President Obama on Tuesday will announce a broad new research initiative, starting with $100 million in 2014, to invent and refine new technologies to understand the human brain, senior administration officials said Monday.
This paper introduces a model of optimal health insurance. This model provides theoretical guidance of the relationship between household preferences, cost-sharing, and premiums. It applies this model to understand how the income tax subsidy distorts optimal cost-sharing in health insurance. Typically, insurance protects individuals from financial risk. Health insurance plans, however, are frequently designed to provide coverage at non-catastrophic levels of financial loss. The presence of a health insurance subsidy in the United States tax code, which enables individuals to pay premiums in pre-tax dollars, encourages the purchase of more generous health insurance plans. Little is known about how the tax subsidy affects preferences for the structure of cost-sharing in private plans. This model illustrates how the tax subsidy can distort the optimal cost-sharing schedule. The model is tested empirically using claims data in the Medical Expenditure Panel Survey and a regression discontinuity strategy that uses discrete changes in the marginal tax rate at the Social Security taxable maximum for identification.
Health care spending in three states – Maine, West Virginia and Mississippi – accounts for one out of every five dollars of state GDP. Conversely, Wyoming spends less one in ten, according to a new study by the National Center for Policy Analysis (NCPA).
“If every state could be like Wyoming, which they cannot, the country as a whole would be spending less of its income on health care than about three-fourths of the other developed countries,” said former Medicare Trustee and NCPA Senior Fellow Thomas R. Saving.
Can Long-Term Care Insurance Partnership Programs Increase Coverage and Reduce Medicaid Costs? by Wei Sun, Anthony Webb :: SSRNMarch 21, 2013
Although long-term care is a substantial financial risk for retired households, only about 10 percent purchase insurance, with many of the remainder relying on Medicaid. Faced with rising Medicaid expenditures on long-term care, states have attempted to encourage the purchase of private long-term care insurance through partnership programs that exempt purchasers of qualifying policies from the Medicaid asset test. Using numerical optimization techniques, and assuming plausible preference parameters, we show that the programs will only increase insurance coverage among single males by 5 percent and single females by 4 percent. Most of the program benefits will go to those who would have purchased non-partnership long-term care insurance anyway. Thus, the cost of the subsidy will exceed the savings in Medicaid costs.
Health Insurance Coverage and Use of Family Planning Services among Current and Former Foster Youth: Implications of the Health Care Reform LawMarch 21, 2013
This research uses data from a longitudinal study to examine how two provisions in the Patient Protection and Affordable Care Act could affect health insurance coverage among young women who have aged out of foster care. It also explores how allowing young people to remain in foster care until age twenty-one affects their health insurance coverage, use of family planning services, and information about birth control. We find that young women are more likely to have health insurance if they remain in foster care until their twenty-first birthday and that having health insurance is associated with an increase in the likelihood of receiving family planning services. Our results also suggest that many young women who would otherwise lack health insurance after aging out of foster care will be eligible for Medicaid under the health care reform law. Because having health insurance is associated with use of family planning services, this increase in Medicaid eligibility may result in fewer unintended pregnancies among this high-risk population.
This paper investigates the potential relevance to health care reform of the Nobel Prize-winning research of Elinor Ostrom on community-based management of natural resource commons. Two related interpretations of the concept of a “health commons” are considered, the first (a micro-commons) consisting of specific programs of quality improvement or health promotion, and the second encompassing the entire system of physical, financial, human, and social resources relevant to the delivery of health care in a region. The proliferation of micro-commons has deepened the fragmentation of health care delivery systems, and rising costs of health care threaten the long-term sustainability of this mode of delivery. Cross-stakeholder collaborations can serve as “stewards” of either of these health commons, under conditions analogous to the Design Principles identified by Ostrom. Examples from the case of Grand Junction, Colorado, are used to illustrate the relevance of these principles to shared stewardship of a regional health commons. The paper concludes with a set of questions that can help assess a community’s ability to more effectively manage their own system of health care delivery.
U.S. medical schools are expanding to meet an expected demand for more doctors spurred by the federal health law. With 12 new schools opening and existing ones growing, enrollment is on track to produce 5,000 more graduates a year by 2019.But medical educators are cautioning that those efforts wont do anything to alleviate a doctor shortage unless the number of medical residency positions rises as well. The number of federally funded residencies has been frozen since 1997.
Effects of Employer-Sponsored Health Insurance Costs on Social Security Taxable Wages by Gary Burtless, Sveta Milusheva :: SSRNMarch 12, 2013
The increasing cost of employer contributions for employee health insurance reduces the share of compensation subject to the Social Security payroll tax. Rising insurance contributions can also have a more subtle effect on the Social Security tax base because they influence the distribution of money wages above and below the taxable maximum amount. This article uses the Medical Expenditure Panel Survey to analyze trends in employer health insurance contributions and the distribution of those costs up and down the wage distribution. Our analysis shows that employer health insurance contributions increased faster than overall compensation during 1996–2008, but such contributions grew only slightly faster among workers earning less than the taxable maximum than they did among those earning more. Because employer health insurance contributions represent a much higher percentage of compensation below the taxable maximum, health insurance cost trends exerted a disproportionate downward pressure on money wages below the taxable maximum.
Testing for Asymmetric Information in Private Health Insurance by Pau Olivella, Marcos Vera‐Hernández :: SSRNMarch 12, 2013
We test for asymmetric information in the UK private health insurance (PHI) market. In contrast to earlier research that considers either a purely private system or one where private insurance is complementary to public insurance, PHI is substitutive of the public system in the UK. Using a theoretical model of competition among insurers incorporating this characteristic, we link the type of selection (adverse or propitious) with the existence of risk‐related information asymmetries. Using the British Household Panel Survey, we find evidence that adverse selection is present in the PHI market, which leads us to conclude that such information asymmetries exist.
Retiree Out-of-Pocket Healthcare Spending: A Study of Consumer Expectations and Policy Implications by Allison Hoffman, Howell Jackson :: SSRNMarch 11, 2013
Even though most American retirees benefit from Medicare coverage, a mounting body of research predicts that many will face large and increasing out-of-pocket expenditures for healthcare costs in retirement and that many already struggle to finance these costs. It is unclear, however, whether the general population understands the likely magnitude of these out-of-pocket expenditures well enough to plan for them effectively. This study is the first comprehensive examination of Americans’ expectations regarding their out-of-pocket spending on healthcare in retirement. We surveyed over 1700 near retirees and retirees to assess their expectations regarding their own spending and then compared their responses to experts’ estimates. Our main findings are twofold. First, overall expectations of out-of-pocket spending are mixed. While a significant proportion of respondents estimated out-of-pocket costs in retirement at or above expert estimates of what the typical retiree will spend, a disproportionate number estimated their future spending substantially below what experts view as likely. Estimates by members of some demographic subgroups, including women and younger respondents, deviated relatively further from the experts’ estimates. Second, respondents consistently misjudged spending uncertainty. In particular, respondents significantly underestimated how much individual health experience and changes in government policy can affect individual out-of-pocket spending. We discuss possible policy responses, including efforts to improve financial planning and ways to reduce unanticipated financial risk through reform of health insurance regulation.