New Gruber Study Raises Major Questions About ACA’s Medicaid Expansion | Mercatus Center

November 30, 2016

A new study by Jonathan Gruber, one of the Affordable Care Act’s (ACA) chief economic architects, suggests that roughly two-thirds of new Medicaid enrollees in 2014 were eligible for the program under previous state eligibility criteria—meaning that they were not made eligible by the ACA. If accurate, then a much smaller share of new Medicaid enrollees were made eligible for the program by the ACA than Washington experts commonly believe. For example, the Congressional Budget Office’s (CBO) most recent projection is that only one of six new Medicaid enrollees were eligible for the program before the ACA.

Source: New Gruber Study Raises Major Questions About ACA’s Medicaid Expansion | Mercatus Center


Hundreds on Medicaid waiting list in Illinois die while waiting for care | Illinois Policy | Illinois’ comeback story starts here

November 25, 2016

The state’s most recent enrollment reports show more than 650,000 able-bodied adults have enrolled in Medicaid since the Obamacare expansion, and this enrollment shows no sign of slowing down. This is nearly twice as many adults as the state said would ever enroll and more than the state said would ever even be eligible.

Expansion costs are also significantly over projections. Despite promises from the administration of former Gov. Pat Quinn that total expansion costs would “only” hit $2.7 billion in the first two years, costs actually came in at $4.7 billion – 70 percent higher than promised.

Source: Hundreds on Medicaid waiting list in Illinois die while waiting for care | Illinois Policy | Illinois’ comeback story starts here


Knowledge About Health Insurance and Finance Linked to Higher Rates of Health Coverage | RAND

November 25, 2016

Uninsured individuals who had greater knowledge about health insurance and financial issues were more likely to gain coverage after health insurance exchanges opened under the federal Affordable Care Act, according to a new RAND Corporation study.For a typical person who was uninsured in 2013, the chance of being insured in 2015 was 9.2 percentage points higher if they had high health insurance literacy as compared to someone with low health insurance literacy, after adjusting for other factors.

Source: Knowledge About Health Insurance and Finance Linked to Higher Rates of Health Coverage | RAND


A Taxpayer Bailout of ACA Insurers Just Got a Lot More Expensive | Mercatus Center

November 25, 2016

The Department of Health and Human Services (HHS) finally released the 2015 Affordable Care Act (ACA) risk corridor data. The data show the rapid deterioration of the ACA exchanges from 2014 to 2015.

The ACA’s risk corridor program was intended to transfer funds from profitable insurers to unprofitable ones for the first three years of the exchanges (2014 to 2016). The program ran a $2.5 billion deficit for the 2014 plan year as far more insurers incurred losses than made profits. In 2015, the deficit increased to more than $5.8 billion—a 132% increase.

Source: A Taxpayer Bailout of ACA Insurers Just Got a Lot More Expensive | Mercatus Center


Bridging Theory and Practice Leadership/Barack Obama by Hassan H. Elkatawneh :: SSRN

November 25, 2016

The paper discusses the style of leadership of the president of the United States of America President Barack Obama, during the eight years of working to achieve his promises to voters. The Obama presidential term has been characterized by great tensions serious events, crisis, overlapping changes at both internal and external levels, in addition, a heavy legacy of economic and security problems. The paper shows how Obama’s leadership style influenced by personal characteristics, and that had an impact on some cases to acquire support and sometimes on the face of fierce opposition, especially from the vanguard political classes. The paper touched Leadership Theories and Behavioral Theories to discuss of President Obama’s leadership style. Where the largest share of the study was to Traits Theory and the Transformational Leadership Theory, with the aid of the Behavioral Theories in analyzing the personal behavior and leadership style of President Obama. The study tries to bridge between theory and practice in harmonizing behaviors and theoretical assumptions, using the Behavioral Theories. When the study found that the transformational leader personality is not enough to earn the necessary support unless the personality of the transformational leader involves a democratic behavior.

Source: Bridging Theory and Practice Leadership/Barack Obama by Hassan H. Elkatawneh :: SSRN


American Healthcare Rackets: Monopolies, Oligopolies, Cartels and Kindred Plunderbunds | THCB

November 25, 2016

The FDA is the object lesson I’ve focused on. But there is a wealth of object lessons all with their distinctive acronym: ACGME, ABIM, AHA, ABMS, ACS, CMS (MIPS, MACRA), HIPAA and there are many more in the alphabet soup. Others are known by their full name like The Joint Commission, a non-governmental agency that wields accreditation with power and authority causing some 20,000 health organization, particularly hospitals, to cringe and comply.  Acronym or not, all these bearers of standards beg critical analysis. All have regulatory influence and all have fallen victim to regulatory capture to some degree.

Source: American Healthcare Rackets: Monopolies, Oligopolies, Cartels and Kindred Plunderbunds | THCB


Health Care and the Housing Crisis by Ben Gilbert, Julian Wade :: SSRN

November 24, 2016

We show that the percentage of people in a county without health insurance in 2005 is a strong and robust predictor of subsequent home value declines in that county during the housing crisis. Our preferred estimates indicate that a 10 percentage point increase in uninsured county residents in 2005 is associated with approximately 4 additional percentage points of home value decline between 2006 and 2010. We also provide evidence that this relationship was essentially nonexistent in Massachussets, where comprehensive health care reform was passed just before the housing crisis began. Our results contribute to the growing literature on the financial benefits of obtaining health insurance, but we are the first to show a link between health insurance and housing market outcomes. We also add to the literature on the household-level determinants of the recession; considering that uninsured households are likely to pay medical debt with consumer credit or home equity loans, our results shed light on one mechanism by which pre-recession household leverage may have exacerbated the recession. These results have important policy implications as the federal government considers a revision of the Affordable Care Act.

Source: Health Care and the Housing Crisis by Ben Gilbert, Julian Wade :: SSRN


Addressing Prescription Opioid Abuse Concerns in Context: Synchronizing Policy Solutions to Multiple Public Health Problems by Kelly K. Dineen :: SSRN

November 24, 2016

This article examines current policy and practices that emerged in response to recent increases in opioid related morbidity and mortality. This is a serious public health problem; however, the issue has been framed narrowly, and inaccurately, as the consequence of opioid abuse alone and directly attributable to inappropriate prescribing practices. These claims are analyzed against existing data and placed in the context of the negative impact on the well-being of individuals with disorders such as chronic pain, substance use disorders, and mental illness.

Many of the policy responses are not aligned to the real and potential harms — the premature death or increased morbidity associated with opioid misuse and substance use disorders. Instead, too many efforts focus on reducing prescription opioid use absent context and include heightened criminal enforcement and restrictive state legislation. Practice level responses focused on enhanced risk management approaches (treatment agreements, random urine screenings, reduced opioid prescribing even to those whom benefit) at the expense of holistic patient care. These are reviewed in light of available evidence. The risks of other types of harm, such as suicide and morbidity associated with mental illness, are compared to the actual risks of opioid misuse and diversion and suggestions for coherent policies and practices are offered.

The ongoing and possibly worsening environment for patients in pain is evaluated in terms of various well-studied cognitive biases and distortions that can lead to faulty policy making and practice decisions. Policy and regulatory responses are examined, both in terms of the possible influence of decision-making errors and of the operation of availability cascades and outrage heuristics. From this context, the current and proposed law and policy is examined in terms of its coherence or “fit” to the problem it purports to address. The specific application of literature of cognitive distortions and biases to decision-making errors in this particular context is a new contribution to the area. I advance that decision-making errors by policy makers and providers are probably a contributing cause of the unnecessary and unjustified suffering of patients by reinforcing incoherent and fragmented approaches. Finally, those policy approaches that do reduce harm and serve to enhance the well-being of these vulnerable populations are evaluated.

Source: Addressing Prescription Opioid Abuse Concerns in Context: Synchronizing Policy Solutions to Multiple Public Health Problems by Kelly K. Dineen :: SSRN


Between a Rock and a Hard Place: Can Physicians Prescribe Opioids to Treat Pain Adequately While Avoiding Legal Sanction? by Kelly K. Dineen, James M. Dubois :: SSRN

November 24, 2016

Prescription opioids are an important tool for physicians in treating pain but also carry significant risks of harm when prescribed inappropriately or misused by patients or others. Recent increases in opioid-related morbidity and mortality has reignited scrutiny of prescribing practices by law enforcement, regulatory agencies, and state medical boards. At the same time, the predominant 4D model of misprescribers is outdated and insufficient; it groups physician misprescribers as dated, duped, disabled, or dishonest. The weaknesses and inaccuracies of the 4D model are explored, along with the serious consequences of its application. This article calls for development of an evidence base in this area and suggests an alternate model of misprescribers, the 3C model, which more accurately characterizes misprescribers as careless, corrupt, or compromised by impairment.

Source: Between a Rock and a Hard Place: Can Physicians Prescribe Opioids to Treat Pain Adequately While Avoiding Legal Sanction? by Kelly K. Dineen, James M. Dubois :: SSRN


Calculating Expected Social Security Benefits by Race, Education and Claiming Age by Geoffrey Sanzenbacher, Jorge D. Ramos-Mercado :: SSRN

November 24, 2016

The option to claim Social Security before the full retirement age (FRA) has been around for over 50 years. But claiming benefits early has an inherent trade-off: more years of income are received in exchange for an actuarially reduced monthly benefit. The actuarial reduction is designed to be “fair” for the average worker in that, regardless of the age at which a person claims, he can expect to receive the same expected present value (EPV) of his lifetime benefits. Aside from a period of high interest rates in the 1980s, this equality has roughly held for the average worker since the inception of the actuarial reduction. But the key word here is average. Workers who live less long than the average might maximize the EPV of benefits by claiming early, while those who live longer than average might benefit more from delay. This paper analyzes this issue by calculating the EPV of Social Security benefits by race, education, and gender, all three of which are correlates of both mortality and earnings.

This paper found that:

– Non-Hispanic men, both black and white, who do not hold a college degree maximize their EPV of benefits by claiming before the full retirement age, especially using a 3-percent interest rate in the EPV calculation.

– On the other hand, white men with a college degree and white women with at least a high school degree maximize the EPV of their benefits when claiming after their FRAs.

– Within some groups, delayed claiming can result in a substantially higher EPV than early claiming, given today’s low interest rates. For white female college graduates, the maximum EPV occurs at age 70 and is 16 percent higher than the EPV at 62, assuming an interest rate of 1 percent.

The policy implications of this paper are:

– More educated workers have more incentive to delay claiming than less educated workers, and non-blacks have more incentive to do so than blacks.

– Since the EPV is not a welfare measure, this result does not necessarily advocate early claiming for some, but it does point to differential incentives across socioeconomic groups.

– Since some workers can maximize their EPV by claiming at 62, policies that delay the early eligibility age to 64 but hold the actuarial reduction constant would cause some workers to sacrifice expected lifetime benefits, although the decrease is small.

Source: Calculating Expected Social Security Benefits by Race, Education and Claiming Age by Geoffrey Sanzenbacher, Jorge D. Ramos-Mercado :: SSRN