The Price and Spending Impacts of Limits on Payments to Hospitals for Out-of-Network Care | RAND

March 23, 2020

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.

Source: The Price and Spending Impacts of Limits on Payments to Hospitals for Out-of-Network Care | RAND


Mandated Sick Pay: Coverage, Utilization, and Welfare Effects

March 13, 2020

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.

Source: Mandated Sick Pay: Coverage, Utilization, and Welfare Effects


Genetic variation in health insurance coverage | SpringerLink

November 25, 2019

We provide the first investigation into whether and how much genes explain having health insurance coverage or not and possible mechanisms for genetic variation. Using a twin-design that compares identical and non-identical twins from a national sample of US twins from the National Survey of Midlife Development in the United States, we find that genetic effects explain over 40% of the variation in whether a person has any health coverage versus not, and nearly 50% of the variation in whether individuals younger than 65 have private coverage versus whether they have no coverage at all. Nearly one third of the genetic variation in being uninsured versus having private coverage is explained by employment industry, self-employment status, and income, and together with education, they explain over 40% of the genetic influence. Marital status, number of children, and available measures of health status, risk preferences, and prevention effort do not appear to be important channels for genetic effects. That genes have meaningful effects on the insurance status suggests an important source of heterogeneity in insurance take up.

Source: Genetic variation in health insurance coverage | SpringerLink


Understanding ‘wage theft’: Evasion and avoidance responses to minimum wage increases – AEI

March 14, 2019

A holistic assessment of the labor market effects of minimum wage regulation requires understanding employer compliance. The economics literature has paid little attention to this issue. We investigate how minimum wage increases and the strength of enforcement regimes affect the prevalence of subminimum wage payments. We find strong evidence that higher minimum wages lead to a greater prevalence of subminimum wage payments. We consistently estimate that increases in measured underpayment following minimum wage increases average between 10 and 25 percent of realized wage gains. We interpret this as evidence that minimum wage evasion and avoidance are an important reality in the low-wage labor market. Finally, we find that enforcement regimes play an important role in shaping both baseline compliance rates and the response of compliance to increases in minimum wages.

via Understanding ‘wage theft’: Evasion and avoidance responses to minimum wage increases – AEI


Brookings/USC Event | Emerging policy solutions to surprise medical bills

February 19, 2019

Too often, patients are surprised to find a bill from an out-of-network provider involved in their treatment who they had no control in choosing. Studies suggest that roughly 1 in 5 emergency room visits and 1 in 10 elective inpatient procedures result in the potential for a surprise out-of-network bill, most commonly when patient seek care at an in-network hospital but end up treated by certain emergency department or ancillary physicians (such as anesthesiologists, radiologists, pathologists, or assistant surgeons) who are outside their insurer’s provider network, and financial consequences can be devastating.In recent years, many states have moved to address surprise billing and a few federal proposals are floating around Congress. While there is broad bipartisan agreement that a problem exists, a solution can sometimes prove elusive. On Wednesday, February 20, 2019, the USC-Brookings Schaeffer Initiative for Health Policy will present new analysis detailing policy approaches to eliminate surprise out-of-network billing and bring together policymakers and stakeholders to discuss how to craft a solution.This event will be live webcast.

Source: Register to watch “Emerging policy solutions to surprise medical bills”


The impact of financial incentives on health and health care: Evidence from a large wellness program – Einav – 2019 – Health Economics – Wiley Online Library

January 10, 2019

Workplace wellness programs have become increasingly common in the United States, although there is not yet consensus regarding the ability of such programs to improve employees’ health and reduce health care costs. In this paper, we study a program offered by a large U.S. employer that provides substantial financial incentives directly tied to employees’ health. The program has a high participation rate among eligible employees, around 80%, and we analyze the data on the first 4 years of the program, linked to health care claims. We document robust improvements in employee health and a correlation between certain health improvements and reductions in health care cost. Despite the latter association, we cannot find direct evidence causally linking program participation to reduced health care costs, although it seems plausible that such a relationship will arise over longer horizons.

via The impact of financial incentives on health and health care: Evidence from a large wellness program – Einav – 2019 – Health Economics – Wiley Online Library


Exploring the Taxation of New York’s New Paid Family Medical Leave Benefit by Richard Barnes :: SSRN

January 2, 2019

This article examines the taxation of benefits received under New York’s new Paid Family Leave Act. The article argues that New York’s Paid Family Leave Act is unique when compared to similar provisions enacted in other states to date and that benefits paid under the tax are excluded from federal gross income by operation of Internal Revenue Code Sections 104 and 105. Additionally, the article contends that New York’s Department of Taxation and Finance’s Notice N-17-12 errs in concluding that amounts paid under the Act are includible in federal gross income. The article contends that insurance policies issued in compliance with the Act are “health insurance” and that income replacement benefits paid under the Act are paid for “sickness” as described in Code Sections 104 and 105.

via Exploring the Taxation of New York’s New Paid Family Medical Leave Benefit by Richard Barnes :: SSRN