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E M P L O Y E E B E N E F I T S , C O M P E N S A T I O N
& P E N S I O N L A W
Vol. 6, No. 18: September 22, 2005
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Publisher: Employment, Labor, Compensation & Pension Law Journals
a division of
Social Science Electronic Publishing, Inc. (SSEP)
and Social Science Research Network (SSRN)
Editor: PAMELA PERUN
Urban Institute
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Copyright: SSEP, Inc. 2005. All rights reserved.
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Topic of This Issue:
Healthcare
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T A B L E of C O N T E N T S
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NEW and FORTHCOMING ARTICLES
"Reviving Managed Health Care with Health Savings Accounts"
Health Affairs, 2005
MARK A. HALL
Wake Forest University
School of Law
CLARK C. HAVIGHURST
Duke University School of Law
"Consumer-Driven Health Care in South Africa: Lessons from
Comparative Health Policy Studies"
Journal of Health & Biomedical Law, 2005
TIMOTHY STOLTZFUS JOST
Washington and Lee University
School of Law
"Subsidization and Choice in the Group Health Insurance Market"
Journal of Risk and Insurance, Vol. 72, No. 3, pp. 413-439,
September 2005
YU-LUEN MA
Illinois State University
Katie Insurance School
MARK J. BROWNE
University of Wisconsin, Madison
School of Business
"Employment Protection for Atypical Workers"
BOUNDARIES AND TRANSITIONS: RE-EXAMINING THE SCOPE OF LABOR
LAW, Guy Davidov and Brian Languille, eds., Forthcoming
KATHERINE VAN WEZEL STONE
University of California, Los Angeles
School of Law
"Tax and Disability: Ability to Pay and the Taxation of
Difference"
University of Pennsylvania Law Review, Vol. 154, June 2005
THEODORE P. SETO
Loyola Law School (Los Angeles)
SANDE BUHAI
Loyola Law School (Los Angeles)
"Employment-Based Health Benefits: Trends in Access and Coverage"
EBRI Issue Brief, No. 284, August 2005
PAUL FRONSTIN
Employee Benefit Research Institute (EBRI)
WORKING PAPERS
"Refundable Tax Credits for Health Insurance: The Sensitivity of
Simulated Impacts to Assumed Behavior"
STEPHEN WOODBURY
Michigan State University
W.E. Upjohn Institute for Employment Research
National Bureau of Economic Research (NBER)
DAVID W. EMMONS
American Medical Association
EVA MADLY
W.E. Upjohn Institute for Employment Research
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N E W and F O R T H C O M I N G Articles
_________________________________________________________________
"Reviving Managed Health Care with Health Savings Accounts"
Health Affairs, 2005
BY: MARK A. HALL
Wake Forest University
School of Law
CLARK C. HAVIGHURST
Duke University School of Law
Contact: MARK A. HALL
Email: Mailto:hall@law.wfu.edu
Postal: Wake Forest University
School of Law
P.O. Box 7206
Winston-Salem, NC 27109 UNITED STATES
Phone: 336-716-9807
Co-Auth: CLARK C. HAVIGHURST
Email: Mailto:hav@law.duke.edu
Postal: Duke University School of Law
Box 90360
Durham, NC 27708 UNITED STATES
ABSTRACT:
Although health savings accounts (HSAs) and managed health care
are often seen as antithetical, they can be integrated in
fruitful ways. Moreover, combining these approaches will serve
policy objectives by clarifying the payment responsibilities of
patients, health plans, and premium payers, thus altering
important perceptions about health care decision making. The
availability in HSAs of funds that patients can use to pay for
services found not covered under insurance contracts should help
to re-legitimize predetermination of benefits and enable the
public and the legal system to take a more benign view of
corporate health plans as agents of their subscribers.
JEL Classification: K23, K32
______________________________
"Consumer-Driven Health Care in South Africa: Lessons from
Comparative Health Policy Studies"
Journal of Health & Biomedical Law, 2005
BY: TIMOTHY STOLTZFUS JOST
Washington and Lee University
School of Law
Paper ID: Washington & Lee Legal Studies Paper No. 05-08
Contact: TIMOTHY STOLTZFUS JOST
Email: Mailto:JOSTT@WLU.EDU
Postal: Washington and Lee University
School of Law
Lexington, VA 24450 UNITED STATES
Phone: 540-458-8510
Fax: 540-458-8488
ABSTRACT:
Consumer-driven health care, based on health savings accounts
and high deductible health insurance policies, seems to be the
next big thing in U.S. health policy. Long supported by
conservative and libertarian advocacy groups, it received a
big-boost with the HSA tax subsidy provisions of the Medicare
Modernization Act. The question remains, however, whether
consumer-driven health care can really bring down health care
costs while improving quality and access, as its supporters
claim that it will.
This article examines the experience of South Africa, where
medical savings accounts have long been available and are widely
used. It concludes that South Africa's experience is not
terribly encouraging. It is not clear that MSAs have been
successful in controlling costs there, and they certainly have
not expanded access. It is likely that they have rather tended
to break down risk-pooling and to assist insurers in achieving
favorable selection. South Africa's experience does not support,
therefore, expanding the use of consumer-driven health care in
the United States, though South Africa's situation is so
different from ours, that there might be little we could learn
from it in any event.
JEL Classification: I18, K32
______________________________
"Subsidization and Choice in the Group Health Insurance Market"
Journal of Risk and Insurance, Vol. 72, No. 3, pp. 413-439,
September 2005
BY: YU-LUEN MA
Illinois State University
Katie Insurance School
MARK J. BROWNE
University of Wisconsin, Madison
School of Business
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=782997
Contact: YU-LUEN MA
Email: Mailto:yma@ilstu.edu
Postal: Illinois State University
Katie Insurance School
Normal, IL 61790 UNITED STATES
Co-Auth: MARK J. BROWNE
Email: Mailto:MJBROWNE@FACSTAFF.WISC.EDU
Postal: University of Wisconsin, Madison
School of Business
975 University Avenue
Madison, WI 53706 UNITED STATES
ABSTRACT:
This study investigates the effect of group health insurance
plan choice on insurance unit price. The empirical findings
suggest that the unit price of insurance, as measured by the
ratio of the premium to expected indemnity benefits, is lower in
group plans that offer employees a choice of different insurance
options and require a premium contribution than it is in plans
lacking at least one of these two features. The analyses suggest
that lower unit prices are related to an increase in indemnity
benefits and that the reduction in the unit price is greater for
lower risks. The findings indicate that although subsidization
of high risks by low risks occurs with group health insurance,
the degree of subsidization is less when employees are offered a
choice of health insurance plans.
______________________________
"Employment Protection for Atypical Workers"
BOUNDARIES AND TRANSITIONS: RE-EXAMINING THE SCOPE OF LABOR
LAW, Guy Davidov and Brian Languille, eds., Forthcoming
BY: KATHERINE VAN WEZEL STONE
University of California, Los Angeles
School of Law
Paper ID: UCLA School of Law Research Paper No. 05-17
Contact: KATHERINE VAN WEZEL STONE
Email: Mailto:stone@law.ucla.edu
Postal: University of California, Los Angeles
School of Law
405 Hilgard Avenue
Box 951476
Los Angeles, CA 90095-1476 UNITED STATES
ABSTRACT:
In the United States, the labor and employment laws were built
on the assumption that workers had career-long, stable
relationships with their employers. Now the workplace is
changing. New ideas about how to organize work have generated
new flexible work practices that are proliferating throughout
American enterprises and disrupting long-term employment
relationships. There has been an explosion in the use of
atypical workers such as temporary workers, leased workers, and
independent contractors. Furthermore, regular full-time
employment no longer carries the presumption of a long-term
attachment between an employee and a single firm and orderly
promotion patterns and upwardly rising wage patterns. Today,
employees now expect to change jobs frequently and firms expect
a regular amount of churning in their workforces. Indeed, the
very concept of the workplace as a 'place', and the concept of
employment as involving an 'employer', are becoming out-dated.
As a result of the transformation of work, the current
regulatory regime is seriously out of alignment with the reality
of today's workplace. In the United States, the labor and
employment laws are for regular workers - those with long term,
steady jobs with steady employers. The labor and employment laws
give regular workers a right to unionize and bargain
collectively, social insurance against unemployment and
workplace injuries, a minimum wage guarantee, and health and
safety protection. Atypical workers - those lacking a long-term
relationship with a particular employer - are usually not
eligible for those employment rights. Yet in the labor market
today, all workers are becoming atypical. Soon the atypical
workers will be typical and the only really atypical ones will
be those we today consider typical. In light of the
transformation of work, it is necessary to rethink the nature of
employment regulation at a fundamental level. The task for labor
law scholars today is to describe the current workplace,
identify the problems and vulnerabilities it creates, and devise
solutions that provide workers with support structures so that
they can weather career transitions and thrive in the new
boundaryless workplace.
JEL Classification: J20
______________________________
"Tax and Disability: Ability to Pay and the Taxation of
Difference"
University of Pennsylvania Law Review, Vol. 154, June 2005
BY: THEODORE P. SETO
Loyola Law School (Los Angeles)
SANDE BUHAI
Loyola Law School (Los Angeles)
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=784692
Paper ID: Loyola-LA Legal Studies Paper No. 2005-15
Contact: THEODORE P. SETO
Email: Mailto:Theodore.Seto@lls.edu
Postal: Loyola Law School (Los Angeles)
919 Albany Street
Los Angeles, CA 90015-1211 UNITED STATES
Phone: 213-736-1154
Fax: 213-380-3769
Co-Auth: SANDE BUHAI
Email: Mailto:Sande.Buhai@lls.edu
Postal: Loyola Law School (Los Angeles)
919 Albany Street
Los Angeles, CA 90015-1211 UNITED STATES
ABSTRACT:
Although people with disabilities make up some 20% of the
American population, scholars have largely ignored U.S. tax
provisions of particular relevance to them. This article
undertakes the first such systematic study. In the process, it
reexamines disability theory, tax theory, and the mechanical
structure of the individual income tax system. Disability theory
has changed dramatically over the past century, to the point
that many tax rules important to people with disabilities are no
longer justified by modern disability theory. Standard tax
theory turns out to be inadequate to deal with the problems of
people with disabilities because, consistent with its
utilitarian origins, it generally assumes that taxpayers are
identical except with respect to income; as a result, it lacks
capacity to deal with other individual differences in ability to
pay. The failure of theory to deal adequately with ability to
pay, in turn, has placed serious strains on the mechanical
structure of the individual income tax system as a whole, which
has become increasingly incoherent. This article analyzes
existing tax provisions of particular relevance to people with
disabilities using an ability-to-pay approach to individual
income taxation and a human variation paradigm of disability
rights, justifying or reframing some and recommending repeal of
others. Among other issues, it explores the general welfare
doctrine and a dramatic expansion of the medical expense
deduction, neither of which has received sufficient scholarly
attention elsewhere. Ultimately, the article suggests, if the
individual income tax system as a whole were to be reframed in
terms of ability to pay, the mechanical complexity of that
system could be rationalized and significantly reduced.
JEL Classification: H24, I38, J14
______________________________
"Employment-Based Health Benefits: Trends in Access and Coverage"
EBRI Issue Brief, No. 284, August 2005
BY: PAUL FRONSTIN
Employee Benefit Research Institute (EBRI)
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=788069
Contact: PAUL FRONSTIN
Email: Mailto:FRONSTIN@EBRI.ORG
Postal: Employee Benefit Research Institute (EBRI)
Suite 600
2121 K Street, NW
Washington, DC 20037-1896 UNITED STATES
Phone: 202-775-6352
Fax: 202-775-6312
ABSTRACT:
This paper examines the state of employment-based health
benefits among workers with respect to offer rates, coverage
rates, and take-up rates. It also examines how the state of
employment-based health benefits has changed since the
mid-1990s, reasons why workers do not have employment-based
health benefits from their own employer, and how these reasons
have changed since the 1990s.
JEL Classification: I1, J3, J32
______________________________
W O R K I N G P A P E R Abstracts
_________________________________________________________________
"Refundable Tax Credits for Health Insurance: The Sensitivity of
Simulated Impacts to Assumed Behavior"
BY: STEPHEN WOODBURY
Michigan State University
W.E. Upjohn Institute for Employment Research
National Bureau of Economic Research (NBER)
DAVID W. EMMONS
American Medical Association
EVA MADLY
W.E. Upjohn Institute for Employment Research
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=760964
Paper ID: W.E. Upjohn Institute Staff Working Paper No. 05-119
Date: July 2005
Contact: STEPHEN WOODBURY
Email: Mailto:WOODBUR2@PILOT.MSU.EDU
Postal: Michigan State University
East Lansing, MI 48824 UNITED STATES
Phone: 517-355-4587
Fax: 517-432-1068
Co-Auth: DAVID W. EMMONS
Email: Mailto:David_Emmons@ama-assn.org
Postal: American Medical Association
515 North State St.
Chicago, IL 60610 UNITED STATES
Co-Auth: EVA MADLY
Email: Mailto:madly@upjohninstitute.org
Postal: W.E. Upjohn Institute for Employment Research
300 South Westnedge Avenue
Kalamazoo, MI 49007-4686 UNITED STATES
Paper Requests:
Contact Customer Service, W.E. Upjohn Institute for Employment
Research, Publications, 300 S. Westnedge Ave., Kalamazoo, MI
49007 USA. Mailto:publications@upjohninstitute.org Phone:
616-343-4330, Fax: 616-343-7310. Fee: $3.00, includes shipping
and handling.
ABSTRACT:
We replicate and extend a simulation model developed by Jonathan
Gruber with the goals of illuminating Gruber's modeling of
health insurance coverage under a tax credit and examining the
sensitivity of the results to changes in the model's key
parameters. The replications suggest that a refundable tax
credit of $1,000 for a single individual or $2,000 for a family
for private health insurance would reduce the number of
uninsured individuals by between 17.5 and 28 percent and require
new government expenditures of between $16.6 and $44 billion, of
which about $7.4 - $9.7 billion would be for coverage of
previously uninsured individuals. These wide simulated ranges
highlight the uncertainty inherent in modeling the effects of
health insurance tax credits and suggest that progress on the
issue of tax credits for health insurance will require improved
evidence on the likely take-up rate of a credit.