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The High Public Cost of Low Wages

April 16, 2015 Comments off

The High Public Cost of Low Wages
Source: University of California-Berkeley (Center for Labor Research and Education)

Even as the economy has at last begun to expand at a more rapid pace, growth in wages and benefits for most American workers has continued its decades-long stagnation. Real hourly wages of the median American worker were just 5 percent higher in 2013 than they were in 1979, while the wages of the bottom decile of earners were 5 percent lower in 2013 than in 1979. Trends since the early 2000s are even more pronounced. Inflation-adjusted wage growth from 2003 to 2013 was either flat or negative for the entire bottom 70 percent of the wage distribution. Compounding the problem of stagnating wages is the decline in employer-provided health insurance, with the share of non-elderly Americans receiving insurance from an employer falling from 67 percent in 2003 to 58.4 percent in 2013.

Stagnating wages and decreased benefits are a problem not only for low-wage workers who increasingly cannot make ends meet, but also for the federal government as well as the 50 state governments that finance the public assistance programs many of these workers and their families turn to. Nearly three-quarters (73 percent) of enrollees in America’s major public support programs are members of working families; the taxpayers bear a significant portion of the hidden costs of low-wage work in America.

This is the first report to examine the cost to the 50 states of public assistance programs for working families. We examine working families’ utilization of the health care programs Medicaid and Children’s Health Insurance Program (CHIP), as well as their enrollment in the basic household income assistance program Temporary Aid to Needy Families (TANF). Both of these programs operate with shared funding from the federal government and the states, and in this report we also examine the costs to the federal government of Medicaid/CHIP and TANF, as well as the Earned Income Tax Credit (EITC) and the food stamps program (Supplemental Nutrition Assistance Program, or SNAP). Our analysis includes only the cash assistance portion of TANF, and it does not include costs for state Earned Income Tax Credits, child care assistance, or other state-funded means-tested programs. Overall, we find that between 2009 and 2011 the federal government spent $127.8 billion per year on these four programs for working families and the states collectively spent $25 billion per year on Medicaid/CHIP and TANF for working families for a total of $152.8 billion per year. In all, more than half—56 percent—of combined state and federal spending on public assistance goes to working families.

CRS — Health Coverage Tax Credit (April 2, 2015)

April 15, 2015 Comments off

Health Coverage Tax Credit (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

The health coverage tax credit (HCTC) expired on January 1, 2014. This federal income tax credit subsidized most of the cost of qualified health insurance for eligible taxpayers and their family members. The Trade Act of 2002 (P.L. 107-210) first authorized the HCTC. Potential eligibility for the HCTC was limited to three groups of taxpayers, two of whom were individuals eligible for Trade Adjustment Assistance (TAA) allowances because they experienced job loss. The third group consisted of individuals whose defined benefit pension plans were taken over by the Pension Benefit Guaranty Corporation because of financial difficulties. Moreover, these potential HCTC-eligible individuals were allowed to claim the tax credit only if they either could not enroll in certain other health coverage (e.g., Medicaid) or were not eligible for other specified coverage (e.g., Medicare Part A)

To claim the HCTC, eligible taxpayers had to have qualified health insurance (specific categories of coverage, as specified in statute). Several of those categories required state action (statequalified health plans) to become available. As of December 2010, 44 states and the District of Columbia made available at least one of the state-qualified health plans. In the remaining six states, the categories of qualified health insurance that were potentially available were ones that were not dependent on state action (automatically qualified health plans), though not necessarily all persons who were eligible for the HCTC could avail themselves of these options.

Quality & Disparities Report — Access to Health Care Improving Among all Racial and Ethnic Groups Following Affordable Care Act; Additional Work Remain

April 14, 2015 Comments off

Quality & Disparities Report — Access to Health Care Improving Among all Racial and Ethnic Groups Following Affordable Care Act; Additional Work Remain
Source: Agency for Healthcare Research and Quality

Insurance rates improved substantially after individuals were able to obtain coverage through provisions of the Affordable Care Act, and the gains in access to care were greater among black and Hispanic adults than whites, according to the 2014 National Quality and Disparities Report released today by HHS’ Agency for Healthcare Research and Quality (AHRQ).

This annual report on the nation’s health care includes a section on measures of access to care that for the first time cover a period after implementation of the Affordable Care Act’s Health Insurance Marketplaces. Data covering January to June 2014 show that the overall rate of “uninsurance”—a measure of access to care—decreased substantially to 15.6 percent in the second quarter of 2014 among those age 18 to 64 (from a high of 22.3 percent in 2010). Because the data run through June 2014, they capture enrollment gains only from the first open enrollment period in the Health Insurance Marketplaces. The second open enrollment period began on November 15, 2014, and is not captured in the report.

The decline in uninsurance was greater among blacks and Hispanics, who historically have had higher uninsurance rates compared with whites. For blacks, the uninsurance rate decreased from 24.6 percent in the last quarter of 2013 to 15.9 percent in the first half of 2014. During the same period, the uninsurance rate dropped from 40.3 percent to 33.2 percent for Hispanics, and the rate declined from 14.0 percent to 11.1 percent for whites.

Enrollment in Private Health Insurance Exchanges Doubled, to 6 Million in 2015, According to Accenture

April 11, 2015 Comments off

Enrollment in Private Health Insurance Exchanges Doubled, to 6 Million in 2015, According to Accenture
Source: Accenture

A new report by Accenture estimates 6 million people enrolled in private health insurance exchanges for their 2015 employer benefits. These findings show private health insurance exchanges – an online marketplace for people to choose their employer-sponsored benefits – doubled enrollment this year, up from 3 million in 2014.

The Insurance Value of Medical Innovation

March 26, 2015 Comments off

The Insurance Value of Medical Innovation (PDF)
Source: National Bureau of Economic Research (via University of Chicago)

Economists think of medical innovation as a valuable but risky good, producing health benefits but increasing financial risk. This perspective overlooks how innovation can lower physical risks borne by healthy patients facing the prospect of future disease. We present an alternative framework that accounts for all these aspects of value and links them to the value of health insurance. We show that any innovation worth buying reduces overall risk, thereby generating positive insurance value on its own. We conduct two empirical exercises to assess the significance of our insights. First, we calculate that conventional methods underestimate the value of historical health gains by 30-80%. Second, we examine a large set of medical technologies and calculate that insurance value on average adds 100% to the conventional valuation of those treatments. Moreover, we find that the physical risk-reduction value of these technologies is ten times greater than the financial risk they pose and the corresponding value of health insurance that insures this financial risk. Our analysis also suggests standard methods disproportionately undervalue treatments for the most severe illnesses, where physical risk to consumers is most costly.

CRS — Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (ACA) in 2015 (March 18, 2015)

March 25, 2015 Comments off

Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (ACA) in 2015 (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

New federal tax credits, authorized under the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended), first became available in 2014 to help certain individuals pay for health insurance. The tax credits apply toward premiums for private health plans offered through exchanges (also referred to as health insurance marketplaces). The ACA also established subsidies to reduce cost-sharing expenses.

Health insurance exchanges operate in every state and the District of Columbia (DC), per the ACA statute. Exchanges may be established and administered by states, the federal government, or a combination of both. Exchanges are not insurers, but they provide eligible individuals and small businesses with access to private health insurance plans. Generally, plans offered through the exchanges provide a comprehensive set of health services and meet all of the ACA’s insurance market reforms, as applicable.

The new premium credits established under the ACA are advanceable and refundable, meaning tax filers need not wait until the end of the tax year to benefit from the credit and may claim the full credit amount even if they have little or no federal income tax liability.

New Hepatitis C Treatments: Considerations and Potential Strategies for States

March 24, 2015 Comments off

New Hepatitis C Treatments: Considerations and Potential Strategies for States
Source: National Governors Association

The National Governors Association Center for Best Practices (NGA Center) convened an expert roundtable to discuss the opportunities and challenges presented by new hepatitis C virus (HCV) treatments and other pharmaceutical therapies known as high-impact drugs. Such drug treatments share the common characteristics of being more effective than prevailing drug therapies, often resulting in a change in clinical practice that includes treating many more people and being much more expensive. Experts participating in the roundtable included state health care leaders, scientists, national health care experts, subject-matter experts from insurance and pharmaceutical companies, Medicaid and corrections legal experts, and senior staff from the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Veterans Affairs (VA). This paper summarizes the expert roundtable discussion supplemented by NGA Center research to flesh out the background information and strategies discussed.

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