Category Archives: Health Care

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. …

How King v. Burwell Creates Tax Problems for 2014-2015 Health Care Enrollees

Source: Andy Grewal, University of Iowa – College of Law, Legal Studies Research Paper No. 14-30, November 21, 2014

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.

Distinguishing the Race-Specific Effects of Income Inequality and Mortality in U.S. Metropolitan Areas

Source: Amani M. Nuru-Jeter, Chyvette T. Williams, Thomas A. LaVeist, International Journal of Health Services, Volume 44 Number 3, 2014
(subscription required)

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.
Related:
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.