Projected impacts of federal tax policy proposals on mortality burden in the United States: A microsimulation analysis

The public health consequences of federal income tax policies that influence income inequality are not well understood. I aimed to project the impacts on mortality of modifying federal income tax structures based on proposals by two recent United States (U.S.) Presidential candidates: Donald Trump and Senator Bernie Sanders. I performed a microsimulation analysis using the latest U.S. Internal Revenue Service public-use tax file with state identifiers (2008 tax year), containing nationally-representative data from 139,651 tax returns. I considered five tax plan scenarios: 1) actual 2008 tax structures; proposals in 2016 by then-candidates 2) Trump and 3) Sanders; 4) a modified Sanders plan with higher top tax rates (75%); and 5) a modified Sanders plan with higher top rates plus revenue redistribution to lower-income households (< $40,000/year). I combined projected changes in income inequality with vital statistics data and past estimates of linkages between income inequality, income, and mortality. 29,689 (95% CI: 10,865-48,920) more deaths/year and 31,302 (95% CI: 11,455-51,577) fewer deaths/year from all causes are anticipated under the Trump and Sanders plans, respectively. Under the modified Sanders plan including higher top rates, 68,919 (95% CI: 25,221-113,561) fewer deaths/year are projected. Under the modified Sanders plan with redistribution, 333,504 (95% CI: 192,897-473,787) fewer deaths/year are expected. Policies that both raise federal income tax rates and redistribute tax revenue could confer large reductions in the total number of annual deaths among Americans. In this era of high income inequality and growing public support to address the rich-poor gap, policymakers should consider joint federal tax and redistributive policies as levers to reduce the burden of mortality in the United States.