Over half of the US population receives health insurance through an employer with premium contributions creating a flat "head tax" per worker, independent of their earnings. This paper develops and calibrates a stylized model of the labor market to explore how this uniquely American approach to financing health insurance contributes to labor market inequality. We consider a partial-equilibrium counterfactual in which employer-provided health insurance is instead financed by a statutory payroll tax on firms. We find that, under this counterfactual financing, in 2019 the college wage premium would have been 11 percent lower, noncollege annual earnings would have been $1,700 (3 percent) higher, and noncollege employment would have been nearly 500,000 higher. These calibrated labor market effects of switching from head tax to payroll tax financing are in the same ballpark as estimates of the impact of other leading drivers of labor market inequality, including changes in outsourcing, robot adoption, rising trade, unionization, and the real minimum wage. We also consider a separate partial-equilibrium counterfactual in which the current head tax financing is maintained, but 2019 US health care spending as a share of GDP is reduced to the Canadian share; here, we estimate that the 2019 college wage premium would have been 5 percent lower and noncollege annual earnings would have been 5 percent higher. These findings suggest that health care costs and the financing of health insurance warrant greater attention in both public policy and research on US labor market inequality.

超过一半的美国人口通过雇主获得健康保险，雇主缴纳保费，为每个工人征收统一的“人头税”，与他们的收入无关。本文开发并校准了劳动力市场的程式化模型，以探讨这种独特的美国医疗保险融资方式如何导致劳动力市场不平等。我们考虑一种部分均衡反事实，即雇主提供的健康保险由企业法定工资税提供资金。我们发现，在这种反事实融资下，2019 年大学工资溢价将降低 11%，非大学年收入将增加 1,700 美元（3%），非大学就业将增加近 500,000 美元。从人头税转向工资税融资的这些经过校准的劳动力市场影响与劳动力市场不平等的其他主要驱动因素的影响估计大致相同，包括外包、机器人采用、贸易增长、工会化和实际最低工资的变化工资。我们还考虑了一个单独的部分均衡反事实，其中维持当前的人头税融资，但 2019 年美国医疗保健支出占 GDP 的份额减少到加拿大的份额；在这里，我们估计 2019 年大学工资溢价将降低 5%，非大学年收入将增加 5%。这些发现表明，医疗保健成本和健康保险融资值得公共政策和美国劳动力市场不平等研究给予更多关注。