We analyze the labor market influence of the duration of occupational licensing statutes for 12 major universally licensed occupations over a 73 year period. These occupations comprise the vast majority of workers in these regulated occupations in the United States. Time from the start of state occupational licensing statutes (i.e., licensing duration) may matter in influencing labor market outcomes. Adding to or raising the entry barriers is likely easier once an occupation is established and has gained influence in a political jurisdiction. States often enact grandfather clauses and ratchet up requirements that protect existing workers and increase entry costs to new entrants. We provide among the first estimates of potential economic rents to grandfathering. We find that duration years of occupational licensing are positively associated with wages for continuing and grandfathered workers. The estimates show a positive relationship of duration with hours worked, but we find moderately negative results for participation in the labor market. The universally licensed occupations, however, exhibit heterogeneity in outcomes. Consequently, unlike some other labor market public policies, such as minimum wages or direct unemployment insurance benefits, occupational licensing would likely influence labor market outcomes when measured over a longer period of time.
Analyzing the Influence of Occupational Licensing Duration on Labor Market Outcomes by Suyoun Han, Morris M. Kleiner :: SSRNNovember 24, 2016
This note discusses the UK regulatory framework for mitochondrial replacement therapies and compares it to the US landscape. It focuses on the regulatory and ethical discussions in both countries to find some lessons for debates about editing human germ cells.The first section introduces some biological characteristics of mitochondria and their implications for mitochondrial diseases, medical interventions and ethical as well as regulatory questions. The second section discusses the regulatory pathway leading to the adoption of the UK 2015 regulations and the main features of the approved text. The third section considers the current regulatory landscape in the US. The fourth section discusses some regulatory and bioethical questions raised by Mitochondrial replacement therapies.
Kickbacks, Referrals and Efficiency in Health Care Markets: Experimental Evidence by Christian Waibel, Daniel Wiesen :: SSRNNovember 24, 2016
We analyse the causal effect of kickbacks (referral payments) on general practitioners’ behaviours and efficiency. In a stylized model, we derive behavioural predictions for general practitioners’ diagnostic efforts and referrals to secondary care (specialized physicians), which we test in a series of controlled laboratory experiments. We exogenously vary the level of regulated referral payments in our experimental treatments. We find that introducing referral payments significantly improves efficiency. An increase in payments leads to less undertreatment of severely ill patients, but also to more unnecessary referrals of mildly ill patients. The net effect is positive, as the former outweighs the latter. Interestingly, the increase in efficiency is mainly driven by behavioural changes of barely altruistic general practitioners.
‘No Imbecile at All’: How California Won the Autism Insurance Reform Battle, and Why Its Model Should Be Replicated in Other States by Ariana Cernius :: SSRNNovember 24, 2016
Autism is the fastest growing developmental disability in the United States today, with the CDC reporting the incidence of autism at 1 in 68 children. The cause and cure of autism remain unknown, and because autism affects each person at different levels of severity, a large number of symptom presentations are possible, making treatment difficult and costly. Despite the existence of effective, evidence-based early intervention treatments such as “Applied Behavioral Analysis (ABA)” therapy, which has lasting, long-term benefits and has been shown to improve functioning while reducing lifetime costs, the growing prevalence of autism has been declared a public health crisis by many states because those with autism who don’t receive enough or any treatment are more dependent on society and have been recently estimated to cost $236 billion in care from childhood through adulthood.
Due to receding state budgets, many states are not able to adequately address the autism population’s early intervention treatment needs through state-funded programs, and since health insurance did not cover treatment for autism until the Autism Insurance Reform Mandates which are the subject of this Note, families could not get treatment for their children with autism unless they were able to pay out-of-pocket. To provide a secure means of accessing treatment for people with autism, as of October 2015, 43 states and Washington D.C. have enacted “Autism Insurance Reform Mandates” requiring health insurance coverage of treatment for autism. While widespread existence of these mandates is surely progress and an acknowledgement of the problem, there is great legislative inconsistency among the mandates, which has created an imbalanced state of affairs for people with autism in the United States in that there are now some states that are better for autism families to live in than others. If the mandates are to accomplish their job of reducing the cost of the autism population to society in the long-term, it matters equally as much that the appropriate evidence-based treatments are covered, and that the length of coverage is measured not by arbitrary criteria like age, but by the continued efficacy of treatment, even if this means continued coverage through adulthood. Thus, there is still much work ahead to instill in society the notion that investing in the present to maximize the potential of this population will pay off in the long term for everyone in the country.
This Note traces the issues that lead to the ongoing national autism insurance reform, and offers insight as to how different modes of advocacy contributed to improving the lives of autism families in California, deemed one of the best states to live in for autism families. The goal of this Note is to compare how those strategies did or did not work in North Carolina, the most recent state to adopt a mandate, and to extend these lessons in social, political, and legal change in these successful states to the remaining states that lack coverage and to improving coverage in the states that currently provide coverage.
Caught in the Gap Between Status and No-Status: Lawful Presence Then and Now by Sara N. Kominers :: SSRNNovember 24, 2016
Where the line is drawn between noncitizens who are incorporated into American society and those who are not has changed greatly over time, resulting in the creation of a gray area where certain immigrants fall between those with lawful immigration status and those with no status at all. These individuals are granted “lawful presence” which permits them to remain and work in the United States, but does not provide them with a path to citizenship. The number of people in this ambiguous category continues to grow and may dramatically expand again soon as President Obama recently exerted broad scale executive action in response to Congress’ refusal to reform immigration laws.
This article looks at the ways immigration law grants lawful presence and the changing responses of the legal system in dealing with this “gap” between status and no-status. The recent exclusion of Deferred Action for Childhood Arrivals from the Affordable Care Act and other essential health insurance programs serves as a case study to demonstrate how inconsistently laws handle this middle category of people today. The consequences of such a narrow division between who receives benefits and who does not is that the gap between status and no-status widens, encouraging state lawmakers to further discriminate against this group. I argue that the struggle over where the line should be drawn to decide which noncitizens should and should not have access to essential rights and benefits is exacerbated by the tension between a progressive President and a conservative Congress. In a system where the Executive branch may confer lawful presence but only Congress can confer lawful status, hundreds of thousands of people are caught in the gap. I conclude by arguing that as the number of people in this gray area continues to grow, courts should lean toward inclusion rather than exclusion of lawfully present noncitizens in resolving this tension in the law.
Pharmaceutical companies use various strategies to protect their market monopoly. One of such practices is an acquisition of a patent developed by a third party. Such acquisitions allow pharmaceutical companies to strengthen their market power by extending the life of the product; for instance, by acquiring patents that cover alternative non-infringing versions of the monopolist’s own product, or acquiring the patent that covers an improvement of its current product. Both the US and EU case law condemn such practices as an abuse of monopoly power. This Article discusses patent acquisitions in the pharmaceutical industry focusing on two recent EU and US cases investigated by the competition authorities.
Safety, Effectiveness, and Patient Heterogeneity: Rethinking Risk-Risk Trade-Offs in Approving New Medical Treatments by Alan Randall :: SSRNNovember 24, 2016
Recent research challenges the foundations of regulatory policy for pharmaceutical drugs and medical treatments in a novel way: rather than a single risky treatment, the regulator should prefer a menu of treatments with ambiguous risks (Viscusi and Zeckhauser 2015). Then, patients would have opportunity to try treatments, eventually settling on the one that works best for them. I examine this argument and offer three conclusions. (1) Patient heterogeneity – i.e. patients respond differently to a given treatment – creates the matching problem that motivates trial-and-switch strategies, and provides the ambiguity that drives the potential gains therefrom. However, trial and switch is not an unmixed blessing. (2) Ambiguity-seeking policy, over and above that provided by patient heterogeneity, would be accomplished by reducing sample sizes and/or replications in pre-approval testing. The mean level of acceptable risk could be maintained, but confidence limits would expand, increasing the risk to individual patients. In effect, this is just another proposal for less regulatory caution regarding treatment risks and more attention to risk-risk trade-offs, as suggested by the quality-adjusted life-years, QALY, framework. (3) The case for risk-neutral regulation of treatment safety should be taken seriously in cases of devastating and life-threatening afflictions. Otherwise it fails, most obviously in the case of treatments for relatively minor ailments, which treatments dominate shelf space at drug stores and advertising in the media.
The Effect of E-Cigarette Minimum Legal Sale Age Laws on Traditional Cigarette Use and Birth Outcomes Among Pregnant Teenagers by Michael F. Pesko, Janet Currie :: SSRNNovember 24, 2016
We use United States birth record data to estimate the effect of e-cigarette minimum legal sale age laws on cigarette use and birth outcomes for pregnant teenagers. While these laws may have reduced e-cigarette use, we hypothesize that these laws may have also increased cigarette use during pregnancy by making it more difficult to use e-cigarettes to reduce/quit smoking. We use cross-sectional and panel data models to find that e-cigarette minimum legal sale age laws increase underage pregnant teenagers’ smoking by 2.1 percentage points. The laws may have also modestly improved select birth outcomes, perhaps by reducing overall nicotine exposure from vaping and smoking combined.
Nearly half of the coverage gains made during Obama’s presidency had nothing to do with ACA provisions and will survive repeal. Many other newly insured people will keep their coverage—if changes are made to health-care financing, and if two popular ACA provisions President-elect Trump has spoken favorably of are retained.
Source: Repeal and Revise | City Journal
STATISTICAL BRIEF #497: Concentration of Health Expenditures in the U.S. Civilian Noninstitutionalized Population, 2014November 23, 2016
- In 2014, the top 1 percent of persons ranked by their health care expenditures accounted for 22.8 percent of total health care expenditures, while the bottom 50 percent accounted for only 2.8.
- Persons age 65 and older comprised 15.1 percent of the U.S. civilian noninstitutionalized population and accounted for 33.6 percent of total health care expenditures. In contrast, children under age 18 comprised 23.2 percent of the population and 10.2 percent of expenditures.
- While 14.4 percent of adults under age 65 were uninsured during 2014, this group accounted for only 5.7 percent of health care expenditures.