RAND researchers estimated the effects that four proposed out-of-network payment limits for hospital care—125 percent of Medicare payments (a strict limit), 200 percent of Medicare payments (a moderate limit), state average payment by private plans (a moderate limit), and 80 percent of average billed charges (a loose limit)—would have on negotiated in-network prices and total payments for hospital care. These four scenarios reflect the variation in base measure (traditional Medicare, market price, and charges) and payment generosity among existing policy proposals.
A Hard Pill to Swallow: Appreciating the Mathematical Dynamics of the Affordable Care Act – Axene Health Partners, LLCMarch 22, 2020
The Affordable Care Act (ACA) is recognized for its role in reducing the uninsured rate in the United States. The federal financial commitment has expanded Medicaid eligibility and provided incentives for people to enroll in individual markets for the first time. Underneath the surface, the structural individual market design results in convoluted mathematical dynamics that challenge stakeholders to understand and improve markets. There has been historical reluctance to freely admit these challenges, partially to avoid potentially providing leverage to ACA detractors. To improve ACA markets, we must first be honest about some of its illogical consequences. For many of us, this is a hard pill to swallow.
This paper evaluates the labor market effects of sick pay mandates in the United States. Using the National Compensation Survey and difference-in-differences models, we estimate their impact on coverage rates, sick leave use, labor costs, and non-mandated fringe benefits. Sick pay mandates increase coverage significantly by 13 percentage points from a baseline level of 66%. Newly covered employees take two additional sick days per year. We find little evidence that mandating sick pay crowds-out other non-mandated fringe benefits. We then develop a model of optimal sick pay provision along with a welfare analysis. Mandating sick pay likely increases welfare.
new data from the California Policy Lab show, it’s likely that 50 percent of the homeless and 78 percent of the unsheltered homeless have a serious mental health condition.
Primary Care: Estimating Democratic Candidates’ Health Plans | Committee for a Responsible Federal BudgetMarch 13, 2020
Senator Bernie Sanders released a new set of proposals to offset the cost of his health care plan this week. Based on these new proposals, we have updated our paper – Primary Care: Estimating Democratic Candidates’ Health Plans – which estimates the fiscal impact of plans put forward by candidates Sanders, Biden, Buttigieg, and Warren. Whereas our previous estimates found Senator Sanders’s plan would fall $13.4 trillion short of being paid for, our newest estimates find his plan would fall just under $13 trillion short. The full analysis is available below. We have also updated our Primary Care infographics.
One of the greatest challenges to affordable health care is the high cost of American hospitals. The most important driver of higher prices for hospital care, in turn, is the rise of regional hospital monopolies. Hospitals are merging into large hospital systems, and using their market power to demand higher and higher prices from the privately insured and the uninsured.
The ProblemAdministrative costs account for one-quarter to one-third of total health-care spending in the United States—far greater than the amount necessary to deliver effective health care. Excessive administrative burden results in higher costs for physicians, insurers, and patients alike.The ProposalCutler proposes several reforms to the U.S. health-care system aimed at reducing administrative costs. Specifically, his proposal would establish a clearinghouse for bill submission, simplify prior authorization, harmonize quality reporting, and enhance data interoperability in the health-care system. Cutler’s proposal to lower administrative costs could save $50 billion annually.
In this document, we provide 12 facts about the economics of U.S. health-care, focusing largely on the private-payer system. We highlight the surge in health-care expenditures and their current high level. We note the wide variation of expenditures across individuals—something that necessitates insurance. We document that the United States pays higher prices than most countries and that these prices vary widely across and within places. We show that a lack of competition and high administrative costs are especially important contributors to high expenditures, indicating the need for reforms to reduce costs in the United States. To keep the focus on these issues, we do not discuss questions of coverage or of how coverage is provided (publicly or via the market), but instead address the questions of why expenditures, costs, and prices are so high.
Competitor’s Veto: State Certificate of Need Laws Violate State Prohibitions on Monopolies | Regulatory Transparency ProjectMarch 10, 2020
CON laws, after all, violate a host of constitutional provisions, including the anti-monopoly clauses found in several state constitutions. Enabling existing providers to use the law to bar others from entering an industry or offering a service is the very definition of a government-created monopoly. Few state courts have so far directly addressed whether CON laws violate state anti-monopoly clauses, but several have noted that they are inherently anticompetitive. Although this paper discusses how CON laws are designed to function in precisely the way prohibited by state constitutions.
Dr. Thomas’ AHRQ-funded work has explored other major patient safety issues such as the impact of medical liability alternatives like non-disclosure agreements. One in three malpractice claims that result in death or disability stem from an inaccurate or delayed diagnosis, according to a 2019 study in Diagnosis. External Link Disclaimer