This article reviews the basic theoretical models that are appropriate for analyzing different types of welfare reforms, as well as the related empirical literature. We first present the canonical labor supply model of a classical welfare program and then extend this basic framework to include in-kind transfers, incomplete take-up, human capital, preference persistence, and borrowing and saving. The empirical literature on these models is presented. The negative income tax, earnings subsidies, US welfare reforms with features that differ from those in other countries, and childcare reforms are then surveyed in terms of both the theoretical models and the empirical literature surrounding each.
Americans joke that college students have so little money that they subsist on 10 cent packs of ramen. Statistically, college students face much higher rates of food insecurity than the general population and the situation is particularly dire for students of color. Much has been written on this area in recent months and years and many commentators are seeking to denormalize poverty, hunger, and the “freshman 15” on campuses. This article will look to a solution for this hungry and often neglected population. In 2010, the Health, Hunger-Free Kids Act (HHFKA) reauthorized the Federal School Lunch Program. HHFKA contained several innovations, however, one that is particularly relevant is the “identified students” provision. Under this scheme, students whose families already receive Supplemental Nutrition Assistance Program (SNAP) benefits, Medicaid, or are enrolled in several other federal assistance programs qualify for free or reduced-price school meals without a separate application. With the next iteration of the Farm Bill, SNAP should be adjusted to similarly accommodate low income college students. Under this new program, students who qualify for Perkins Loans, Federal Work Study, Pell Grants, Federal Supplemental Educational Opportunity Grants, and similar federal programs would also receive SNAP benefits without an additional application. The benefits to such a program would be tremendous. In many states, college students are specifically excluded from receiving benefits such as SNAP and Medicaid. This policy change would move students away from food insecurity, reduce the burden of schools providing high quality dining experiences that are a major contributor to the cost of higher education, reduce student debt, and bring the political capital of university students to SNAP.
Health Insurance, Hospitals, or Both? Evidence from the United Mine Workers’ Health Care Programs in Appalachia by Theodore F. Figinski, Erin Troland :: SSRNSeptember 18, 2018
Should the government subsidize health insurance, health care facilities, or both? The United States has subsidized both for many decades, targeting under-served populations and geographic areas. We study these questions in the first rigorous quantitative analysis of two major natural experiments in Appalachian coal country. In the early 1950s, the United Mine Workers of America (UMWA) coal mining union began to provide free health insurance to coal miners and their families. A few years later, the UWMA opened ten new state-of-the-art hospitals in Appalachia. These interventions give us the unique opportunity to separately identify (i) the effect of health insurance from (ii) the combined effect of the insurance plus new hospitals for the same place, time, and population. To do so, we use difference-in-differences at the county-year level. We find that the health insurance had large effects on pregnant women and infants. A woman’s probability of delivering her baby in a hospital increased from 60 percent to over 90 percent. The probability of her infant dying before the age of one decreased from 36 to 9 per 1,000. For the new hospitals, crowd-out was low. Adding UMWA hospitals increased hospital beds by more than 50 percent. Health care workers more than doubled.
Donate Today so Your Loved One Can Receive a Future Live Donor Kidney: Are Kidney Vouchers Enforceable Contracts? by Evelyn M. Tenenbaum :: SSRNSeptember 18, 2018
The kidney voucher program was started by the National Kidney Registry (NKR) in December 2014. Under the program, live donors can donate a kidney in return for a voucher that entitles their intended recipients to a live donor kidney from the end of a future kidney chain. The purpose of the program is twofold. First, it allows live donors to donate when it is convenient or possible for them to do so. For example, the first voucher donor was 64 years old and had a four-year-old grandson with one poorly functioning kidney. Under the kidney voucher program, the grandfather could donate his kidney before he was too old to donate and provide an advantage for his grandson, who was not expected to need a kidney for ten to fifteen years. Second, voucher donors will help alleviate the shortage of live donors needed to start kidney chains.
To make the kidney voucher program a success, live donors must trust that their intended recipients will receive kidneys when they need them. Viewing the voucher as an enforceable contract would help engender this trust. This article addresses the major legal and policy issues related to whether vouchers should be considered enforceable contracts. The article first confronts whether kidney vouchers violate the proscription in the National Organ Transplant Act (NOTA) against trading organs for valuable consideration. The article demonstrates that, with the current safeguards in place, the legislative history of NOTA supports the legality of trading a live donor kidney for a voucher that entitles the intended recipient to an end-of-chain kidney. The article also tackles the issues of whether a voucher agreement can be considered binding given that the live kidney donor cannot be compelled to donate even if he or she agrees to do so and whether the voucher agreement is illusory because the NKR does not guarantee that the intended voucher recipient will ever receive a kidney. The article concludes that the voucher agreement is binding, discusses the policy implications of reaching this conclusion, and makes some suggestions to deal with the policy concerns.
Attitudes Towards Large Income Risk in Welfare States: An International Comparison by Fred Schroyen, Karl Ove Aarbu :: SSRNSeptember 18, 2018
Using survey data and the instrument developed by Barsky et al. ([Barsky, R. B., 1997]), we estimate the distribution of attitudes towards income risk in a country where many employment and health‐related risks are generously covered by a tax‐financed social insurance system (Norway in 2006). Under a constant relative risk aversion assumption, the sample average for the coefficient of relative risk aversion is 3.8 with standard deviation 2.3. This number is then contrasted to that for five other OECD countries where risk attitudes have been measured using the same instrument and also prior to the financial crisis: Chile, France, Italy, the Netherlands and the USA. When we relate this distribution for stated relative risk aversion to that for generosity of social insurance and the risks related to employment and health expenditure, a picture emerges suggesting that more extensive welfare states induce higher risk tolerance for foreground risks—a relationship that is in line with the theory on risk vulnerability.
Health Data and Privacy in the Digital Era by Lawrence O. Gostin, Sam Halabi, Kumanan Wilson :: SSRNSeptember 18, 2018
In 2010, the social networking site Facebook launched a platform allowing private companies to request users’ permission to access personal data. Few users were aware of the platform, which was integrated into Facebook’s terms of service. In 2014, Cambridge Analytica, a UK-based political consulting firm, developed a data-harvesting app. That app prompted Facebook users to provide psychological profiles, including responses such as “I get upset easily” and “I have frequent mood-swings” as part of a “research project.”
The Facebook platform allowed users to share their friends’ data as well, enabling Cambridge Analytica to access tens of millions of personal profiles, identifying voters’ political preferences. The controversy revealed risks to identifiable health data posed by social media and web services companies’ practices. After the Cambridge Analytica controversy, Facebook suspended a project that aimed to link data about users’ medical conditions with information about their social networks.
Individuals often reveal detailed, sensitive health information online. Through wearable devices, social media posts, traceable web searches, and online patient communities, users generate large volumes of health data. Although some individuals participate in online patient forums and wellness information sharing apps under their own names, others participate via pseudonyms, assuming their privacy is preserved. Many users believe their data will be shared only with those they designate.
Hashing it Out: Blockchain as a Solution for Medicare Improper Payments by William J. Blackford :: SSRNSeptember 18, 2018
Part I highlights the inadequacies and inefficiencies of our Medicare payment system, focusing on the initiatives currently in place and the susceptibilities that persist. Part II offers a broad overview of the development, importance, features, and collateral technologies surrounding blockchain. Part III posits that Congress and HHS, through its various subsidiary agencies, should work in tandem with private stakeholders to create and/or implement a blockchain-based infrastructure to facilitate federal healthcare payments and support future growth of quality-based initiatives. This Note concludes with a recommendation for future agency research focusing on the viability and cost efficiency of a blockchain solution.