The Congressional Budget Office is a federal agency within the legislative branch of the United States government that provides budget and economic information to Congress.The CBO was created as a nonpartisan agency by the Congressional Budget and Impoundment Control Act of 1974. Wikipedia.
Pelech D.,Congressional Budget Office
Journal of Health Economics | Year: 2017
This paper explores how provider and insurer market power affect which markets an insurer chooses to operate in. A 2011 policy change required that certain private insurance plans in Medicare form provider networks de novo; in response, insurers cancelled two-thirds of the affected plans. Using detailed data on pre-policy provider and insurer market structure, I compare markets where insurers built networks to those they exited. Overall, insurers in the most concentrated hospital and physician markets were 9 and 13 percentage points more likely to exit, respectively, than those in the least concentrated markets. Conversely, insurers with more market power were less likely to exit than those with less, and an insurer's market power had the largest effect on exit in concentrated hospital markets. These findings suggest that concentrated provider markets contribute to insurer exit and that insurers with less market power have more difficulty surviving in concentrated provider markets. © 2017
News Article | May 9, 2017
Senate Majority Leader Mitch McConnell speaks to reporters on following a policy luncheon on Capitol Hill in Washington, D.C., U.S. May 9, 2017. REUTERS/Aaron P. Bernstein WASHINGTON (Reuters) - Barely two days into crafting a new bill to roll back Obamacare, U.S. Senate Republicans were already on the defensive on Tuesday over the absence of any women in their core working group. After a meeting of the Senate healthcare group, lawmakers were bombarded with questions as to why no women were named to the 13-man panel. Senate Majority Leader Mitch McConnell tried to explain. "The working group that counts is all 52 of us," McConnell told reporters, referring to all 52 Republican senators in the 100-member chamber. "Nobody is being excluded based upon gender ... Everybody's at the table. Everybody." Democrats pounced. Republican men are negotiating "a secret healthcare plan, which I really hope is not happening in the men's locker room," said Senator Patty Murray, a member of the Democratic leadership from Washington state. If the criticism was any sign of what lies ahead as senators try to improve on a rollback bill passed on Thursday by House of Representatives Republicans, it could be a long road ahead. Dismantling the parts of President Barack Obama's signature healthcare law that they dislike and preserving other parts of it is proving to be a difficult task for President Donald Trump and his fellow Republicans. A House of Representatives’ plan for doing that, approved last week amid much drama, faces an uncertain future in the Senate. Some Republicans eye drafting a similar Senate bill by mid-summer, possibly with the involvement of Democrats. Others indicate the House bill requires major surgery and that the effort to replace the Affordable Care Act, also known as Obamacare, could take months. Regardless of timing, two decisive factors will come into sharper focus soon. One is voter reaction to the House bill, now being voiced in town hall events being hosted nationwide by House members in their home districts. The other factor is an expected analysis by the non-partisan Congressional Budget Office of how many million Americans would lose their health insurance coverage under the House bill, if it became law, and how it would affect the U.S. budget deficit. Both the CBO analysis and the town hall events have the potential to do damage to the House legislation, which Trump hailed as a triumph just days ago. Senators are already talking about major changes in the House bill concerning Medicaid, the government healthcare program for the poor, and tax subsidies for healthcare coverage. Trying to get past the controversy over the absence of women on the healthcare panel, Senate Republicans said they expected to devote much time to healthcare in the near future. "I don't think we're going to be talking about much else other than healthcare at least three days a week with all members of our conference present," said Senator John Cornyn, the No. 2 Republican. Cornyn said senators would start with the House bill. "If we have to make modifications in order to pass it, we’ll make those modifications and work out the differences with the House." Medicaid was the topic at the Senate working group meeting Tuesday. The House bill would cut federal spending on Medicaid by $880 billion over 10 years. But some Republicans want any reductions to be more gradual, and Trump made a campaign pledge not to cut the program. "There ought to be a glide path where you do not have a cliff that the House provides in 2020," when the expansion of Medicaid under Obamacare is abruptly ended, said Senator Rob Portman of Ohio. But other Republicans said cutbacks were important to save taxpayer money. "The public wants every dime you can give them. Let's face it, once you get them on the dole, they are going to take every dime they can. We've got to find some way of getting things under control, or this country and your future’s going to be gone," said Republican Senator Orrin Hatch, a member of the healthcare working group.
News Article | May 11, 2017
New legislation passed in the House to repeal and replace Obamacare puts access to health care for the sickest, poorest, and even older Americans on Medicare at risk, warns The Senior Citizens League (TSCL). Says TSCL’s Medicare and Social Security policy analyst, Mary Johnson, “The GOP’s American Health Care Act: “The Senior Citizens League strongly opposes this effort to overturn Americans’ access to health care,” Johnson asserts. It’s important for the public to understand how the bill would increase costs and affect access to health care. The May 4th House vote took place less than 24 hours after the revised bill was posted, and without the nonpartisan Congressional Budget Office’s (CBO) analysis of the new bill. “Meaning that House GOP Members voted without having adequate time to review the bill, knowing the full cost of the legislation or how the new changes in the bill would impact coverage for their own constituents,” Johnson points out. “The public has a right to know that information prior to our elected lawmakers enacting legislation.” According to a March analysis of an earlier version of the bill by the CBO, the legislation would restructure Medicaid safety net by capping costs. “This would have a profound impact on low-income Medicare beneficiaries,” Johnson says. About 1 in 5 people on Medicare, 11 million beneficiaries in all, have incomes so low that they qualify for Medicaid, according to the nonpartisan Kaiser Family Foundation. The public frequently confuses the two programs. Like Social Security, people become eligible for Medicare based on payroll tax withholdings from their earnings. Eligibility for Medicaid is based on low income. Medicaid is a combined state and federal program, in which the federal government pays roughly 60% of program costs for all whose income is low enough to qualify under current law. The new House law would end the open-ended nature of funding and cap per person costs, adjusting reimbursements for inflation using the consumer price index. “Medicaid plays an essential role for both low-income older Americans and middle-income seniors made poor by their health care costs,” Johnson notes. Medicaid benefits can include paying premiums and out-of-pocket costs for Part B coverage. It is also the primary payer of costs not covered by Medicare, including nursing home care. The CBO estimated that, the American Health Care Act, introduced in March, would cut federal spending on Medicaid by nearly $880 billion over the 2017 – 2026 period. The CBO estimated that, by 2026, Medicaid spending would be about 25 percent less than projected under current law, yet Medicaid spending growth would exceed the rate of growth of the inflation adjustment. “With costs growing faster than reimbursements, states would have to come up with the money in some other way or be forced to cut services, restrict eligibility for enrollment or otherwise ration care,” says Johnson.” The American Health Care Act will go next to the Senate. TSCL strongly opposes this legislation and is urging older Americans to contact their Members of Congress. To learn more, visit http://www.SeniorsLeague.org. With 1.2 million supporters, The Senior Citizens League is one of the nation’s largest nonpartisan seniors groups. Its mission is to promote and assist members and supporters, to educate and alert senior citizens about their rights and freedoms as U.S. Citizens, and to protect and defend the benefits senior citizens have earned and paid for. The Senior Citizens League is a proud affiliate of The Retired Enlisted Association. Visit http://www.SeniorsLeague.org for more information.
News Article | May 11, 2017
Constituents heckle and boo Tom MacArthur, calling him a ‘killer’ as 500 people gather for New Jersey event: ‘I don’t think I’ll vote for him again’ Tom MacArthur, the New Jersey congressman who has been celebrated in conservative circles for helping pass the Republican healthcare bill, came back down to earth with a bang on Wednesday night when he was booed, heckled and generally chastised during a nearly five-hour town hall meeting. In Willingboro, hundreds showed up to lambast MacArthur, most fuelled by their congressman’s intervention to revive the ailing American Health Care Act (AHCA). MacArthur was branded a “weasel”, a “killer” and an “idiot” by constituents angry at his amendment to the bill, which would allow states to opt out of rules that protect individuals with pre-existing conditions from being charged more for healthcare coverage. This stipulation proved enough to satisfy the hard-right Freedom Caucus and the bill – which would probably see millions of Americans lose their healthcare coverage – passed the House on 4 May. The majority of Republicans who voted for the bill are not holding public events this week, despite being on recess. Those who have dared face voters have been pilloried. Aware of this, MacArthur kicked off his town hall at 6.30pm with a promise to respond to every single question, for “as long as it goes”. He was still being quizzed by angry residents at 11.20pm. More than 500 people had gathered outside the Kennedy Center in Willingboro, just across the Delaware river from Philadelphia. It was a lively and loud scene, a number of voters chanting, waving signs and generally causing a ruckus. “Our health matters more than Tom’s net worth,” one banner read. A sign showed a picture of MacArthur with “I took your healthcare” written on his forehead. Another described MacArthur, a former insurance executive who was elected in 2014, as “MacWeasel”. Claudia Storicks, a former nurse who has been on disability for the past two years, had travelled from Pemberton, New Jersey. She has diabetes and charcot foot – a weakening of the bones caused by nerve damage – and was using an electric scooter. She is insured under the Affordable Care Act (ACA), the Obama administration legislation the AHCA seeks to replace. “It was the only insurance that I could afford,” she said. “I’ve been able to afford my medication and my doctor’s visits because I’m on the ACA. Otherwise I probably would have lost my house and my foot.” Storicks voted for MacArthur in 2016 – “he’s a businessman and I thought he had a good sense about taxes,” she said – but now described herself as “very angry” at the prospect of the ACA being repealed. “That would mean that my diabetes would get out of control, my foot would probably get worse, and I’d probably end up in hospital and losing my house.” Medford, New Jersey, resident Jay Wilder, 72, was first in line. He arrived six hours early. “I’m really worried about pre-existing conditions because I dealt with it when I was going from my job before I had Medicare,” he said. Wilder had had a heart attack and said he couldn’t afford healthcare. “I just lived without healthcare, hoping that nothing would happen. It was very difficult because when you’re 64 years old you start having health issues.” The anger outside the venue set the tone for the event itself. MacArthur walked out to Coldplay’s A Sky Full of Stars, and to a similarly tepid round of applause from the 250 people who had made it inside. The congressman smiled and offered his hand to a man wearing a green shirt, sitting in the front row. The man kept his arms folded and thrust his head away. The four hours and 50 minutes that followed were no less hostile. MacArthur had asked constituents not to boo him but that proved to be in vain. People repeatedly told him he had “blood” on his hands. A man who had received a kidney transplant feared what would happen to people like him under the AHCA. A resident whose wife had recovered from breast cancer was concerned that she would “always have a pre-existing condition” and did not want that to determine which state she lived in. A woman had brought her two young children, one of whom had learning difficulties, and objected to them potentially being placed in a “high-risk pool” – an aspect of MacArthur’s amendment designed to assist people with pre-existing conditions, but which could lead to higher health insurance costs. MacArthur’s responses – that only 7% of Americans were in the individual market, that people would not lose their insurance (the Congressional Budget Office, in its assessment of an earlier version of the bill, said 24 million would probably do so), and that “there are loads of other people who don’t agree with you” – did not placate the crowd. Nor did his response to repeated chants calling for single-payer healthcare. “Government bureaucrats can be very dangerous when they have power” to make decisions on people’s health, MacArthur said, prompting one woman to tell the congressman she would prefer that scenario than “someone in an office” of an insurance company making the same decisions. Just 14 of the 217 Republicans who voted in favor of the AHCA are holding public events this week. Those who have ventured out have not been warmly received. On Monday, Rod Blum of Iowa walked out of an interview with a local television station and was then roundly booed at an event in Dubuque. On Tuesday, David Brat, a congressman from Virginia, was jeered and booed at a town hall in Midlothian, near Richmond. Constituents waved red signs that said “shame” and “nope”, a gesture suggested by the progressive Indivisible organization, which aims to use Tea Party-esque, assertive tactics to oust Republicans in the 2018 midterm elections. Charlene Thompson, a Brat constituent, said she cried when the House approved the AHCA. “Something was awoke in me,” she said. “I just gave birth last summer. I fought long and hard to have that guy and to think that I would be considered a pre-existing is just awful.” In New Jersey on Wednesday, people began to quietly leave the MacArthur town hall at about 9.30pm. But at least 25 stayed until the bitter end. Storicks, who sat patiently in her scooter for hours, was one of the last people to speak. She told the congressman about how she relied on the ACA for medication related to her illnesses. Storicks said she would suffer under the Republican plan “because I was born with bad genes”. MacArthur stuck to the answer he had given all night: that high-risk pools would actually protect people like Storicks, and that people would not have to pay more due to a pre-existing condition – claims which are heavily disputed by health experts. “I get he’s an insurance man and he’s coming at this from an insurance and business perspective and it’s all about profits and minimizing costs,” she said, “but I’m frustrated because I don’t think he’s really of a mind to change his opinions. “But next year the public will have a chance to speak. And I don’t think I’m going to vote for him again.”
News Article | May 9, 2017
Members of Congress who voted for the controversial plan will be met by activists on the left, who are attempting to save the Affordable Care Act As House Republicans return to their districts after approving a controversial plan to dramatically reshape the country’s healthcare system, activists on the left are mobilizing at town halls in an effort to save the Affordable Care Act, the 2010 law that extended coverage to millions of Americans. At a meeting in Lewiston on Friday, a woman challenged Raúl Labrador, a Republican congressman from Idaho and a member the arch-conservative House Freedom Caucus, over his support for the Republican healthcare bill. “You are mandating people on Medicaid to accept dying,” she said. Labrador replied: “That line is so indefensible. Nobody dies because they don’t have access to healthcare.” (In a later statement, the Idaho conservative conceded that his comment “wasn’t very elegant” and argued that it had been taken out of context.) The activism drew more testy exchanges in upstate New York, where Tom Reed, a Republican congressman, defended his decision to support the Republican healthcare plan against boos and jeers from angry crowds at his three town halls on Saturday. At a firehouse in Busti, New York, a man told Reed that he had recently donated a kidney, which he said was considered a pre-existing condition. “Now that I have a pre-existing condition, my cost of healthcare could go up significantly or I could lose health care,” the man said, according to ABC News. With the House on recess until 16 May, activists are planning similarly furious receptions for the handful of Republican lawmakers who are scheduled to hold town halls in their home districts. Activists are specifically targeting congressional Republicans who supported the unpopular healthcare plan. Of the 217 Republicans who voted for the plan, just 14 will hold town halls during the recess, according to the scheduled of events compiled by TownHallProject.com. While it is hard to predict which ones will draw fireworks, a few seem likely prospects. Rod Blum, an Iowa Republican whose district voted for Obama twice before tipping for Trump last year, is holding a series of three town halls this week. On Monday, Blum walked out of an interview with a local TV channel after the journalist asked him why his staff was screening attendees to his town halls. Hours later, Blum, a member of the conservative Freedom Caucus, faced boos and jeers from a crowd as he struggled over the din to explain why he voted for the healthcare plan. Congressman Jeff Denham, who was one of 14 California Republicans who voted for the GOP healthcare plan, will hold a coffeehouse meeting on Tuesday. But perhaps no town hall will be watched as closely as the one with Tom MacArthur, a moderate Republican congressman who helped craft a compromise amendment that ensured support from conservatives. The New Jersey lawmaker represents a district that voted for Obama twice and only narrowly swung for Trump in 2016. MacArthur told reporters that he expected to encounter angry constituents at his town hall but would “relish” the opportunity to correct what he views as misconceptions about what the healthcare plan would do. MacArthur’s provision, which was crucial to passing the bill, was hammered out behind closed doors. No public hearings were held on the bill after the addition of the provision, which was made public hours before the House approved it. The nonpartisan Congressional Budget Office is due to analyze how much it would cost and how many people might lose coverage if the plan takes effect, perhaps as early as this week. The agency’s analysis of the initial proposal found that 24 million people would lose health coverage over the next decade. And with the bill heading to the Senate, activists hope that the Republicans taking it up next see that there is a political cost to supporting a measure that could strip healthcare from millions. Since the inauguration of Donald Trump, Republican lawmakers have routinely faced the wave of backlash from the so-called “resistance”, a coalition of liberal groups and activists opposed to the president’s agenda. For months, protesters – many of whom are first-time political activists – have packed Republican town halls, rallied outside GOP offices and filled lawmakers’ voicemails in an urgent attempt to save the Affordable Care Act. The liberal resistance has vowed to hold Republicans who supported the healthcare bill to account by voting them out of office in the 2018 midterms. But Republicans have scoffed at that notion, arguing that they voted to fulfill a seven-year campaign promise to repeal and replace Obamacare. Mick Mulvaney, director of the White House Office of Management and Budget, said Republicans had no reason to duck constituents – rather, they should welcome the opportunity to engage with them after delivering on a seven-year campaign promise. “I’d be ecstatic about going back and saying, ‘Look, here is what we did. Here is the process. Was it ugly? Yeah. But did we get it done? Did we follow through on a promise to repeal in the House? Yes,’” Mulvaney, a former congressman from South Carolina, told CBS’ Face the Nation. “No, I think it would be something that Republicans should run to, not run away from.”
News Article | May 9, 2017
Another day, another contentious town hall for a Republican congressman. In Dubuque, Iowa, on Monday, Republican Rep. Rod Blum faced pointed questions from constituents angry about his yes vote on the Republican bill to repeal and replace Obamacare. Blum, a member of the House Freedom Caucus, initially opposed the GOP plan, but wound up voting for the updated legislation, which narrowly passed on Thursday without receiving a score from the Congressional Budget Office. “You voted for this bill in a rush,” one woman said. “There were no committee hearings. This is my life. The Congressional Budget Office didn’t score this bill. … What was the rush?” “I have always said the process was bad,” Blum said. “It was rushed. There should have been hearings.” Blum insisted that the current version of the health care bill — now in the Senate — is “better than what we have” and is “heading in the right direction.” The argument drew boos from the audience. As the boos grew louder, Blum turned to an aide and said, “Nobody’s listening.” Related: GOP rep: ‘Nobody dies because they don’t have access to health care’ According to the Washington Post, Blum was just one of 14 House Republicans who voted for the bill to schedule a town hall this week. (A total of 217, all Republicans, voted for the legislation.) Earlier Monday, Blum abruptly walked out of an interview with a local television station at a community center when a reporter asked why he was requiring town hall attendees to show their identification to be admitted. “This is ridiculous,” Blum said as he left the room, which was filled with schoolchildren. “He’s just going to sit here and badger me.” Blum later said he was “ambushed” by the reporter, KCRG-TV’s Josh Scheinblum. But Scheinblum tweeted that he had informed Blum’s staff of his intentions weeks ahead of time. On Friday, Rep. Raul Labrador, R-Idaho, was booed during a town hall when he claimed, “Nobody dies because they don’t have access to health care,” while defending his vote for the GOP bill. Over the weekend, Labrador conceded the quip “wasn’t very elegant.”
News Article | May 18, 2017
NEW YORK, NY, May 18, 2017--(T.A.O.) just announced its plan to accommodate at least one million new members over the next three months. T.A.O. provides a non-insurance health program that aggregates nine healthcare services into one comprehensive and easy to use package. The program includes Telemedicine, a Health Advocate, a Medication Advocacy Program (MAP), and six discount networks for dental, vision, hearing, prescription, diabetic supply, and vitamins.28.2 million Americans were uninsured in the first nine months of 2016 according to the National Center for Health Statistics. Now at least 24 million people may lose their insurance over the next decade according to the Congressional Budget Office. "The Access Organization was created to provide an affordable healthcare solution" says Vince Prezioso, CEO and Co-Founder. "We feel that we've accomplished that with a program that is comprehensive, and provides excellent medication access as well as great service." Members have access to 24/7 Board Certified Doctors over the phone or online video who can diagnose and prescribe medication, if necessary. You are able to speak with a doctor, and can even have a "face-time"-like experience with a doctor right from your phone, as well as send pictures if needed. To see a doctor, members have a Health Advisor service to research doctors, obtain the best rate possible, and even schedule the appointment for them. Advisors also arrange non-emergency surgical procedures, saving patients an average of 66% over the past year, as well as negotiate upcoming or outstanding medical bills with an average reduction rate of 50 to 70% over the past year as well. T.A.O. also gives members access to over 6,000 brand-name monthly maintenance drugs for $25.00 per month or any group of brand-name maintenance drugs for $45.00 per month. This is regardless of the retail cost of the medication. Over 60,000 other brands and generics are also available at pre-negotiated rates. The only additional fee is a one-time $25.00 registration once the member is matched with their medication and agrees to receive it."When people ask me how much this is, they really don't believe me," says Prezioso. The cost for a family isper month, and that includes all calls to the doctor and health advisor." The discounted rates will apply to the other services; dental, vision, hearing, prescriptions, diabetic supply, and vitamins. New members can sign up directly on the website, taomembers.com , and be active in three business days. You can also leave your information at bit.ly/2taoinfo and someone will reach you. To watch a brief two-minute video about the program, go to bit.ly/2taovideo . Vince's personal favorite is to direct new members to a webinar. He says, "It gives the best explanation of our product. I always say, give me ten minutes of your time, and I'll show you how we can save you and your family thousands of dollars." The webinar can be viewed at bit.ly/2learntao Prezioso had his own personal experience in the early days of developing The Access Organization when he was prescribed Vyvanse for ADD which was costing him $250.00 per month. He was able to get it through The Access Organization for $25.00 per month. "I saved about $8,000.00 in three years from my own program," he says. "And that doesn't include the costs and time I saved by calling doctors instead of going in for visits." Prezioso is excited about the mission of The Access Organization. He explains, "This company was designed and created to help people. I know what it's like not to have any healthcare options. I was there myself. Our goal has been to provide an option for the artist and the freelancer, but it looks like a lot more people are going to need us really soon."Founded in 2012, the mission of The Access Organization (T.A.O.) is to provide individuals and families access to a discount healthcare program that is easy to use, reliable, convenient, and delivers savings on a wide range of products and services. Visit www.TAOMembers.com for complete program information and taomembers.com/disclosures for disclosures.The Access Organization, LLC275 Madison Avenue, 6th FloorNew York, NY 10016Contact:Misty Schwartz323-570-1328
News Article | May 18, 2017
Earlier this month, the U.S. House of Representatives narrowly passed the American Health Care Act (AHCA), a piece of legislation that, if signed into law, is likely to impact the health care coverage of nearly every American, including the 50% of Americans who receive insurance through their employers. Now it’s the Senate’s turn to take up the bill. While it’s been suggested that the measure will likely see major revisions there, as it stands, it’s wildly unpopular. A remarkable coalition of doctors, civic organizations, and health care industry interest groups has opposed its passage, as has nearly every major health insurer in our country. As the bill stands, it will cause tens of millions of Americans to lose insurance–through cuts to Medicaid and various regulatory rollbacks, including protections for pre-existing conditions–while cutting taxes for high earners. But the AHCA’s impact on employers would go further than even the Congressional Budget Office predicted when it analyzed the bill in March (the agency has yet to publish a report on the version passed by the House). We spend a lot of time thinking about employee health benefits as part of our day-to-day roles; Laszlo spent more than 13 years building industry-leading health benefits programs at GE and Google, and Ali, after enduring a freak medical emergency and getting stuck with $200,000 in uncovered medical expenses, founded a company to give self-insured employers more control and flexibility in the coverage they offer employees. We’ve read the bill and have come to the same conclusion: If the employer-specific elements of the AHCA become law, American companies will be faced with a difficult decision: They’ll either limit the scope of health care coverage they provide in order to save money today, knowing that will likely lead to higher costs down the road, or they’ll decide to pay more in the near-term for health care in hopes of significantly better outcomes (and consequently lower costs) in the long run. It’s a choice between taking a little medicine now or a lot later. The law basically incentivizes the shortsighted option, which will be disastrous for employers and employees alike. Health coverage is a major cost for American employers. Today, they spend a total of $1.2 trillion per year and cover more than 90% of our country’s private health care costs. The Affordable Care Act’s mandates, along with the rise of high-deductible health plans over the last decade, have together succeeded in helping control medical cost inflation. The ACA model is far from perfect, but it was meant to encourage smarter health care spending without comprising preventive care and essentials like emergency room visits, maternity care, and behavioral health coverage. And to a considerable degree, it’s worked as intended. But if the AHCA passes, this model would be jettisoned. Employers won’t be required to provide a federally mandated minimum level of coverage to employees and their dependents, thanks to a loophole letting them adopt the plan requirements of any state. That means a company in one state can cherry-pick from another state with more lenient essential benefits requirements. For example, an employer could choose to not cover behavioral health or maternity care by adopting the coverage requirements of a state that doesn’t mandate those forms of coverage–even if the employer doesn’t operate there. Over the long term, this can increase the overall cost of health care as people wait longer for or avoid treatment to save money, and ultimately get sicker. At the same time, the bill that passed the House addresses neither the underlying drivers of health care costs nor how employers, as a powerful buying group, can be leveraged to drive those costs down. That could mean enabling employers to deregulate access to clinical care, for instance, or giving them more power to negotiate bulk drug pricing, or even just adding incentives to promote healthy behaviors among their workforces. But the AHCA does nothing of the kind. Instead, it removes a powerful incentive for employers to provide better care to employees. That’s not only a short-sighted approach to controlling costs, it’s actually one that we believe will ultimately drive them up much more significantly over the long run. Tax Credits That Hurt Women And Help The Wealthy One of the more confusing aspects of the AHCA as it stands is its impact on the tax advantages–for both employers and employees–that incentivize businesses to offer health care coverage. In particular, the bill appears to redefine what a qualified health plan is without providing much detail about what that actually means. One detail, however, is clear: Employers whose plans cover abortion costs will lose eligibility for tax credits. This will mostly affect the plans of smaller employers, which depend on those credits to offer insurance to employees, but the message for working women is clear and frightening. The change would clearly disadvantage women in the workplace and further reinforce the gender stereotypes that we as a country have spent decades trying to undo. This sexist ethos extends to other parts of the bill that don’t directly affect employers; the AHCA would also let insurance companies charge patients significantly more based on medical histories that include postpartum depression, Cesarean sections, or issues stemming from sexual assault. At the same time, another group stands to gain handsomely from the AHCA’s tax treatment: highly paid executives. The bill bizarrely changes rule 162(m), which limits the tax deductibility of salaries greater than $1 million for public companies. That’s a massive gift to highly compensated executives and CEOs, whose companies would no longer face tax hits for paying them more than $1 million every year. What that has to do with health care is a mystery to us. Employers Have An Important Decision To Make While the Senate reshapes the AHCA in the days and weeks ahead, employers are already facing an urgent conundrum; they’re in the midst of planning a 2018 health benefits year without a clear picture of the federal and state laws that will guide them. If the AHCA does become law, they’ll also likely face an ethical and business dilemma: Should they reap the immediate economic benefits the AHCA would hand them, or keep investing in their employees’ health? It’s nice to imagine that employers will continue to provide at least the same level of benefits to their employees, if not actually spend more to protect the long-term health and productivity of their workforce, but many surely won’t. The reality is that the opportunity to lower costs may be too good to pass up. Collective Health recently polled more than 150 benefits leaders and found that nearly 40% were exploring new benefits solutions with the primary goal of driving down health care investment costs. These weren’t all struggling startups, either. Even successful, cash-rich technology and financial services employers–which typically provide some of the most generous benefits packages in the U.S.–have gradually begun covering a lower share of employees premiums as health care costs have risen steadily over the last decade. When weighing the decision, it’s important to focus on the word “investment.” Yes, health care is expensive, and controlling costs is a real, pressing issue for everyone involved. But as research has long confirmed, healthy employees are critical to long-term business performance; they’re happier, better engaged, and more productive. Employees also see health benefits as a major part of their compensation packages, making it a key element in where they decide to work. So if you want to attract, retain, and get the most out of the best and the brightest talent, reducing health care coverage is simply a risky strategy. Unfortunately, it’s the one the AHCA seems to want employers to adopt. Whatever the fate of the legislation, though, employers will still have to decide whether to make near-term cost reductions, or to build workforces of happy, healthy employees who trust that they’re cared about for the long haul. As CEOs of our own respective companies, and as executives who’ve been entrusted with the welfare of the people we serve, that choice is easy. Laszlo Bock is the CEO of Humu, Inc as well as the author of Work Rules! and former SVP of People Operations at Google. Ali Diab is cofounder and CEO of Collective Health.
News Article | May 14, 2017
In this May 10, 2017 photo, students leave South Park High School in Buffalo, N.Y. The Medicaid changes being advanced as part of the health overhaul are sounding familiar alarms for school districts still getting their financial footing after the Great Recession. (AP Photo/Carolyn Thompson) For school districts still getting their financial footing after the Great Recession, the Medicaid changes being advanced as part of the health care overhaul are sounding familiar alarms. Administrators say programming and services even beyond those that receive funding from the state-federal health care program could be at risk should Congress follow through with plans to change the way Medicaid is distributed. They say any reduction in the estimated $4 billion schools receive in annual Medicaid reimbursements would be hard to absorb after years of reduced state funding and a weakened tax base. "If they have less Medicaid money, something's going to go away," said Randy Liepa, superintendent of the Wayne County Regional Education Service Agency, which works with 33 school districts in the Detroit area. The agency covers about 21,000 children with special needs who are on Medicaid and it helps districts recoup about $30 million annually in reimbursements. Districts would have to look at nonmandated positions and programs if forced to bear more of the costs for services for poor and disabled students required by federal law, said Thomas Gentzel, executive director of the National School Boards Association. The Senate is up next in efforts to do away with President Barack Obama's health law, and school leaders are watching to see whether the changes advanced by the House survive. The House bill would transform the open-ended federal entitlement, which reimburses schools a percentage of the cost of the eligible services they provide to poor and disabled students, to one where reimbursements will come in a fixed, per-person amount. But, said Kriner Cash, superintendent of public schools in Buffalo, New York, "individual student care comes with highly variable costs, especially in the case of students with disabilities." In the school district, more than 80 percent of students are low income and 22 percent have disabilities. The district gets about $2.5 million annually from Medicaid. In March, a Congressional Budget Office estimate for an earlier version of the House bill found that federal Medicaid subsidies to states would be $880 billion less over 10 years. President Donald Trump's administration argues that states will get more freedom to experiment with the program and make sure that people who rely on Medicaid get the care and coverage they need. Medicaid spending is "not getting out of control because of schools, because schools are getting less than 1 percent of the dollars," said Sasha Pudelski, assistant director of policy and advocacy at The School Superintendents Association. "It's not kids who are breaking the bank." An association survey polling 1,000 school leaders reported that schools spent two-thirds of the money to support specialists, from school nurses and social workers to speech pathologists. The association, as part of a coalition of more than 50 school and child health advocates, warned congressional leaders in a recent letter against shifting more costs to states and in turn, local communities. They said that would lead to cuts in services and benefits to children, especially in districts with high poverty rates. "A lot of districts have never really covered from the Great Recession, they're still in it," Gentzel said, "and some states have not restored their funding. I think it's the context of all of this that's almost as important as the story about Medicaid." Opponents of the changes say these are potential impacts: Students needing to check their temperature or searching for a tampon may not be able to walk down the hall to see a school nurse. Health professionals such as nurses, physical therapists, speech pathologists, social workers and psychologists may be forced to rove between schools, outsourced or have some of their duties taken on by administrative staff. "There are health barriers to students getting their education," said Donna Mazyck, executive director of the National Association of School Nurses. Individualized Education Plans mandated under federal law may require nurses to give medication and tend to feeding tubes and tracheotomies. "That service won't be done if Medicaid isn't paying for it," she said. Behavioral issues in the classroom are often addressed with counseling through social workers and psychologists. Schenectady City School District in New York, where a majority of students live in poverty, has had a dramatic increase in the number of social workers at its schools dealing with mental health issues. "They're all front-line responders to kids in crisis," Superintendent Laurence Spring said. He said they counsel kids traumatized by domestic violence and street crimes and others who experience anxiety from not having enough food at home. The district files for about $2 million in annual Medicaid reimbursements. When schools host campus-wide preventative screenings, for everything from vision, hearing, asthma and mental health, some costs are recouped based on the number of Medicaid-eligible students who are treated. Advocates say that vulnerable children may not have access to such preventative services outside of school, but the screenings can catch health issues before they become more serious. Liepa, from the Detroit-area agency, said children living in poverty regularly come to school facing significant impairments to their health and with little or no support at home to address them, which ultimately affects learning. "It's no different than if they're coming in hungry, which is supported by the federal lunch program." School districts often direct and assist students' families with resources, such as helping them sign up for Medicaid or referring them to an eye doctor for glasses. Some hours spent on these administrative tasks are reimbursable by Medicaid. Poquoson City Public Schools in Virginia spend some of their $35,000 in annual reimbursements for events targeting children who aren't even in school yet, in hopes of getting families resources as early as possible. "It's a jump start for kindergarten. If we can get some services, with disabilities, at an early age, they're likely far more successful in the years with us," Superintendent Jennifer Parish said. A major hit on school budgets could mean less for new or replacement equipment and supplies. That could affect things such as outfitted buses, assistive devices and other items for children with special needs so they can be in school. This could trickle down to nonmandated items such as special science lab materials or theater club costumes for general education students. Liepa said the Medicaid money has helped school districts afford programs and operational costs, from upgrading buses to buying new textbooks, while balancing their budgets. "It's been a life-saver for school districts. It's one less thing I have to worry about or think about reducing," he said. Optional but highly popular programs for students and families, such as sports, clubs and after-school activities, could be slashed, as the offerings are generally the first to go in a budget crisis. "Most districts have long picked the low-hanging fruit in their budgets," Gentzel said. Ho reported from Las Vegas and Thompson reported from Buffalo, New York
Stocking A.,Congressional Budget Office
Journal of Environmental Economics and Management | Year: 2012
Price controls established in a cap-and-trade allowance market are intended to reduce cost uncertainty by constraining allowance prices between a ceiling and floor; however, they could provide opportunities for strategic actions by firms that would lower government revenue and increase emissions. In particular, when the ceiling price is supported by introducing new allowances into the market, firms could choose to buy allowances at the ceiling price, regardless of the prevailing market price, in order to lower the equilibrium price of all allowances. Those purchases could either be transacted by firms intending to manipulate the market price or be induced through the introduction of inaccurate information about the cost of emissions abatement. Theory and simulations using allowance elasticity estimates for U.S. firms suggest that the manipulation could be profitable under the stylized setting and assumptions evaluated in the paper, although in practice many other conditions will determine its use. © 2011 .