Category Archives: Health Care

Outbreaks: Protecting Americans from Infectious Diseases

Source: Jeffrey Levi, Laura M. Segal, Dara Alpert Lieberman, Kendra May, Rebecca St. Laurent, Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF), December 2014

From the summary:
The Outbreaks: Protecting Americans from Infectious Diseases report finds that the Ebola outbreak exposes serious underlying gaps in the nation’s ability to manage severe infectious disease threats.
Half of states and Washington, D.C. scored five or lower out of 10 key indicators related to preventing, detecting, diagnosing and responding to outbreaks. Maryland, Massachusetts, Tennessee, Vermont and Virginia tied for the top score – achieving eight out of 10 indicators. Arkansas has the lowest score at two out of 10.

New Evidence on the Risk of Requiring Long-Term Care

Source: Leora Friedberg, Wenliang Hou, Wei Sun, Anthony Webb and Zhenyu Li, Center for Retirement Research at Boston College, WP#2014-12, November 2014

From the abstract:
Long-term care is one of the major expenses faced by many older Americans. Yet, we have only limited information about the risk of needing long-term care and the expected duration of care. The expectations of needing to receive home health care, live in an assisted living facility or live in a nursing home are essential inputs into models of optimal post-retirement saving and long-term care insurance purchase. Previous research has used the Robinson (1996) transition matrix, based on National Long Term Care Survey (NLTCS) data for 1982-89. The Robinson model predicts that men and women aged 65 have a 27 and 44 percent chance, respectively, of ever needing nursing home care. Recent evidence suggests that those earlier estimates may be extremely misleading in important dimensions. Using Health and Retirement Study (HRS) data from 1992-2010, Hurd, Michaud, and Rohwedder (2013) estimate that men and women aged 50 have a 50 and 65 percent chance, respectively, of ever needing care. But, they also estimate shorter average durations of care, resulting, as we show, from a greater chance of returning to the community, conditional on admission. If nursing home care is a high-probability but relatively low-cost occurrence, models that treat it as a lower-probability, high-cost occurrence may overstate the value of insurance.

We update and modify the Robinson model using more recent data from both the NLTCS and the HRS. We show that the low lifetime utilization rates and high conditional mean durations of stay in the Robinson model are artifacts of specific features of the statistical model that was fitted to the data. We also show that impairment and most use of care by age has declined and that the 2004 NLTCS and the 1996-2010 HRS yield similar cross-sectional patterns of care use. We revise and update the care transition model, and we show that use of the new transition matrix substantially reduces simulated values of willingness-to-pay in an optimal long-term care insurance model.
Related Issue in Brief:
“Long-Term Care: How Big a Risk?”

Comments on the HHS’ Flawed Post-Hobby Lobby Rules

Source: Lyman Johnson, David Millon, Stephen M. Bainbridge, Ronald J. Colombo, Brett McDonnell, Alan J. Meese, Nathan B. Oman, Hofstra Univiversity Legal Studies Research Paper No. 2014-23, October 20, 2014

From the abstract:
In late August 2014, after suffering a defeat in the Supreme Court Hobby Lobby decision when the Court held that business corporations are “persons” that can “exercise religion,” the Department of Health and Human Services (“HHS”) proposed new rules defining “eligible organizations.” Purportedly designed to accommodate the Hobby Lobby ruling, the proposed rules do not comport with the reasoning of that important decision and they unjustifiably seek to permit only a small group of business corporations to be exempt from providing contraceptive coverage on religious grounds. This comment letter to the HHS about its proposed rules makes several theoretical and practical points about the Hobby Lobby holding and how the proposed rules fail to reflect the Court’s reasoning. The letter also addresses other approaches to avoid in the rulemaking process and argues for rules that, unlike what the HHS has proposed, align with the Supreme Court’s reasoning while being consonant with generally applicable precepts of state law and principles of federalism.

What’s Next for VEBAs? The Impact of Declining Employer-Provided Health Care Coverage and the Affordable Care Act

Source: Erin Leighty, Pension Research Council, Working Paper, WP2014-19, July 2014

From the abstract:
A voluntary employee beneficiary association or VEBA, is a U.S. tax-exempt organization set up to pay for employee health and welfare benefits. The 2007 establishment of a stand-alone VEBA trust funded by the Big Three US automakers and managed by the UAW seemed to mark a defining moment for employer-provided retiree health care benefits. After years of declining employer-provided medical benefits, the VEBA trust seemed to offer an innovative structure to maintain these promises while moving the liability off of the employer’s balance sheet. Nevertheless, the 2008 financial crisis and government-assisted bailouts of GM and Chrysler immediately tested the stand-alone VEBA structure. Additionally, the passage of the Affordable Care Act is expected to accelerate the decline of employer-provided retiree health care benefits. With retirees able to receive medical coverage through the Affordable Care Act’s health care exchanges, the number of VEBA plans has already begun to decline. VEBAs will still serve a purpose as a tax-advantaged benefit funding mechanism and will be important for companies in financial distress looking to reduce the level and uncertainty of their significant benefit liabilities.

Kansas: Baseline Report – State-Level Field Network Study of the Implementation of the Affordable Care Act

Source: Rockefeller Institute of Government, Brookings Institution, Fels Institute of Government, ACA Implementation Research Network, December 2014

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.

Racial/ethnic differences in uninsurance rates under the ACA: Where you live matters

Source: Lisa Clemans-Cope and Hannah Recht and Anna Spencer, Urban Institute, Metro Trends, December 16th, 2014

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….

Spotlight on Retiree Health Care Benefits for State and Local Employees in 2014

Source: Joshua Franzel and Alex Brown, National Association of State Retirement Administrators (NASRA) and the Center for State and Local Government Excellence (SLGE), December 2014

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.

Key findings:
– 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.

Everything’s on the table

Source: Robert Barkin, American City and County, Vol. 129 no. 10, October 2014

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. …