170255 Health spending compared to income tax levels by states' political affiliation

Monday, October 27, 2008

Jason S. Egginton, MPH , Division of Health Care Policy & Research, Mayo Clinic, Rochester, MN
James M. Naessens, ScD, MPH , Division of Health Care Policy & Research, Mayo Clinic, Rochester, MN
Randy D. Swanson, MS , Division of Health Care Policy & Research, Mayo Clinic, Rochester, MN
We assessed the relationship of the 2004 presidential election results, income tax data and personal health care spending-(PHCS) by performing a cross-sectional assessment of state-level data, using linear regression analysis overall and within the election result groups. The associations of these data with voting record were assessed with Student's t-tests and Wilcoxon rank sum tests. Tax information was gathered from the IRS. For population-based estimates, we used US Census Bureau data. To determine any health or societal value of additional paid income taxes and higher PHCS, a variety of sources, including the United Health Foundation, were accessed. Differences between red and blue states in PHCS and income taxes were statistically significant, (p<.004, p<.001). Though blue states are taxed at a higher median rate as a percentage of household income per capita —about 13%, while red ~10.3%— there is only a weak association between taxes and PHCS within blue or red states (r=.34 and r=.08); but the association was stronger overall,(r=.43). When compared to states' health ranking, neither taxes nor PHCS correlated strongly overall or by group. In general, blue states paid more in taxes and in PHCS, but also show some indications of better health and well-being from a societal prospective. The differences in PHCS and tax rates may be the results and/or determinants of state-specific priorities and preferences with regard to community life. Whether the current outcome measures examined represent a good “value” remains the decision of the policymakers evaluating these trade-offs. In a presidential election year where payment for— and delivery of— healthcare is a central issue, policymakers at all levels need to find ways to determine and communicate the value of medical care and spent taxes. It is difficult to quantify precisely what higher PHCS and tax rates purchase. As AB Martin et al. point out in a recent Health Affairs paper, “[There are] many factors that contribute to health spending patterns across states. Variation in payer mix, provider supply or demographic and socioeconomic influences” are all potential drivers and consequences of healthcare costs. Continually monitoring these trends as the landscapes shift will behoove the policymaker.

Learning Objectives:
1. Articulate general associations between states' political voting and current spending. 2. Describe current relationship between income tax and personal healthcare spending. 3. Define two positive outcomes that are associated with increased state spending.

Keywords: Health Care Politics, Health Care Utilization

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the primary author of the paper.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.