Affordable Care Act payment model saves more than $25 million in first performance year

Source: Centers for Medicare & Medicaid Services, Press Release, June 18, 2015

The Centers for Medicare & Medicaid Services (CMS) today announced positive and promising results from the first performance year of the Independence at Home Demonstration, including both higher quality care and lower Medicare expenditures. ….

The CMS analysis found that Independence at Home participants saved over $25 million in the demonstration’s first performance year – an average of $3,070 per participating beneficiary – while delivering high quality patient care in the home. CMS will award incentive payments of $11.7 million to nine participating practices that succeeded in reducing Medicare expenditures and met designated quality goals for the first year of the demonstration.

According to CMS’ analysis, all 17 participating practices improved quality in at least three of the six quality measures for the demonstration in the first performance year. Four participating practices met all six quality measures. Medicare beneficiaries who are participating in Independence at Home practices, on average:
• Have fewer hospital readmissions within 30 days;
• Have follow-up contact from their provider within 48 hours of a hospital admission, hospital discharge, or emergency department visit;
• Have their medications identified by their provider within 48 hours of discharge from the hospital;
• Have their preferences documented by their provider; and
• Use inpatient hospital and emergency department services less for conditions such as diabetes, high blood pressure, asthma, pneumonia, or urinary tract infection….

Why Chicago Won’t Go Bankrupt—And Detroit Didn’t Have To

Source: Saqib Bhatti, In These Times, June 22, 2015

Detroit’s bankruptcy wasn’t inevitable. Neither is Chicago’s. But the austerity hawks don’t want you to know that. …

….Because conventional wisdom held that bloated pensions had bankrupted Detroit, the conversation revolved around other cities with large pension shortfalls, such as New York, Philadelphia and Jacksonville, Florida. …. All of this uproar rested on a basic falsehood in the dominant public narrative around Detroit: that pensions played a key role in driving the city bankrupt. But those who studied the bankruptcy closely know that the reverse is true: The city filed bankruptcy so that it could cut pensions.

Detroit’s bankruptcy was not borne out of financial necessity and was not a foregone conclusion. It was a political decision made by state officials. Gov. Rick Snyder and the Michigan Legislature chose to push the distressed city over the edge in order to accomplish two otherwise difficult political goals: slashing pensions and regionalizing the Detroit Water and Sewerage Department. It was disaster capitalism at its finest.

Austerity hawks are now hoping to use the Detroit playbook in other cities to force the public to accept extreme measures to fix budget crises. ….

….The $198 million shortfall could have been addressed fairly easily—in part, simply by undoing state actions that had pushed Detroit into bad financial straits in the first place. For example, Detroit had taken a major financial hit over the course of 2011 and 2012, when Snyder and the Michigan Legislature decided to cut annual state revenue sharing with the city by $67 million. Restoring that funding would have filled one-third of the city’s shortfall. Second, there were state-imposed restrictions on the city’s ability to raise local taxes, dating back to the 1990s. Lifting those restrictions would have allowed the city to raise taxes and bring in new revenue. …..

State Sales Taxes 2015

Source: Jennifer Burnett, Council of State Governments, Capitol Research, June 2015

Forty-five states levy a general statewide sales tax, with rates ranging from 2.9 to 7.5 cents per $1 as of Jan. 1, 2015. Over the past decade, sales tax rates have remained relatively stable, with few states making significant changes. ….
Download the Excel Version of the Table: “State Sales Taxes

Budding Growth

Source: Carrie Abner, Council of State Governments, The Current State, Issue: 21, June 22, 2015

Anecdotally, it’s been a top cash crop in a number of states for decades. But with the opening of recreational marijuana sales in Colorado and Washington, states are just now beginning to understand the full financial impact of cannabis to government coffers. As more states look to add marijuana and its cannabis cousin, industrial hemp, to their agricultural industries, the costs and benefits are becoming clearer. ….

Our Universities: The Outrageous Reality

Source: Andrew Delbanco, New York Review of Books, July 9, 2015

…..Colleges and universities cannot be expected to solve America’s problems of inequity. They cannot repair broken families, or make up for learning deficits incurred early in childhood, or “level the playing field” for students with inadequate preparation. But they should be expected to try to mitigate these problems rather than worsen them—and one main reason they are failing to do so is their relentlessly rising cost…..

….But if there are problems in the private sector, by far the biggest driver of rising tuition has been the lack of economic investment in public institutions. Between 1998 and 2008, tuition rose at four-year private colleges by 33 percent, while at four-year public universities it climbed by 54 percent—a divergence that widened with the Great Recession.16 And this has happened at a time when most Americans have experienced wage stagnation.

To make matters worse, the trend in dispensing financial aid—both by the states and by colleges themselves—has been moving away from calculations of need toward assessments of “merit” as demonstrated by test scores, extracurricular activities, and the like.17 Since low-income students are often saddled with family responsibilities and summer and term-time jobs, they tend to have fewer opportunities than their more affluent peers for the sort of entrepreneurship, volunteer work, or studies abroad that may impress admissions officers…..

The pernicious role of asymmetric history in negotiations

Source: Linda Dezső, George Loewenstein, Jonathan Steinhart, Gábor Neszveda, Barnabás Szászi, Journal of Economic Behavior & Organization, Volume 116, August 2015
(subscription required)

From the abstract:
The role of history in negotiations is a double-edged sword. Although parties can develop trust over time, there are also countless examples of protracted feuds that developed as a result of conflicting interpretations and invocations of history. We propose that, due to biased invocations of the past, history is likely to play a pernicious role in negotiations – particularly when given an asymmetric history in which one party benefited at the expense of the other. We test this prediction in two, two-stage experiments. We find that asymmetric history in a first stage leads to increased impasses in a second stage, but that this effect holds only when the second stage pairs the same two parties who shared the asymmetric history in the first.

• Two experiments demonstrate the significance of asymmetric history in negotiations.
• In both experiments, dyads negotiate to divide joint earnings.
• We find incompatible bargaining claims when partners share asymmetric history.
• Asymmetry only matters when parties share history.

How history adds conflict to negotiations
Source: Shilo Rea – Carnegie Mellon, Futurity, June 22, 2015

New research shows how past histories can harm negotiations, particularly when an event in the past benefited one party at the other’s expense.

In these situations, the party that got the short end of the stick tends to believe that they’re owed retribution. The party that triumphed in the past, in contrast, tends to think that the past is irrelevant—bygones should be treated as bygones.

Although different sides can develop trust over time, there are also countless instances of prolonged feuds that developed because of conflicting histories.

A prime example is World War II, which was fought in part to rectify perceived wrongs from the past. The phenomenon also extends to day-to-day situations such as sharing utility costs with a roommate or jockeying for position at grocery store checkout lanes.

The 2015 White House Conference on Aging: Agenda Setting and Issue Framing

Source: Public Policy & Aging Report, Volume 25 Issue 2, Spring 2015

From the introduction:
White House Conferences on Aging, held roughly every 10 years since 1961, have “generated ideas and momentum prompting the establishment of and/or key improvements in … programs that represent America’s commitment to older Americans” (The White House, 2015a). In terms of economic security, notably, the 1961 conference gave a push to the enactment of Medicare by recommending the provision of medical care for the aged through Social Security (Senate Special Committee on Aging, 1961). In 1971, President Nixon advocated inflation-proofing Social Security benefits, saying “It does not make sense to have … benefits constantly behind inflation” (Nixon, 1971), language backed-up when he signed the 1972 amendments to the Social Security Act implementing automatic cost of living adjustments (the “COLA”). While unlikely that this year’s conference will see the fruits of its labor enacted into sweeping policy change in the near term, it could play an important agenda-setting role for future congresses and presidents if conference planners and delegates:
• Explicitly reject the “entitlement crisis frame” and language;
• Advance the intergenerational understanding of Social Security;
• Highlight economic insecurity among today’s seniors
• Sound the alarm on the looming retirement income crisis;
• Consider benefit increases in Social Security as a critical option….

Articles include:
The 2015 White House Conference on Aging: Agenda Setting and Issue Framing
Robert B. Hudson
Optimizing Health in Aging Societies
Laura L. Carstensen, Mary E. Rosenberger, Ken Smith, and Sepideh Modrek

Healthy Aging and Age-Friendly Community Initiatives
Emily A. Greenfield

Advancing a Retirement Income Security Agenda for All Generations
Eric R. Kingson and Molly W. Checksfield

How Administrative Burdens Are Preventing Access to Critical Income Supports for Older Adults: The Case of the Supplemental Nutrition Assistance Program
Pamela Herd
Long-term Services and Supports (LTSS): A Growing Challenge for an Aging America
Kali S. Thomas and Robert Applebaum

Fulfilling the Promise of the Elder Justice Act: Priority Goals for the White House Conference on Aging
Daniel B. Kaplan and Karl Pillemer
Editor’s choice: Unsolved Mysteries in Aging Policy
Debra Bailey Whitman

Retirement Security Summit: The Evolving Social Contract

Source: Center for State and Local Government Excellence, June 15, 2015

On June 9, 2015, SLGE convened a Retirement Security Summit in order to explore pension and health benefit changes, retirement income trends, the implications of shifting demographics, and the evolving social contract with employees.

Program Moderator – Peter Harkness, Founder and Publisher Emeritus, Governing magazine
Welcome – Elizabeth Kellar, President & CEO, Center for State and Local Government Excellence
Introduction – Robert O’Neill, Executive Director, ICMA and Chair, Board of Directors, Center for State and Local Government Excellence
Keynote Speaker – Dallas Salisbury, President & CEO, Employee Benefit Research Institute [Download a pdf of Mr. Salisbury’s presentation]

Session 1: Retirement Income Trends and Pension Reforms

Dana Bilyeu, Executive Director, National Association of State Retirement Administrators [Download a pdf of Ms. Bilyeu’s presentation]
Gerri Madrid-Davis, Director, Financial Security & Consumer Affairs, State Advocacy & Strategy Integration, AARP [Download a pdf of Ms. Madrid-Davis’ presentation]
Bob Schultze, President & CEO, ICMA-RC
Wendy Dominguez, President and co-founder, Innovest Portfolio Solutions LLC

Session 2: The New Social Contract with Employees

Neil Reichenberg, Executive Director, International Public Management Association for Human Resources [Download a pdf of Mr. Reichenberg’s presentation]
Steven Kreisberg, Director of Collective Bargaining & Health Care Policy, American Federation of State, County and Municipal Employees
Rebecca Hunter, Commissioner, Tennessee Department of Human Resources
Joshua Franzel, Vice President of Research, Center for State and Local Government Excellence [Download a pdf of Dr. Franzel’s presentation]

Session 3: Boosting Retirement Savings

Elizabeth Kellar, President & CEO, Center for State and Local Government Excellence
Cathie Eitelberg, National Public Sector Market Director, Segal Group [Download a pdf of Ms. Eitelberg’s presentation]
Steven Montagna, Chief Personnel Analyst, City of Los Angeles Personnel Department [Download a pdf of Mr. Montagna’s presentation]

Civil Rights Policy

Source: Mark Tushnet, Harvard Public Law Working Paper No. 15-10, April 2, 2015

From the abstract:
This essay offers an overview of US civil rights policy from the nineteenth century to the present. The expansion of the range of substantive interests covered by the term “civil rights” has been accompanied by an increasing emphasis on the connection between equality and civil rights. From the late nineteenth century through the first half of the twentieth, the term referred to racial equality with respect to whatever fit into the category, whether property rights, the right to vote, or social rights. Starting roughly in the middle of the twentieth century, “civil rights” began to be connected to other categories, such as gender, religion, sexual orientation, and by the twenty-first century quite a bit more. After examining the history of the idea and its implementation, the essay concludes with a discussion of contemporary controversies over disparate impact versus disparate treatment, affirmative action, and accommodation mandates.