocket health expenses not covered by employer-provided health insurance, making health care cheaper ex post, but also reducing the incentive to insure. We use a cross section of .rm-level data to show that FSAs are indeed associated with reduced insurance coverage, and to evaluate the welfare consequences of this shift. Correcting for selection effects we find that FSAs are associated with insurance contracts that have coinsurance \nrates about 7 percentage points higher, relative to a sample average coinsurance rate of 17 percent. Meanwhile, coinsurance rates net of the subsidy are approximately unchanged, providing evidence that FSAs are welfare-neutral. These results show that FSAs may explain a significant fraction of the shift in health care costs to employees that has occurred in recent years.
Keywords: Health Expenditure; Subsidies; Moral Hazard; Flexible Spending Accounts
JEL Codes: D60; H21; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| FSAs (G23) | coinsurance rates (G52) |
| FSAs (G23) | welfare effects of FSAs (I38) |
| More generous employers (M52) | FSAs (G23) |
| FSAs (G23) | insurance coverage (G52) |