2019 Segal Health Plan Cost Trend Survey

Source: Segal Consulting, Public Sector Data Fall 2018

From the summary:
Increases in Medical and Prescription Drug Costs Projected to Be Lower for 2019

Medical and prescription drug cost trends, for both actives and non-Medicare retirees, are projected to be lower in 2019 than in previous years.

That’s the headline finding from Segal’s 2019 Health Plan Cost Trend Survey, which surveyed more than 100 managed care organizations (MCOs), health insurers, pharmacy benefit managers (PBMs) and third-party administrators (TPAs).

Other Key Findings
– Medical plan cost trends are projected to be lower than 2018 projections.
– Actual medical and prescription drug trend results for 2017 were significantly lower than carrier projections for 2017.
– Actual prescription drug plan cost trends for 2017 were the second lowest in the last 13 years.
– Price inflation continues to be the primary driver of overall medical and prescription drug cost trends.
– Network physician reimbursement rate increases are projected to increase by less than 2 percent for both primary care and specialists, below overall CPI rates.
– Prescription drug cost-management strategies and improved vendor contracting are still plan sponsors’ top priorities.

Related:
Multiemployer

Union Membership Narrows the Racial Wealth Gap for Families of Color

Source: Christian E. Weller and David Madland, Center for American Progress, September 4, 2018

Wealth is critical to families’ immediate and long-term economic well-being. It helps families pay their bills if their income drops due to unforeseen events such as a layoff or medical emergency. It also allows them to invest in their future by sending their children to college; moving to a desirable neighborhood due to, for instance, better schools; switching jobs; or starting a business. Yet wealth is highly unequally distributed in the United States—particularly by race and ethnicity. (see Appendix for more information) White families, for instance, have significantly more wealth than nonwhite families. There are a few institutions that help shrink this systematic divide; unions are one such institution.

Unions help increase the wealth for all workers. Indeed, previous Center for American Progress Action Fund research showed that a typical worker covered by a union contract has roughly twice the wealth of a typical nonunion worker. And new Center for American Progress analysis shows that unions boost wealth the most for those who are nonwhite.

Proportion of Non–US-Born and Noncitizen Health Care Professionals in the United States in 2016

Source: Yash M. Patel, Dan P. Ly, Tanner Hicks, et al, JAMA: Journal of the American Medical Association, Research Letter, Vol. 320 no. 21, December 4, 2018
(subscription required)

From the abstract:
National estimates of the proportion of current health care professionals, including physicians, who are non–US-born or noncitizens are unknown. These proportions may be significant. For example, non–US-born medical graduates comprise approximately one-fifth of practicing US physicians, and among non–US-born medical graduates who match into residency positions in the United States, approximately 60% are not US citizens. Using data from the US Census, this study estimated the proportion of non–US-born and noncitizen health care professionals in the United States in 2016.

After Janus

Source: Martin H. Malin, Catherine Fisk, California Law Review, Forthcoming, Date Written: September 6, 2018

From the abstract:
The Supreme Court in Janus v. American Federation of State, County, and Municipal Employees Council 31 upended public sector labor law by finding a novel First Amendment right of public employees to refuse to pay union fees and declaring unconstitutional scores of laws and thousands of labor contracts. This Article assesses the constraints on public sector labor law post-Janus, examines the variety of legislative responses, and proposes a path forward.

Janus makes it difficult to address the collective action problem facing all large groups. Although it is in the interest of every member of a group to engage in collective action to provide common goods, it is also in the each individual’s interest to let others incur the costs of doing so. The Janus Court misstated the nature of the collective action problem when it said the problem was free-riding on union-negotiated benefits. The problem is that, without some way to require all who benefit to share the costs, unions will not negotiate effectively for the benefits in the first place, so there will be no common goods to free ride on.

This Article explains public sector unions’ apparently surprising reluctance to respond to the collective action problem exacerbated by Janus in the way that some scholars and a number of legislatures have proposed. Most proposals and enacted legislation continue union financial solvency in the short-term but sacrifice the fundamental nature of unions as membership organizations governed by and for workers. Some adopt some form of members-only representation, thus abandoning the principles of majority and exclusive representation.

Can Unions Be Sued for Following the Law? Responding to William Baude & Eugene Volokh, The Supreme Court, 2017 Term — Comment: Compelled Subsidies and the First Amendment

Source: Aaron Tang, Fred O. Smith, Harvard Law Review, Vol. 132 no. 2, November 2018
(subscription required)

From the abstract:
Here is a short summary of the right-to-work movement’s legal strategy in the aftermath of its victory in Janus v. AFSCME: If you can’t kick a man when he’s down, when can you kick him? For within weeks of Janus’s pronouncement that the First Amendment forbids public sector unions to collect agency fees from objecting employees, right-to-work groups filed a flood of class action lawsuits seeking the refund of millions of dollars’ worth of fees that were paid in the years before Janus was even decided, when such fees were indisputably lawful. Commentators have observed that these retroactive refund suits threaten to bankrupt unions around the nation.

In Compelled Subsidies and the First Amendment, Professors William Baude and Eugene Volokh argue that “Janus makes it likely” that public sector unions will indeed be liable under 42 U.S.C. § 1983 for refunds of money they collected in years before Janus was even issued. We think otherwise, and this Response explains why.

We start in Part I by presenting a vision of the world as it would exist if Baude and Volokh are right. It turns out that imposing financial liability on public sector unions for conduct that was perfectly lawful when it took place (because both state law and judicial precedent authorized the unions to collect fair-share fees) is a kind of maneuver that cannot be neatly confined to the context of union fee refunds.

In Part II, we explain why this unsavory state of affairs is hardly necessary. In fact, the law requires otherwise. In particular, we describe three legal arguments that should stop the union-refund suits from getting off the ground: careful application of the doctrine of civil retroactivity; defenses that were available against the most closely analogous tort at common law, including that unions acted in good faith reliance on existing law; and ordinary principles of class action certification.

Five-Year Trends Available for Median Household Income, Poverty Rates and Computer and Internet Use

Source: U.S. Census Bureau, Press Release, Release Number CB18-187, December 6, 2018

Today, the U.S. Census Bureau announced the release of the 2013-2017 American Community Survey (ACS) five-year estimates, which features more than 40 social, economic, housing and demographic topics, including homeownership rates and costs, health insurance, and educational attainment. The ACS five-year data release produces statistics for all of the nation’s 3,142 counties. It is the only full data set available for the 2,316 counties with populations too small to produce a complete set of single-year ACS estimates. ….

Some highlights from the report include that, when comparing the 2013-2017 period to the 2008-2012 period, median household income increased in 16.6 percent of all counties (521 counties) between the 2008-2012 period and the 2013-2017 period while poverty declined in 14 percent of all counties 441 counties). Alternatively, when comparing the same time periods, median household income declined in 222 counties (7.1 percent) and poverty rates increased in 264 counties (8.4 percent)…..

DELTA 8.7 – New data dashboards launched to inform policymaking on modern slavery and child labor

Source: United Nations University – Centre for Policy Research (UNU-CPR), 2018

What does delta mean?
The Greek letter delta—Δ—is used in mathematics and science to signify the amount of change in a particular variable.

What is 8.7?
In Target 8.7 of the Sustainable Development Goals, States committed to take immediate and effective measures to eradicate modern slavery, human trafficking, forced labour and child labour.

What do they mean together?
Delta + 8.7 = Measuring the change towards Target 8.7.

On any given day in 2016, the latest year for which we have a reliable estimate, 40.3 million people were in situations of modern slavery or forced labour—or one in every 174 people alive —and 152 million children were victims of child labour. Urgent action is needed to address these problems. With Target 8.7 of the United Nations Sustainable Development Goals (SDGs), 193 countries pledged their commitment to take effective measures to eradicate modern slavery, human trafficking, forced labour and child labour.

But what are effective measures? What works to address these problems?

To answer these questions, the United Nations University – Centre for Policy Research (UNU-CPR) created Delta 8.7—an innovative project that helps policy actors understand and use data responsibly to inform policies that contribute to achieving Target 8.7. Delta 8.7 brings together the most useful data, evidence, research and news, analyses cutting-edge data, and helps people understand that data so it can be translated it into effective policy.

Resources
Dive deeper into Thematic Overviews, online and offline Learning Opportunities, original Research by the Delta 8.7 team, or explore the site Glossary.

Data and Measurement
Visit the Data Dashboards to explore evidence at the national, regional and global levels, or learn How to Measure the Change through our introductory materials on data science and measurement.

Forum
The Forum is the world’s leading venue for discussion of the latest data and evidence about forced labour, modern slavery, human trafficking and child labour, and what it means for policy to achieve Target 8.7.

Call to Action
Explore the efforts of countries that have endorsed the UK’s Call to Action to End Forced Labour, Modern Slavery and Human Trafficking.