Say Hello To The Modest Good Life For Me

Source: Terry J. Fitzgerald and Ronald A. Wirtz, fedgazette, September 2008

Anxiety over middle class living is complex, but probably not as warranted as the hand-wringing might suggest.

Gone are the wistful days of the 1960s and 1970s, when it seemed that everyone–well, every dad at least–had a good manufacturing job that paid enough for mom to stay home and for the family to afford all the trappings of middle class life: a house in a decent neighborhood, good health care, paid vacation, a pension to retire on and college for the kids.

So much for nostalgia, right? Government data portray a stagnant middle class. And like the saying goes, if you’re not getting ahead, you’re falling behind. It’s enough to make a middle class guy mutter a few no-class expletives.

But what if all this isn’t true, or is only partially true? What if the middle class in the Ninth District is continuing to get ahead, particularly in the big picture? This fedgazette article takes a close look at changes in middle American income, wages and living standards since 1979 in Ninth District states and finds that middle class living might not be as bad, threatened or besieged as is commonly portrayed.

Towers Perrin Health Care Cost Survey Shows Average Annual Per-Employee Cost of $9,660 in 2009 — And the Health Care Affordability Gap Widens

Source: Towers Perrin, Press Release, 24 September 2008

High-performing companies again beat low performers on costs by double-digit percentages informing policy debate with insights into what works in health care.

New data from Towers Perrin indicate that the business and social impacts of rising health care costs still loom large, but also that leading companies are successfully mitigating that threat through a variety of health-focused management techniques that are paying off in significant ways and point toward broader solutions to the cost crisis.

“The most striking result of our survey is the contrast between the high- and low-performing companies, said Dave Guilmette, Managing Director of the Towers Perrin Health and Welfare practice. “The high performers will pay, on average, 14% less in 2009 a differential that quickly adds up to millions of dollars in annual savings for companies and for their employees. While high-performing companies spend almost $1,500 less per employee overall, $350 of those savings, on average, are shared with employees in the form of lower contributions. This shared ‘health dividend’ also creates important workforce performance advantages, as reported by these organizations such as high employee engagement. Overall, the high performers are reaping a health dividend that can be a source of true competitive advantage and a model for the health care reform debate.”

Headed for a Crunch: An Update on Medicaid Spending, Coverage and Policy Heading into an Economic Downturn

Source: Vernon Smith, Kathleen Gifford, Eileen Ellis, Robin Rudowitz, Molly O’Malley and Caryn Marks, Kaiser Family Foundation, September 2008

From the press release:
With states confronting a weakening economy, enrollment in Medicaid began to rise last year with states expecting even larger increases for fiscal year 2009, according to a new 50-state survey released today by the Kaiser Family Foundation’s Kaiser Commission on Medicaid and the Uninsured (KCMU). With the increased enrollment, Medicaid spending is also rising more rapidly than in the recent past, raising the potential for program cutbacks as states confront the combined impact of more enrollees and fewer available resources.

The survey finds that Medicaid enrollment across the country grew 2.1 percent in fiscal year 2008, more than erasing a slight decline in enrollment experienced the previous year. States also experienced spending growth of 5.3 percent, up significantly from the previous two years. For fiscal year 2009, states expect to see even larger increases in Medicaid enrollment (3.5 percent) and spending (5.8 percent).

The survey comes as states face serious financial constraints, with 30 states having confronted significant budget shortfalls as they prepared their fiscal year 2009 budgets. Looking ahead, two thirds of state Medicaid directors say that there is at least a 50-50 chance that they will face a shortfall in their Medicaid budgets during the current year. Such shortfalls could force mid-year changes to control costs, potentially including cuts in eligibility and outreach efforts.
See also:
Executive Summary
Slides
Podcast of Media Briefing

Rx Watchdog Report: Trends in Prices of Prescription Drugs Used by Medicare Beneficiaries

Source: David J. Gross, Stephen W. Schondelmeyer, Leigh Purvis, AARP Policy & Research Research Report September 2008

From the press release:
According to a report released today by AARP, drug manufacturers have substantially raised prices on the 144 specialty drugs most commonly used by people in Medicare Part D.

The latest AARP Rx Watchdog Report, from AARP’s Public Policy Institute, is the first to look at what drug makers charge for specialty drugs, which include prescription medications used to treat complex, chronic conditions and require special administration, handling and care management. Specialty drugs are currently among the most expensive drugs on the market, with prices that can range from $5,000 to more than $300,000 per year.

According to the report, the prices of specialty drugs most commonly used by Medicare Part D beneficiaries have risen faster than the general inflation rate every year since 2004, peaking in 2007 when the price spiked by 8.7% – or three times the general rate of inflation (2.9%).

Brand Name Prescription Drugs
2007 Year-End Update (Publication ID: 2008-05), March 2008 (PDF, 49 pages)

Generic Prescription Drugs
2007 Year-End Update (Publication ID: 2008-08), May 2008 (PDF, 38 pages)

Specialty Prescription Drugs
2007 Year-End Update (Publication ID: 2008-15), September 2008 (PDF, 38 pages)

Workdays for People in Healthcare Occupations

Source: Bureau of Labor Statistics, Issues in Labor Statistics, Summary 08-07, September 12, 2008

According to 2003-07 data from the American Time Use Survey, people employed in the two healthcare occupation subgroups were more likely than those in other occupations to work on weekend days. Thirty-nine percent of healthcare support employees and 35 percent of healthcare practitioners worked on an average weekend day. By comparison, only 31 percent of those employed in nonhealthcare occupations did so. When they worked on weekend days, people employed in both healthcare occupation subgroups also worked more hours than those employed in other occupations. On weekend workdays, those in healthcare practitioner and technical occupations worked an average of 6.5 hours, and those in healthcare support occupations worked an average of 7.3 hours. By contrast, those employed in all other occupations worked an average of 5.5 hours on weekend days on which they worked.

Demographic Trends Affecting Transportation in the U.S.

Source: Robert Puentes, Brooking Institution, Metropolitan Policy Program, Women’s Transportation Policy Seminar, September 11, 2008

From the summary:
In this PowerPoint presentation Robert Puentes provides a deeper understanding of trends that are impacting metropolitan America and how those trends may impact the transportation demand and service in the coming decades. The presentation stresses several key points including dramatic changes in household formation, the increasing diversity reflected in both cities and suburban areas, and the key spatial effects on the American landscape.

The Distribution Of Public Spending For Health Care In The United States, 2002

Source: Thomas M. Selden and Merrile Sing, Health Affairs Web Exclusives, Vol. 27 no. 5, July 2008
(subscription required)

From the abstract:
U.S. health care spending is projected to approach $2.4 trillion in 2008; a large share will be paid by government outlays and tax subsidies. Other countries routinely conduct incidence analysis of public health care spending, yet we know of no recent and comprehensive incidence studies for the United States. We examined data for 2002 from the Medical Expenditure Panel Survey aligned to the National Health Expenditure Accounts and augmented with simulated tax subsidies. The public sector accounted for 56.1 percent of health spending within the civilian noninstitutionalized population. Our analysis highlights this sector’s role in financing the care of seniors and people in poor health.

Caught In The Competitive Crossfire: Safety-Net Providers Balance Margin And Mission In A Profit-Driven Health Care Market

Source: Peter J. Cunningham, Gloria J. Bazzoli and Aaron Katz, Health Affairs, Web Exclusives, Vol. 27 no. 5, August 2008
(subscription required)

From the abstract:
This paper describes how intensifying competitive pressures in the health system are simultaneously driving increased demand for safety-net care and taxing safety-net providers’ ability to maintain the mission of serving all, regardless of ability to pay. Although safety-net providers adapted to previous challenges arising from managed care, health system pressures have been more intense and more generalized across different sectors in recent years than in the past. Providers are adopting some of the same strategies being used in the private sector to attract higher-paying patients and changing their “image” as a safety-net provider.

Private Equity Investment And Nursing Home Care: Is It A Big Deal?

Source: David G. Stevenson and David C. Grabowski, Health Affairs, Vol. 27 no. 5, 2008
(subscription required)

From the abstract:
Private equity investors have recently targeted nursing home chains as investment opportunities. Media attention has raised quality-of-care concerns, but little has been published in the research literature on the topic. Using a multivariate framework, we assessed how private equity purchases of nursing homes affected a range of outcomes. Although some transactions are quite recent, we found little evidence to suggest that nursing home quality worsens significantly following purchase by private equity companies. Nonetheless, recent nursing home ownership trends raise important questions about oversight and accountability, whose answers extend beyond private equity ownership.

Domestic Partner Benefits: Facts and Background

Source: Employee Benefit Research Institute, Vol. 29 no. 9, September 2008

How widespread are domestic partner benefits? New updated research by the Employee Benefit Research Institute shows that 17% of organizations provided domestic partner coverage to same-sex couples only, while 1% offered coverage to opposite-sex couples only, and 32% offered coverage for both same-sex and opposite-sex couples.