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Side Effects and Complications

The Economic Consequences of Health-Care Reform

The Affordable Care Act will have a dangerous effect on the American economy. That may sound like a political stance, but it’s a conclusion directly borne out by economic forecasts.  In Side Effects and Complications, preeminent labor economist Casey B. Mulligan brings to light the dire economic realities that have been lost in the ideological debate over the ACA, and he offers an eye-opening, accessible look at the price American citizens will pay because of it.

Looking specifically at the labor market, Mulligan reveals how the costs of health care under the ACA actually create implicit taxes on individuals, and how increased costs to employers will be passed on to their employees. Mulligan shows how, as a result, millions of workers will find themselves in a situation in which full-time work, adjusted for the expense of health care, will actually pay less than part-time work or even not working at all. Analyzing the incentives—or lack thereof—for people to earn more by working more, Mulligan offers projections on how many hours people will work and how productively they will work, as well as how much they will spend in general. Using the powerful tools of economics, he then illustrates the detrimental consequences on overall employment in the near future.

Drawing on extensive knowledge of the labor market and the economic theories at its foundation, Side Effects and Complications offers a crucial wake-up call about the risks the ACA poses for the economy. Plainly laying out the true costs of the ACA, Mulligan’s grounded and thorough predictions are something that workers and policy makers cannot afford to ignore.

352 pages | 26 color plates, 4 halftones, 47 tables | 6 x 9 | © 2015

Economics and Business: Business--Industry and Labor, Economics--Government Finance, Health Economics

Political Science: American Government and Politics, Public Policy


“The supply side is the great neglected side of the health-care debate, and Mulligan has written the best book on it to date.”

Tyler Cowen, George Mason University

“In Side Effects and Complications Mulligan provides an in-depth examination of the future of health care in the United States through a perceptive analysis of the unintended consequences of the new health-care law.  The book focuses on the incentive effects of the Affordable Care Act on employment.  At a time when our economy isn't creating many ‘good jobs,’ could this law impede progress? Mulligan masterfully applies insights from price theory to one of the most crucial public policy issues of our era. “

Matthew Kahn, University of California, Los Angeles

“When the government subsidizes health insurance for people who do not have full-time jobs, that subsidy discourages work and job creation, just as much as a tax of thousands of dollars on employment would do. In this splendid book, Mulligan comprehensively surveys this and related disincentives created by the many pieces of the Affordable Care Act, and he estimates their overall effect on employment and economic growth. You will come away shocked at how unaffordable the act is for the economy as a whole.” 

John H. Cochrane, University of Chicago

“Mulligan is certainly right to emphasize the importance of asking about the potential adverse side-effects of any significant social reform—and at the very least, he offers cautionary notes about the need to monitor the actual consequences of the Affordable Care Act.”

Cass Sunstein | Bloomberg View

Table of Contents


1 The Paradox of Affordability
2 Too Good to Be True: The Health Reform’s Hidden Taxes
3 Some Unpleasant Penalty Arithmetic
4 Some Unpleasant Subsidy Arithmetic
5 Exchange Subsidies and Their Implicit Income Taxes
6 Consequences for Employee Work Schedules
7 Adam Smith’s Equalizing Differences: More Hidden Taxes and More Health Coverage
8 The ACA’s Productivity Distortions
9 Other Significant Causes of Economic Change, 2007–2017
10 Romneycare Times Eleven
11 Conclusions

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