The Hidden $700 Billion Debt Owed to Public Workers – Hit & Run : Reason.com

September 22, 2017

Connecticut, for example. Last year’s state budget (the current state budget is still being hammered out) projected $731 million to cover health care costs for retired state employees in 2017, compared to just $698 million for the health care costs of current employees.

Because Connecticut failed to save-up for the long-term costs of their retirees, state taxpayers are now paying more money to cover the costs of people who aren’t providing any government services—because they are retired—than for people who actually are.

Source: The Hidden $700 Billion Debt Owed to Public Workers – Hit & Run : Reason.com

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Politics, Hospital Behavior, and Health Care Spending

September 4, 2017

This paper examines the link between legislative politics, hospital behavior, and health care spending. When trying to pass sweeping legislation, congressional leaders can attract votes by adding targeted provisions that steer money toward the districts of reluctant legislators. This targeted spending provides tangible local benefits that legislators can highlight when fundraising or running for reelection. We study a provision – Section 508 – that was added to the 2003 Medicare Modernization Act (MMA). Section 508 created a pathway for hospitals to apply to get their Medicare payment rates increased. We find that hospitals represented by members of the House of Representatives who voted ‘Yea’ on the MMA were significantly more likely to receive a 508 waiver than hospitals represented by members who voted ‘Nay.’ Following the payment increase generated by the 508 program, recipient hospitals treated more patients, increased payroll, hired nurses, added new technology, raised CEO pay, and ultimately increased their spending by over $100 million annually. Section 508 recipient hospitals formed the Section 508 Hospital Coalition, which spent millions of dollars lobbying Congress to extend the program. After the vote on the MMA and before the vote to reauthorize the 508 program, members of Congress with a 508 hospital in their district received a 22% increase in total campaign contributions and a 65% increase in contributions from individuals working in the health care industry in the members’ home states. Our work demonstrates a pathway through which the link between politics and Medicare policy can dramatically affect US health spending.

Source: Politics, Hospital Behavior, and Health Care Spending


Blame Congress for high health-care costs

September 4, 2017

Hospitals in districts where a Republican congressman supported the Medicare Modernisation Act were five times more likely to receive a waiver than those in ones where a Republican lawmaker voted against. Those hospitals spent 25% more than they otherwise would have in the seven years after the law, according to the researchers. Between 2005 and 2010 the 29 hospitals that received the most lucrative waivers spent an average of $1.25bn more than if they had not received one.

Source: Blame Congress for high health-care costs


Impacting Entry into Evidence-Based Supported Employment: A Population-Based Empirical Analysis of a Statewide Public Mental Health Program in Maryland by David S. Salkever, Michael Abrams, Kevin Baier, Brent Gibbons :: SSRN

February 10, 2017

Access to evidence-based supported employment (SE) services for persons with serious mental illness is limited in the U.S., despite evidence such services are effective and could benefit more persons. Major barriers to SE expansion are overlapping and limited funding streams, and interagency coordination problems. An important recent initiative in one state (Maryland) addressed both types of barriers. This longitudinal analysis of SE take-up probabilities for population-based cohorts of Medicaid recipients, during 2002-2010, provided tentative evidence of initiative impacts (particularly during the recession downturn), and evidence of effects for a schizophrenia diagnosis, prior work-history, health and demographic characteristics, and geographic accessibility.

Source: Impacting Entry into Evidence-Based Supported Employment: A Population-Based Empirical Analysis of a Statewide Public Mental Health Program in Maryland by David S. Salkever, Michael Abrams, Kevin Baier, Brent Gibbons :: SSRN


Social Assistance and Minimum Income Levels and Replacement Rates Dataset by Jinxian Wang, Olaf van Vliet :: SSRN

February 9, 2017

The Social Assistance and Minimum Income Levels and Replacement Rates Dataset provides two new indicators for comparisons of social assistance and minimum income benefits across countries and over time, namely real net minimum income benefit levels and net minimum income benefit replacement rates. The dataset contains information for 33 countries for the period 1990–2009. For information on social assistance and minimum income benefits, the dataset draws upon information from Nelson’s (2013) dataset. The minimum income replacement rates are comparable to unemployment replacement rates.

Source: Social Assistance and Minimum Income Levels and Replacement Rates Dataset by Jinxian Wang, Olaf van Vliet :: SSRN


The Happiest States in 2016: Full List

February 4, 2017

A new poll from Gallup-Healthways shows which states had the highest and lowest well-being in 2016. Well-being scores are based on participants’ answers to questions about their sense of purpose, social relationships, financial lives, community involvement and physical health.

Source: The Happiest States in 2016: Full List


Reproductive Justice & Preventable Deaths: State Funding, Family Planning, Abortion, and Infant Mortality, US 1980–2010 by Nancy Krieger, Sofia Gruskin, Nakul Singh, Mathew Kiang, Jarvis Chen, Pamela Waterman, Jason Beckfield, Brent Coull :: SSRN

January 23, 2017

Introduction: Little current research examines associations between infant mortality and US states’ funding for family planning services and for abortion, despite growing efforts to restrict reproductive rights and services and documented associations between unintended pregnancy and infant mortality.

Material and methods: We obtained publicly available data on state-only public funding for family planning and abortion services (years available: 1980, 1987, 1994, 2001, 2006, and 2010) and corresponding annual data on US county infant death rates. We modeled the funding as both fraction of state expenditures and per capita spending (per woman, age 15–44). State-level covariates comprised: Title X and Medicaid per capita funding, fertility rate, and percent of counties with no abortion services; countylevel covariates were: median family income, and percent: black infants, adults without a high school education, urban, and female labor force participation. We used Possion log-linear models for: (1) repeat cross-sectional analyses, with random state and county effects; and (2) panel analysis, with fixed state effects.

Results: Four findings were robust to analytic approach. First, since 2000, the rate ratio for infant death comparing states in the top funding quartile vs. no funding for abortion services ranged (in models including all covariates) between 0.94 and 0.98 (95% confidence intervals excluding 1, except for the 2001 cross-sectional analysis, whose upper bound equaled 1), yielding an average 15% reduction in risk (range: 8–22%). Second, a similar risk reduction for state per capita funding for family planning services occurred in 1994. Third, the excess risk associated with lower county income increased over time, and fourth, remained persistently high for counties with a high percent of black infants.

Conclusions: Insofar as reducing infant mortality is a government priority, our data underscore the need, despite heightened contention, for adequate public funding for abortion services and for redressing health inequities.

Source: Reproductive Justice & Preventable Deaths: State Funding, Family Planning, Abortion, and Infant Mortality, US 1980–2010 by Nancy Krieger, Sofia Gruskin, Nakul Singh, Mathew Kiang, Jarvis Chen, Pamela Waterman, Jason Beckfield, Brent Coull :: SSRN