Author Archives: afscme

Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System

Source: Cathy Schoen, Stuart Guterman, Mark Zezza, and Melinda Abrams, Commonwealth Fund Commission on a High Performance Health System, January 2013

The Commonwealth Fund Commission on a High Performance Health System, to hold increases in national health expenditures to no more than long-term economic growth, recommends a set of synergistic provider payment reforms, consumer incentives, and systemwide reforms to confront costs while improving health system performance. This approach could slow spending by a cumulative $2 trillion by 2023—if begun now with public and private payers acting in concert. Payment reforms would: provide incentives to innovate and participate in accountable care systems; strengthen primary care and patient-centered teams; and spread reforms across Medicare, Medicaid, and private insurers. With better consumer information and incentives to choose wisely and lower provider administrative costs, incentives would be further aligned to improve population health at more affordable cost. Savings could be substantial for families, businesses, and government at all levels and would more than offset the costs of repealing scheduled Medicare cuts in physician fees.
See also:
Executive Summary
Chartpack (PDF)
Chartpack (PPTX)
Technical Report
Overview

Political Speech and Association Rights after Knox v. Seiu Local 1000

Source: Catherine Fisk, Erwin Chemerinsky, Cornell Law Review, Vol. 98, No. 5, 2013

From the abstract:
In Citizens United, Boy Scouts of America v. Dale, and other recent cases, the Supreme Court has given organizations a newly-robust First Amendment right to use the entity’s money in ways that stakeholders within the organization may find anathema and to discriminate against employees and members in order to advance the expressive interest of the entity. Yet, in Knox v. SEIU Local 1000 in 2012, the Court held that a labor union violates the First Amendment rights of dissenters if it levies a special assessment for political speech without first having dissenters opt in. The Court’s jurisprudence on associational speech lacks any theory of when and why an organization’s speech violates the rights of dissenters. Nor does it consider what kinds of internal organizational governance mechanisms are necessary to ensure a fair allocation of speech protections between those who wish the organization to promote one message and those who wish it to promote another. Moreover, the majority in Knox casts First Amendment doubt on the validity of the entire concept of collective bargaining by a union elected by a majority to represent all employees in a bargaining unit of government employees. As ballot measures in various states have been enacted or are pending limiting the rights of unions to raise and spend money on politics in the name of protecting dissident employees, a principled approach to the free speech rights of unions, corporations, and other associations is ever more needed.

In this article we offer an approach to reconciling the First Amendment expressive interests of organizations with the expressive interests of dissenting stakeholders within them. We suggest an approach to resolving the inconsistency between Citizens United, the union-dues cases, and the Court’s other compelled speech and associational speech jurisprudence. Contrary to the prevailing wisdom, we suggest not that shareholders be given the opt out (or opt in) rights of dissenting union employees but instead that unions be given the same broad speech rights as corporations to use dues and fees paid by all employees on political activity.

Funding Important Transportation Infrastructure in a Fiscally Constrained Environment

Source: Robert W. Poole, Jr., Reason Foundation, Policy Brief, no. 102, January 2013

From the summary:
Transportation infrastructure is too important to the economy to be subject to across-the-board cuts in federal funding without first ensuring that alternate revenue streams are available. Ideally, each transportation mode should be made as self-supporting as possible via direct user fees. This would also make it feasible to use revenue-bond financing to do more reconstruction and new construction than would occur under the current policy of funding capital investment from operating cash flow. This approach would also tend to weed out projects whose benefits don’t significantly exceed their costs.

One inspiration for this policy brief is the report of the National Commission on Fiscal Responsibility and Reform (Simpson-Bowles Commission) in 2010. While its recommendations were not implemented, its proposals for transportation infrastructure reflected the above approach, including utilizing highway user tax revenues to make the Highway Trust Fund once again self- supporting, removing large and medium hub airports from the federal airport grants program to allow them to support themselves via passenger fees, and making inland waterway systems fully user-funded. This policy brief seeks to apply these users-pay/users-benefit principles more thoroughly to transportation infrastructure. …

… Another underlying problem is that the current federal grant funding approach has encouraged state and local infrastructure owners to fund most capital projects out of annual cash flow, rather than financing them. A basic principle of public finance is that long-lived infrastructure can and should be financed (i.e., capital should be raised up-front from the capital markets) and paid for over time, as the users of that infrastructure derive benefits from it. This is analogous to the way most people acquire their homes: not by saving until they can afford to pay cash, or building the home a room at a time as cash flow permits, but by taking out a long-term mortgage and paying it off over time, so as to obtain the benefits of home-ownership much sooner. Non-transportation infrastructure entities—electric and gas utilities, pipelines, telecommunications and water utilities—generally finance their major projects via revenue bonds, paid for by their users over many years. Railroads and toll roads do likewise, as do airports (to some extent) and air traffic control providers overseas. The United States is one of the few advanced developed countries that makes relatively little use of revenue-based financing for its transportation infrastructure.

Thus, the emerging and ongoing fiscal crisis of the federal government offers an opportunity to rethink how this country pays for and manages its critically important transportation infrastructure.

Mental Health Care Transformation Coming to America

Source: Dylan Scott, Governing, January 9, 2013

…The Affordable Care Act (ACA), President Barack Obama’s signature health law, includes arguably the most significant reforms to mental health coverage in our nation’s history. The ACA names mental health and substance abuse treatment as one of the 10 essential health benefits that insurance plans must cover starting in 2014. While most large-group plans offer some kind of mental health benefits, according to a 2011 HHS survey, only 18 percent of small-group and individual plans cover mental health, and a mere 34 percent cover substance abuse treatment. Those markets — which will make up the plans sold on the health insurance exchanges that are soon to be rolled out in every state under the ACA — should see a significant upgrade next year in the quantity and quality of mental health benefits that are offered. In addition to the essential health benefits provision, the Obama administration has pledged to implement the 2008 Mental Health Parity and Addiction Equity Act. It requires insurers to cover mental health at a level that’s comparable to their physical health coverage. …

What To Do When the Boss Catches Wellness Fever

Source: Jane Slaughter, Labor Notes, January 08, 2013

Wellness programs are designed to bring down employers’ health insurance costs by preventing illness. Some provide gym memberships or smoking cessation programs. Others require workers to pay more for their insurance if they don’t get certain screenings. The most coercive programs require workers to meet health targets or pay a penalty. … Read about wellness programs here and see below for advice on how to address such programs in the workplace. Sections include: At The Bargaining Table, Information Requests, and Best Practices

Opportunities for Police Cost Savings Without Sacrificing Service Quality: Reducing False Alarms

Source: Philip S. Schaenman, Aaron Horvath, Harry P. Hatry, Urban Institute, November 2012

From the abstract:
In many cities, false alarms from home and business security systems number in the tens of thousands each year, waste millions of dollars of officer time, and detract from attention to reducing crimes. Options are presented on ways to substantially reduce the effects of such false alarms and the police responses to them. We analyzed experiences of Montgomery County, MD; Seattle, WA; and Salt Lake City, UT, which reduced false alarms by 66-90% and saved 10-30 police officer-years annually.

The New Great Debate about Unionism and Collective Bargaining in U.S. State and Local Governments

Source: David Lewin, Jeffrey H. Keefe, and Thomas A. Kochan, Industrial and Labor Relations Review, Vol. 65, No. 4, October 2012
(subscription required)

From the abstract:
Recently some state and local governments in the United States have sharply reduced or eliminated public employee unionism and bargaining rights in the belief that their fiscal adversity stems mainly from overcompensation of public employees caused by collective bargaining. The authors examine public-private sector pay and benefit relationships, the effects of unions on public employee pay, the effectiveness of employment dispute resolution procedures, and the ability of public sector labor and management to combat fiscal adversity. They provide new evidence showing that: on balance, public employees are undercompensated relative to their private sector counterparts; the effects of unions on compensation are smaller in the public than the private sector; and public sector dispute resolution procedures and joint labor-management initiatives to reform work function reasonably well.

Texas Public Libraries: Economic Benefits and Return on Investment

Source Prepared for the Texas State Library and Archives Commission by the Bureau of Business Research IC² Institute, The University of Texas at Austin, December 2012

From the summary:
Public libraries in the State of Texas provide significant economic benefits for their communities. This report examines these economic benefits, and documents those activities which contribute to economic activities throughout all regions of Texas. In 2011 Texas public libraries collectively were found to provide $2.407 billion in benefits while costing less than $0.545 billion, a return on investment of $4.42 for each dollar invested.

Appendix C (scroll down) contains:
Summaries of Prior State and City Impact Studies
States: Colorado, Florida, Indiana, Pennsylvania, South Carolina, Wisconsin
Cities: Charlotte, Philadelphia, Seattle, Consortium of Southwestern Ohio Municipalities

The Budget Balancing Act: LJ’s Budget Survey Shows Modest Improvement, and Signs of More To Come

Source: Meredith Schwartz, Library Journal, January 9, 2013

Though there aren’t a lot of whoops and cheers to be heard, a cautious optimism seems to describe the 2012 library budget landscape, according to LJ’s annual survey. Some 60 percent of libraries increased their funding, while 36 percent decreased it. Only four percent stayed the same.

Overall, the 488 libraries responding saw an average 1.2 percent increase compared to last year, which saw a 0.7 percent drop. Since 2008, library budgets have remained essentially flat: minor seesawing from year to year has added up to a 0.7 percent increase. Inflation in the same period has increased 6.9 percent, meaning that in comparable dollars libraries have 6.2 percent less spending power.

The year saw some regional variation in library support. Libraries in the Northeast were the most likely to increase their library budgets, at 65 percent, yet those that saw cuts saw the deepest cuts of all: the region was the only one to notice a negative percent change overall. The South and the West hovered closely around the national average of 60 percent with increases, but the Midwest lagged—only 54 percent of libraries saw an increase in funding, and 43 percent suffered cuts. The total change was greatest in the West, however, at 2.5 percent—the only region to beat inflation….

The Changing U.S. Electorate

Source: Michael Jackson, Dēmos, Policy Shop blog, January 8, 2013

In the two months since the 2012 presidential election, a fuller picture has emerged of the changing face of the American electorate. However, it is essential that this diversity be more than simply cosmetic, but rather is reflected in public policies that are similarly more broadbased and inclusive. Here are a few key points to consider about the 2012 electorate…