A look back at how state and local government workers fared this year in terms of pensions, health care and jobs.
Researchers at the Kansas Health Institute have just released their baseline report from Kansas and are highlighting the diverse approaches to ACA implementation taken by Kansas state elected officials to the level of the governor. The Kansas report is the 19th baseline study to come out of the 36-state network established by the Rockefeller Institute, in conjunction with the Brookings Institution and the Fels Institute of Government at the University of Pennsylvania, to examine the implementation of the ACA.
Initial estimates suggest that the Affordable Care Act (ACA) has already reduced uninsured rates across all racial/ethnic groups, likely reducing longstanding racial/ethnic differences in health insurance coverage between whites and minorities. However, for poor and near-poor adults living in nonexpansion states—states that have elected not to expand their Medicaid programs under the ACA by January 2015—a substantial share have no affordable coverage option and are likely to remain uncovered. For low-income individuals without health insurance coverage, where you live matters….
From the summary:
An overview of the health care and other postemployment benefits state and local governments provide for their retired employees and how they pay for them.
– For most employees who retire from state (or covered local) government service, this coverage continues into retirement.
– The style and size of coverage varies and state and local government retiree health programs do not have a uniform design.
– Different plan designs, coverage levels, and financing arrangements produce different costs for sponsoring state governments.
– States vary in how they approach financing retiree health benefits, with some prefunding future benefit obligations while others pay for the associated costs annually as part of the state operating budget.
– The value of assets states hold in trust varies significantly.
This brief updates finance data on health care and other postemployment benefits (or OPEB) provided to general state employees featured in the 2013 report. The update also expands data to include additional state and local government employee cohorts including teachers, public safety officers, university employees, and legislators, among others.
Local governments operate within the Affordable Care Act to create unique health systems. … While political leaders in Congress and state capitals across the nation continue to debate the merits of the controversial health reform law, there is clear evidence that the nation’s health system is undergoing a pervasive redesign that continues to evolve as ACA’s provisions take hold. Leaders in public health remain uncertain about the exact contours of this new health system and what role the traditional public health system will play. …
The health secretary of Maryland, the only state yet to adopt another state’s technology, details the switch that led to a successful second-year launch after an initial glitch-ridden rollout.
From the abstract:
Commentators have expressed concern that a government loss in King v. Burwell, which addresses whether taxpayers can enjoy tax credits for policies purchased on federal health care exchanges, will lead to a “death spiral” during future enrollment seasons.
However, this discussion threatens to mask the potential tax problems facing persons who purchase policies this enrollment season. As this short article explains, purchasers may be faced with a surprising tax bill when they complete their 2015 tax returns.
Source: Amani M. Nuru-Jeter, Chyvette T. Williams, Thomas A. LaVeist, International Journal of Health Services, Volume 44 Number 3, 2014
From the abstract:
In the United States, the association between income inequality and mortality has been fairly consistent. However, few studies have explicitly examined the impact of race. Studies that have either stratified outcomes by race or conducted analyses within race-specific groups suggest that the income inequality/mortality relation may differ for blacks and whites. The factors explaining the association may also differ for the two groups. Multivariate ordinary least squares regression analysis was used to examine associations between study variables. We used three measures of income inequality to examine the association between income inequality and age-adjusted all-cause mortality among blacks and whites separately. We also examined the role of racial residential segregation and concentrated poverty in explaining associations among groups. Metropolitan areas were included if they had a population of at least 100,000 and were at least 10 percent black. There was a positive income inequality/mortality association among blacks and an inverse association among whites. Racial residential segregation completely attenuated the income inequality/mortality relationship for blacks, but was not significant among whites. Concentrated poverty was a significant predictor of mortality rates in both groups but did not confound associations. The implications of these findings and directions for future research are discussed.
Greater income inequality linked to more deaths for black Americans
Source: Sarah Yang, University of California, Berkeley, Press release, December 1, 2014
Greater income inequality is linked to more deaths among African Americans, but the effect is reversed among white Americans, who experienced fewer deaths, according to a new study by researchers at the University of California, Berkeley.
Source: Arnold M. Epstein, Benjamin D. Sommers, Yelena Kuznetsov, and Robert J. Blendon, Health Affairs, Vol. 33 no. 11, November 2014
From the abstract:
Expansion of Medicaid under the Affordable Care Act to millions of low-income adults has been controversial, yet little is known about what these Americans themselves think about Medicaid. We conducted a telephone survey in late 2013 of nearly 3,000 low-income adults in three Southern states—Arkansas, Kentucky, and Texas—that have adopted different approaches to the options for expansion. Nearly 80 percent of our sample in all three states favored Medicaid expansion, and approximately two-thirds of uninsured respondents said that they planned to apply for either Medicaid or subsidized private coverage in 2014. Yet awareness of their state’s actual expansion plans was low. Most viewed having Medicaid as better than being uninsured and at least as good as private insurance in overall quality and affordability. While the debate over Medicaid expansion continues, support for expansion is strong among low-income adults, and the perceived quality of Medicaid coverage is high.
Source: Evan S. Cole, Daniel Walker, Arthur Mora, and Mark L. Diana, Health Affairs, Vol. 33 no. 11, November 2014
From the abstract:
Medicaid disproportionate-share hospital (DSH) payments are expected to decline by $35.1 billion between fiscal years 2017 and 2024, a reduction brought about by the Affordable Care Act (ACA) and recent congressional action. DSH payments have long been a feature of the Medicaid program, intended to partially offset uncompensated care costs incurred by hospitals that treat uninsured and Medicaid populations. The DSH payment cuts were predicated on the expectation that the ACA’s expansion of health insurance to millions of Americans would bring about a decline in many hospitals’ uncompensated care costs. However, the decision of twenty-five states not to expand their Medicaid programs, combined with residual coverage gaps, may leave as many as thirty million people uninsured, and hospitals will bear the burden of their uncompensated care costs. We sought to identify the hospitals that may be the most financially vulnerable to reductions in Medicaid DSH payments. We found that of the 529 acute care hospitals that will be particularly affected by the cuts, 225 (42.5 percent) are in weak financial condition. Policy makers should recognize that decreases in revenue may affect these hospitals’ ability to give vulnerable populations access to care.