Medicare Advantage: Private health plans in Medicare

Source: J. Timothy Gronniger and Robert A. Sunshine, Economic and Budget Issue Brief, Congressional Budget Office, June 28, 2007

Medicare provides federal health insurance for 43 million people who are aged or disabled or who have end-stage renal disease. Most receive services through the traditional fee-for-service (FFS) part of the program, which pays providers a set fee for each covered service (or bundle of services). Participants can choose their providers and are not required to obtain prior authorization for any covered service.

Medicare beneficiaries have the option of enrolling in Medicare Advantage–the program through which private plans participate in Medicare–rather than receiving their care through the FFS program.1 They may choose to do so because such plans provide additional benefits beyond those available within traditional Medicare, including coverage for services not covered by FFS Medi- care (for instance, dental services) and cash rebates of premiums or reduced cost-sharing. As of June 2007, about 18 percent of beneficiaries are enrolled in Medicare Advantage plans.2 This brief describes how those private plans function, how they are paid, how their costs com- pare with the costs of traditional Medicare, and how those costs vary by geographic area.
See also: Testimony on the Medicare Advantage Program

Taxing the Poor: A Report on Tobacco, Alcohol, Gambling, and Other Taxes and Fees That Disproportionately Burden Lower-Income Families

Source: Michael L. Davis, National Center for Policy Analysis, NCPA Policy Report No. 300, June 2007

Press release
As Congress seeks to fund the expansion of government-provided health care for children by increasing taxes on tobacco and possibly alcohol, a new report from the National Center for Policy Analysis (NCPA) notes these taxes disproportionately impact the poor. The report notes that governments at all levels are raising revenues in a number of regressive ways, particularly through a lottery and excise taxes on products such as alcohol and tobacco and essential services such as utilities and gas.

Many States’ Poor Populations Lose If Cigarette Taxes Are Hiked to Pay for Health Insurance

Source: The Tax Foundation, News Release, June 29, 2007

Most states will pay more in tax than they receive in federal spending from Senator Gordon Smith’s proposal to expand federal health spending with money from a higher federal excise tax on cigarettes.

The five states that would come out furthest ahead are New Mexico, Alaska, Kansas, Arizona, and California. They combine comparatively low smoking rates with fairly large populations of households eligible for the State Children’s Health Insurance Program (SCHIP).

The five states that would fare the worst are New Hampshire, Vermont, Missouri, Massachusetts, and Iowa. Iowa and Vermont have low levels of children in poverty and above-average cigarette consumption, while Missouri has a very high smoking rate.

The study is titled “A State-by-State Estimate of the Impact of SCHIP Expansion and a 156 Percent Cigarette Tax Hike,” by Tax Foundation economist Gerald Prante. It is number 88 in the Tax Foundation Fiscal Fact series.

The Blogging Revolution: Government in the Age of Web 2.0

Source: David C. Wyld, IBM Center for the Business of Government, E-Government Series, 2007

Dr. Wyld examines the phenomenon of blogging in the context of the larger revolutionary forces at play in the development of the second-generation Internet, where interactivity among users is key. This is also referred to as “Web 2.0.” Wyld observes that blogging is growing as a tool for promoting not only online engagement of citizens and public servants, but also offline engagement. He describes blogging activities by members of Congress, governors, city mayors, and police and fire departments in which they engage directly with the public. He also describes how blogging is used within agencies to improve internal communications and speed the flow of information.

Based on the experiences of the blogoneers, Wyld develops a set of lessons learned and a checklist of best practices for public managers interested in following in their footsteps. He also examines the broader social phenomenon of online social networks and how they affect not only government but also corporate interactions with citizens and customers.
Subject: Public Sector

Occupational Cancer / Zero Cancer : Work started it. Unions will stop it.

Source: International Metalworkers’ Federation, March 23, 2007

The International Metalworkers’ Federation has launched a global union campaign, “Occupational Cancer/Zero Cancer.”

Occupational cancer is the most common work-related cause of death. The International Labor Organization estimates the human toll at over 600,000 deaths a year – one death every 52 seconds. At least 1 in every 10 cancers – probably many more – is the result of preventable, predictable workplace exposure. Today, more people face a workplace cancer risk than at any other time in history. It’s just that most of them don’t know it. Unions have won recognition of causes of occupational cancer, restrictions on their use and compensation for their victims. By finding out about workplace risks and taking action to eliminate, substitute or control the risks, workers and their unions can make the workplace safer. Occupational Cancer/Zero Cancer is a global union campaign to prevent occupational cancer. On this campaign page you will find links to campaign materials, background information and other relevant resources.

Medicaid Funding for Nonprofit Healthcare Organizations

Source: Courtney Burke, The Aspen Institute, June 2007

Medicaid, a publicly funded health insurance program, paid for approximately 16 percent of all healthcare delivered in the United States in 2005.1 Because nonprofit organizations comprise a notable percentage of health providers, and because many of these nonprofits disproportionately rely on Medicaid as a payment source, revenue for nonprofit organizations is inextricably linked to Medicaid. The percentage of healthcare providers that are nonprofit varies depending on the service they provide and the state in which they operate. For instance, nonprofits make up a larger percentage of all hospitals in comparison to their prevalence among all nursing homes. They are more common in Northeastern states compared with Southern and Western states. This is due to several factors, including states’ laws and regulations governing nonprofits, the competitiveness of the marketplace, and differences in states’ policies governing coverage and payment for healthcare services.

There is no doubt that the financial relationship between Medicaid and nonprofit organizations has significant implications for their missions, management and budgeting tactics. The effect of Medicaid funding on the mission of an organization is particularly striking in instances where less medically oriented social-service providers change their service delivery model to meet Medicaid reimbursement criteria. Understanding the extent of the financial affiliation between Medicaid and nonprofits is the first step in understanding the organizational effects—but doing so is difficult because the monetary relationship may vary by the type of service provided, state, or industry. Adding to the difficulty of estimating and understanding the financial relationship between Medicaid and nonprofits is the fact that there is no single database to track the flow of Medicaid money to nonprofits. The lack of a dedicated data system necessitates use of various sources to estimate the amount of Medicaid money going to nonprofits.

Each source has several caveats and only allows for imprecise estimates. Taking these caveats into account, this paper uses existing literature, analyses from industry trade organizations, and data from state officials, the Census Bureau, and Medicaid to make rough estimates of the potential amount of Medicaid money going to nonprofit healthcare providers.

The financial relationship between Medicaid and nonprofits may have additional effects on nonprofit organizations. Understanding the financial relationship between Medicaid and nonprofits can further illuminate the possible organizational effects and demonstrate Medicaid’s role in shaping the healthcare marketplace. This paper shows how and how much Medicaid funding flows to nonprofits, that Medicaid expenditures impact a significant number of nonprofits and a large portion of funds for nonprofit healthcare organizations, and that various trends and changes in the marketplace may affect nonprofit healthcare providers in different ways.

How Much Is Too Much?: A Framework for Evaluating Health Care Affordability

Source: David Carroll, California Budget Project Budget Brief, May 2007

The Governor and legislative leaders have proposed to substantially expand health coverage for uninsured Californians. These proposals would require individuals to purchase or share in the cost of coverage.1 However, these proposals may not go far enough to make health coverage affordable for California families

Interpreting Local Government Financial Statements

Source: Stephen J. Gauthier, Government Finance Review, Vol. 23 no. 3, June 2007

The published financial report of a local government provides a wealth of information to anyone with an interest in the government’s economic condition. Taking advantage of this information, however, poses a real challenge to many users of these reports. This article aims at helping potential users of local government financial statements to meet this challenge.

The Next Drug Problem

Source: Patricia Frank, American City & County, Vol. 122 no. 6, June 1, 2007

Hidden among the well-known problems faced by water professionals — aging infrastructure, dwindling supply — is another emerging issue: rising amounts of pharmaceutical compounds in surface water and drinking water. And, considering the increasing numbers of people being treated with drugs at earlier ages and an aging population taking multiple medications for a variety of health conditions, more of those compounds likely will find their way into the nation’s wastewater facilities.

Early signs of the problem were discovered in US Geological Survey (USGS) research in 1999. Of the 60 pharmaceuticals the agency was testing for, it found 30 of them in 139 streams in 30 states. In addition, 80 percent of the streams had one or more contaminants, 54 percent had five or more, and 13 percent showed 20 or more.

“We can measure over 150 compounds in water alone,” says Dana Kolpin, a research hydrologist and member of the USGS study team. “Now, the big question is, what kind of environmental consequences [do they pose] to terrestrial and aquatic ecosystems and, maybe in the long term, even human health. We just don’t know what the exposure risk is to many of these compounds.”

Recognizing the Emotion Work of Public Service

Source: Meredit Newman, Mary Guy, and Sharon Mastracci, Public Management, Vol. 89 no. 6, July 2007
(subscription required)

Police officer, social service counselor, 911 call taker, caseworker, prison guard, receptionist, public health nurse, counter clerk, and public schoolteacher: What do all these public service jobs have in common? They all require that a relationship be developed between the service provider and citizen. This requires artful affect and is called emotional labor. Our research into the work experiences of local government workers makes it clear that emotion work is at the heart of service transactions and can be described as “real work.” Many, if not most, public service jobs require interpersonal contact that is either face to face or voice to voice. Those who staff the counter at the tax collector’s office are expected to greet the 100th citizen of the day with the same sincerity as they greeted the first. Those who staff the phone lines for the manager’s office are expected to be “nicer than nice.” Caseworkers must care about strangers, and inspectors who work for planning and zoning departments are required to treat each aggravated homeowner with fairness and courtesy. In the aftermath of a hurricane, first responders must address not only physical disaster but emotionally traumatized citizens. Police officers and prison guards will tell you that they engage in emotion work every day, but at the other extreme. Rather than being nurturing and gentle, their jobs require them to wear a “game face,” to act tougher than they actually feel, and to engage in verbal judo with lawbreakers. This work is relational in nature and is called emotional labor. Such work “greases the wheels” so that people cooperate, stay on task, and work well together. It is essential for job completion. In fact, such skills are prerequisites for quality public service.