MACPAC | Comparing Section 1332 and Section 1115 Waiver Authorities

June 19, 2017

As discussed above, states cannot combine savings under Section 1115 and Section 1332 waivers into a single budget-deficit neutrality test. This clarification, along with the further definition of the guardrails, has been characterized by some as limiting states’ flexibility under the statute. As such, it is not clear how many states will pursue Section 1332 waivers and whether any of the reforms will lead to changes in Medicaid or CHIP. Furthermore, given the timing of their implementation (January 2017), the change in
administration at the federal level may alter the parameters in which states can seek these waivers.

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Green Cards, Patents, and Firm Value by Erdem Aktug :: SSRN

February 8, 2017

This is the first study to use the approved Green Card Applications (or Certified Permanent Residency Applications) from the Program Electronic Review Management (PERM) database, and the first to link the PERM database to patents database kept by the US Patent and Trademark Office (USPTO). We find that the number of approved permanent residency applications (perms, as a percentage of total employment) has a positive impact on firms’ value and growth opportunities proxied by Tobin’s Q (TQ). Specifically, a 1% increase in perms lead to a 15-20% increase in firm value. Although we were not able to confirm that more green cards lead to more innovation, we discover that more innovation gets firms more Green Cards. We find that a 1% increase in the patent variable (patents as a percentage of total employment) lead to a 0.03% increase in Green Card Approvals. Our findings carry importance for US policy makers, firms, investors, and academics.

Source: Green Cards, Patents, and Firm Value by Erdem Aktug :: SSRN

Still Falling Short on Hours and Pay: Part-Time Work Becoming New Normal by Lonnie Golden :: SSRN

January 7, 2017

The share of people working part-time involuntarily remains at recessionary levels. In 2015, there were 6.4 million workers who wanted to work full time but were working part time, accounting for 4.4 percent of those at work; this is roughly 2.0 million more involuntary part-time workers, or a 1.3 percentage-point increase in the rate of involuntary part-time employment prior to the recession. In fact, data from 2007 to 2015 show that involuntary part-time work is increasing almost five times faster than part-time work and about 18 times faster than all work.

It is this rise in involuntary part-time work that is driving an overall increase in part-time employment generally, as the share of the workforce working part time voluntarily has been stable since 2007. Thus, the “new normal” of underutilized labor primarily reflects the increased employer use of part-time employees and not any increased preference among workers for part time employment.The currently elevated level of part-time work — and of involuntary part-time work in particular — is no longer “cyclical,” i.e., it does not reflect a delayed and slow recovery, although reaching full employment could eventually yield a diminution in part-time work as workers are able to secure full-time employment.

The structural nature of today’s involuntary part-time employment is evident in the decrease in workers who say they are involuntarily part time due to slack work. Involuntary part-time work has gradually decreased since 2009 but almost entirely because fewer workers are working part-time hours due to “slack work or business conditions,” which had ballooned during the Great Recession. Slack work is an indicator of cyclical business lows.

In contrast, the share of those working involuntarily part time because they “could find only part-time” work (i.e., employers were offering only part-time work, indicative of structural factors) is just as high as it was at the end of the recession in 2009.Involuntary part-time work and its growth are concentrated in several industries that more intensively use part-time work, specifically, retail and leisure and hospitality. Retail trade (stores and car dealers, etc.) and leisure and hospitality (hotels, restaurants, and the like) contributed well over half (63.2 percent) of the growth of all part-time employment since 2007, and 54.3 percent of the growth of involuntary part-time employment. These two industries, together with educational and health services and professional and business services, account for the entire growth of part-time employment and 85.0 percent of the growth of involuntary part-time employment from 2007 to 2015.Trends in the reason for part-time employment by industry also suggest structural factors in play.

In 2015, involuntary part-time workers made up 7.8 percent of all those at work in the retail sector. That is 3.4 percentage points higher than before the recession started, in 2007. Roughly 60 percent of this growth in involuntary part-time work reflects those who “could find only part-time work.” Involuntary part-time work was an even higher proportion of employment, 10.4 percent, in the leisure and hospitality industry in 2015, up 3.6 percentage points from 2007. Roughly half of this growth in involuntary part-time work reflects those who “could find only part-time work,” indicating structural factors were at least as important as cyclical factors.

The suggestion that the “shared responsibility provision” of the Affordable Care Act (ACA) is behind some of the shift toward part-time work is not supported by the data. The provision requires that certain employers pay a fee if they don’t offer a minimum level of health insurance to employees working 30 or more weekly hours. Had these health care-related labor costs prompted employers to reduce more positions to part-time hours, there would be a number of trends in the data that suggest a structural change in involuntary part-time working or hours worked, and these trends do not appear.

Certain groups of Americans are most vulnerable to the burdens of involuntary part-time work.Hispanic and black workers have been hardest hit by the structural shift toward involuntary part-time work. Hispanics and blacks are relatively much more likely to be involuntarily part-time (6.8 percent and 6.3 percent respectively) than whites, of whom just 3.7 percent work part time involuntarily. And blacks and Hispanics are disproportionate shares of involuntary part-time workers: together they constitute just 27.9 percent of those “at work,” they represent 41.1 percent of all involuntary part-time workers. The greater amount of involuntary part-time employment among blacks and Hispanics is due to their both having a greater inability to find full-time work and facing more slack work conditions. Black and Hispanic women (and women of “other race/ethnicity”) are the groups most likely to experience involuntary part-time employment and represented 21.1 percent of all invo

Source: Still Falling Short on Hours and Pay: Part-Time Work Becoming New Normal by Lonnie Golden :: SSRN

Spending on US Health Care, 1996-2013 | Health Care Economics, Insurance, Payment | JAMA | The JAMA Network

January 3, 2017

Importance  US health care spending has continued to increase, and now accounts for more than 17% of the US economy. Despite the size and growth of this spending, little is known about how spending on each condition varies by age and across time.

Objective  To systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care.

Design and Setting  Government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 through 2013 were collected and combined. In total, 183 sources of data were used to estimate spending for 155 conditions (including cancer, which was disaggregated into 29 conditions). For each record, spending was extracted, along with the age and sex of the patient, and the type of care. Spending was adjusted to reflect the health condition treated, rather than the primary diagnosis.Exposures  Encounter with US health care system.

Main Outcomes and Measures  National spending estimates stratified by condition, age and sex group, and type of care.Results  From 1996 through 2013, $30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Among these 155 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion (uncertainty interval [UI], $96.7 billion-$106.5 billion) in spending, including 57.6% (UI, 53.8%-62.1%) spent on pharmaceuticals and 23.5% (UI, 21.7%-25.7%) spent on ambulatory care. Ischemic heart disease accounted for the second-highest amount of health care spending in 2013, with estimated spending of $88.1 billion (UI, $82.7 billion-$92.9 billion), and low back and neck pain accounted for the third-highest amount, with estimated health care spending of $87.6 billion (UI, $67.5 billion-$94.1 billion). The conditions with the highest spending levels varied by age, sex, type of care, and year. Personal health care spending increased for 143 of the 155 conditions from 1996 through 2013. Spending on low back and neck pain and on diabetes increased the most over the 18 years, by an estimated $57.2 billion (UI, $47.4 billion-$64.4 billion) and $64.4 billion (UI, $57.8 billion-$70.7 billion), respectively. From 1996 through 2013, spending on emergency care and retail pharmaceuticals increased at the fastest rates (6.4% [UI, 6.4%-6.4%] and 5.6% [UI, 5.6%-5.6%] annual growth rate, respectively), which were higher than annual rates for spending on inpatient care (2.8% [UI, 2.8%–2.8%] and nursing facility care (2.5% [UI, 2.5%-2.5%]).

Conclusions and Relevance  Modeled estimates of US spending on personal health care and public health showed substantial increases from 1996 through 2013; with spending on diabetes, ischemic heart disease, and low back and neck pain accounting for the highest amounts of spending by disease category. The rate of change in annual spending varied considerably among different conditions and types of care. This information may have implications for efforts to control US health care spending.

Source: Spending on US Health Care, 1996-2013 | Health Care Economics, Insurance, Payment | JAMA | The JAMA Network

Have Private Medicare Plans Bid Competitively –

December 1, 2016

Yet the way that these private plans are paid today is extremely inefficient. While plans “bid” to offer coverage, actual payments to plans are based on administrative benchmarks. This is why the Medicare Payment Advisory Commission has routinely supported introducing “competitive bidding” into the program. While details vary by proposal, this would tie beneficiaries’ premiums to some plan in the market, be it a private plan or traditional Medicare itself. This would ensure financial neutrality between the two programs — incentivizing beneficiaries to seek out lower-cost plans — while also saving $275 billion over 10 years if it were structured similar to the Affordable Care Act’s exchanges.

Source: Have Private Medicare Plans Bid Competitively –

Size and Development of the Shadow Economies of 157 Countries Worldwide: Updated and New Measures from 1999 to 2013 by Mai Hassan, Friedrich Schneider :: SSRN

November 13, 2016

This paper is a first attempt to study the size and development of the shadow economies of 157 countries over 1999 to 2013. Using a MIMIC model, we find that higher tax and regulatory burden, unemployment and self-employment rates are drivers of the shadow economy, meaning that an increase of these causal variables increases the shadow economy. Our result also confirms previous findings of Friedrich Schneider, Andreas Buehn and Claudia Montenegro (2010). The estimated average of informality of 157 countries around the world, including developing, eastern European, central Asian and high income OECD countries averaged over 1999 to 2013 is 33.77% of official GDP [the average value for the U.S. is 9.17%]. A critical discussion about the size of these macro-estimates comes to the conclusion that most likely the “true” shadow economy of these countries is only 69% of their estimated macro-MIMIC-values.

Source: Size and Development of the Shadow Economies of 157 Countries Worldwide: Updated and New Measures from 1999 to 2013 by Mai Hassan, Friedrich Schneider :: SSRN

Did Obamacare reduce un-insurance in 2015, or not? | TheHill

January 16, 2016

That total of $52.6 billion helped reduce the number of uninsured by 8.8 million on net in 2014, an average per capita cost of nearly $6,000.

Of course, the government incurred other costs in getting ObamaCare up and running—financing the creation of exchanges, launching its website, bankrolling star-crossed co-ops, promoting enrollment, and undertaking other efforts to implement and hype the law. Then there were the costs ObamaCare imposed on households and businesses—cancelled policies, premium hikes, higher deductibles, narrow physician networks, erroneous subsidy payments that resulted in loss of coverage among low-income households, a tax on the uninsured, and new levies on insurance premiums, drugs and medical devices—all of which have combined to make the law unpopular.

The eventual Democratic presidential nominee will nonetheless cite the reduction in the uninsurance rate as proof that ObamaCare has succeeded.  That is a mistake.  Though most Americans favor government intervention to make health insurance more widely available to people with low-incomes and pre-existing medical conditions, they chafe at the disruption the law has inflicted on their own coverage.  They will likely be as skeptical of presidential candidates who declare the law a success as they are of those who merely insist on its repeal.

Source: Did Obamacare reduce un-insurance in 2015, or not? | TheHill