January 21, 2017
On August 15, 2016, CDC shared for initial public comment newly proposed regulations to clarify its powers pursuant to the Public Health Service Act (PHSA). These regulatory powers, reserved largely for public health exigencies, explain CDC’s authority to assess, apprehend, quarantine, test, examine, isolate, and monitor ill individuals with potentially infectious conditions arriving or traveling in the U.S.
CDC is attempting to strengthen its national public health powers amidst expanding infectious disease threats, particularly among foreign and interstate travelers, within a federalist structure traditionally dominated by state, territorial, tribal, and local public health efforts. Modernizing federal social distancing powers may be beneficial especially for health providers (and their legal counsels) responsible for screening and treating suspect patients. Yet CDC’s draft regulations raise numerous legal and policy concerns that could limit their utility.
This article examines the need for revamped federal powers in a globalized society rife with disease risks as a backdrop to CDC’s proposed regulations in response. Public health support for CDC’s role is explored coextensively with potential constitutional and other legal pitfalls that may derail execution of the regulations absent final changes.
Source: Reforming Federal Powers to Control Emerging Infectious Conditions: CDC’s Regulatory Proposals by James G. Hodge, Sarah Wetter, Danielle Chronister, Sarah Noe :: SSRN
January 21, 2017
Why are some people rich while others are poor? To what extent can governments affect inequality? Which instruments should they use? Answering these questions requires understanding why people save. Dynamic quantitative models of wealth inequality can help us understand and quantify the determinants of the outcomes that we observe in the data and to evaluate the consequences of policy reform. This paper surveys the savings mechanisms generated by the transmission of bequests and human capital, by preference heterogeneity, by rates of returns heterogeneity, by entrepreneurship, by richer earnings processes, and by medical expenses. It concludes that the transmission of bequests and human capital, entrepreneurship, and medical expense risk are crucial determinants of savings and wealth inequality.
Source: Saving and Wealth Inequality by Mariacristina De Nardi, Giulio Fella :: SSRN
December 13, 2016
Medicaid is a program in great need of reducing costs and improving outcomes for its beneficiaries. Medicaid managed care programs can assist in accomplishing both of these goals. Medical homes, developed in conjunction with managed care programs, can provide even greater benefit, particularly for those patients with the greatest needs, such as children, the aged and the disabled. Medical homes provide for enhanced coordination of care, with particular consideration given to each patient’s (and their families’) desires and limitations. Medicaid managed care programs working in conjunction with medical homes could provide significant benefits to patients, as well as federal and state budgets. Quality metrics and evidence-based standards of care designed specifically for children and patients with chronic needs should be developed.
Source: Medicaid Managed Care and Medical Homes – AAF
December 13, 2016
Our simulations show that a primary driver of long-term fiscal challenges for the state and local government sector continues to be the growth in health-related costs. Specifically, state and local Medicaid expenditures and the cost of health care compensation for state and local government employees and retirees generally grow at a rate that exceeds GDP.7 The model’s simulations suggest that the sector’s health-related costs will be about 4.1 percent of GDP in 2016 and 6.3 percent of GDP in 2065. From 2016 through 2065, Medicaid expenditures are expected to increase on average by 0.5 percentage points more than GDP—referred to as excess cost growth. Other health related receipts and expenditures, including health care compensation for state and local government employees and retirees, are expected to increase on average by 0.9 percentage points more than GDP each year from 2016 to 2023, and then begin to decline, reaching 0.7 percentage points in 2065.
Source: U.S. GAO – State and Local Governments’ Fiscal Outlook: 2016 Update
December 9, 2016
The Samaritan’s dilemma posits a downside to charity: recipients may rely on free aid instead of their own efforts. Anecdotally, the expectation of free assistance is thought to be important for decisions about insurance and risky behavior in numerous settings, but reliable empirical evidence is scarce. We estimate whether the Samaritan’s dilemma exists in U.S. agriculture, where both private crop insurance and frequent federal disaster assistance are present. We find that bailout expectations are qualitatively and quantitatively important for the insurance decision. Furthermore, aid expectations reduce both the amount of farm inputs and subsequent crop revenue.
Source: Does the Samaritan’s Dilemma Matter? Evidence from U.S. Agriculture by Tatyana Deryugina, Barrett Kirwan :: SSRN
December 7, 2016
States abdicate many of their federal responsibilities to local governments. They do not monitor local compliance with those laws; they disclaim responsibility for the actions of their local governments; and they deny state officials the legal capacity to bring local governments into compliance. When sued for noncompliance with these federal laws, states attempt to evade responsibility by arguing that local governments — and not the state — are responsible. These arguments create serious and unexplored barriers to enforcing federal law. They present thorny issues of federalism and liability, and courts struggle with them. Because neither courts resolving these conflicts nor advocates litigating them are aware that abdication occurs regularly across a number of policy areas, courts have failed to develop a consistent methodology for addressing it. This Article argues that courts should reject these state arguments in most cases and outlines the contours of a “nonabdication doctrine” that would be less solicitous and accommodating of existing state laws and more attentive to the language of federal laws.
This Article is the first to uncover these state arguments and mark them as a pattern across a surprisingly diverse set of states and federal policies: indigent defense, election law, public assistance, conditions of incarceration, and others. It uses state filings — including archived documents — as well as interviews with numerous advocates and state officials, to explore the concept of state abdication. It posits that abdication is a consequence of superimposing federal responsibilities onto the diverse legal and political relationships between states and their local governments. It suggests that abdication provides a new lens through which to reassess previous thinking on localism, federalism, and decentralization. Because abdication permits states to shelter noncompliance with federal law at the local level and mutes productive local dissent, it reveals a failure of decentralizing federal policy that federalism scholars currently overlook.
Source: Abdication and Federalism by Justin Weinstein-Tull :: SSRN
December 7, 2016
Powerful currents have reshaped the structure of families over the last century. There has been (i) a dramatic drop in fertility and greater parental investment in children; (ii) a rise in married female labor-force participation; (iii) a decline in marriage and a rise in divorce; (iv) a higher degree of assortative mating; (v) more children living with a single mother; (vi) shifts in social norms governing premarital sex and married women’s roles in the labor market. Macroeconomic models explaining these aggregate trends are surveyed. The relentless flow of technological progress and its role in shaping family life are stressed.
Source: Family Economics Writ Large by Jeremy Greenwood, Nezih Guner, Guillaume Vandenbroucke :: SSRN