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SOCIAL SCIENCE RESEARCH NETWORK
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. 7, No. 33: November 9, 2006
Editors: PAMELA J. PERUN
Urban Institute
PAMELA@PLANETNOW.COM
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Topic of This Issue:
Healthcare
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T A B L E O F C O N T E N T S
"Global Perspectives on Financing Long-Term Care"
KIM DAYTON
William Mitchell College of Law
"Health Insurance Enrollment Decisions: Preferences for Coverage,
Worker Sorting, and Insurance Take Up"
ALAN MONHEIT
University of Medicine & Dentistry of New Jersey
(UMDNJ), National Bureau of Economic Research (NBER)
JESSICA PRIMOFF VISTNES
U.S. Department of Health and Human Services - Agency
for Healthcare Research & Quality (AHRQ) - Center for
Financing, Access & Cost Trends
"How Readable are Summary Plan Descriptions for Health Care
Plans?"
COLLEEN MEDILL
University of Nebraska at Lincoln - College of Law
RICHARD WIENER
University of Nebraska at Lincoln - College of Law
BRIAN BORNSTEIN
University of Nebraska at Lincoln - Department of
Psychology
E. KIERNAN MCGORTY
University of Nebraska at Lincoln
"Sources of Health Insurance and Characteristics of the
Uninsured: Analysis of the March 2006 Current Population Survey"
PAUL FRONSTIN
Employee Benefit Research Institute (EBRI)
"Federalism, Federal Regulation, or Free Market? An Examination
of Mandated Health Benefit Reform"
AMY MONAHAN
University of Missouri at Columbia - School of Law
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"Global Perspectives on Financing Long-Term Care"
Contact: KIM DAYTON
William Mitchell College of Law
Email: kdayton@wmitchell.edu
Auth-Page: http://ssrn.com/author=594862
Abstract: http://ssrn.com/abstract=939830
ABSTRACT: The vast majority of the world's nations will
experience a dramatic change in the structure of their
"population pyramids" over the next forty years. Longer life
expectancies and decreasing birth rates in all but a handful of
countries will result in an enormous increase in the number and
percentage of elderly persons relative to the non-elderly
population, with elderly populations tripling or quadrupling
between 2000 and 2050 in many nations. In less than twenty-five
years, some 1.5 billion of the world's 8 billion persons will be
65 older, compared to fewer than 500 million today. The number of
persons 80 and over will increase by more than 500% during that
period. Sixty-two percent of these "oldest old" will be women.
As the world's population ages, and its old get even older,
industrialized and developing nations alike must re-evaluate
social, economic, and cultural institutions that historically
have had little need to account for particularly large elderly
populations. Global aging has the potential to generate a crisis
with regard to the financing of long term care for elderly
individuals who are disabled or significantly compromised by
disease or frailty. Although most elderly persons do not need
long term care at the level typically provided in a skilled
nursing home or similar residential institutions, as a group they
suffer disproportionately from conditions and diseases that mean
they will need assistance to live independently. Some will become
debilitated enough that they must in institutional facilities
such as "aged care" or "nursing" homes that can provided intense,
around-the-clock assistance and medical care.
Until recently, very few nations have been confronted with
significantly large enough populations of elderly persons in need
of long term care to perceive long term care financing as a
matter imperative - a lack of immediacy has kept the issue under
the radar of laypersons and politicians alike. But as the number
and percentage of elderly has crept upward in both the
industrialized and developing world, the need to address
deficiencies in the way in which long term care is financed and
delivered has become paramount. Long term care is a product that,
until very recently, has not been bought or sold. Family
caregiving of the elderly is the norm in virtually all of the
developing and developed world, and in nations where it is not
existing resources have until recently been largely adequate to
serve the relatively small elderly population. It is only in the
last fifteen years or so that the demographic "sea change"
described above has begun to threaten public resources and
private lives so significantly as to merit closer scrutiny of the
inability of social welfare and insurance systems to support long
term care for the elderly under current funding schemes.
This paper describes how three particular nations - Japan, the
United States, and Italy - currently deliver and pay for the
principal components of "long term care" for those elderly who
may need it, and suggests how these mechanisms may or may not
offer solutions to the world's future need to provide quality of
life to all its citizens, including the oldest of them. It
proposes what should be regarded as the minimum components of an
economically sustainable, gender-neutral, and
inter-generationally just system of providing long term care to
the disabled elderly.
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"Health Insurance Enrollment Decisions: Preferences for Coverage,
Worker Sorting, and Insurance Take Up"
NBER Working Paper No. W12429
Contact: ALAN MONHEIT
University of Medicine & Dentistry of New Jersey
(UMDNJ), National Bureau of Economic Research
(NBER)
Email: monheiac@umdnj.edu
Auth-Page: http://ssrn.com/author=382345
Co-Author: JESSICA PRIMOFF VISTNES
U.S. Department of Health and Human Services -
Agency for Healthcare Research & Quality (AHRQ) -
Center for Financing, Access & Cost Trends
Email: jvistnes@ahrq.gov
Auth-Page: http://ssrn.com/author=53454
Full Text: http://ssrn.com/abstract=923352
ABSTRACT: The weak response by the uninsured to policy
initiatives encouraging voluntary enrollment in health insurance
has raised concerns regarding the extent to which the uninsured
value health insurance. To address this issue, we use data from
the 2001 Medical Expenditure Panel Survey to examine the
association between health insurance preferences and coverage
status. We also consider the role of such preferences in
decisions to seek out and enroll in employment-based coverage. We
find that adults with weak or uncertain preferences for health
insurance are more likely than persons with strong preferences to
be uninsured and less likely to acquire coverage. Our econometric
work indicates that workers with weak or uncertain preferences
are less likely to obtain job offers with insurance, reinforcing
prior evidence that workers sort among jobs according to
preferences for coverage. We also find that workers with weak or
uncertain preferences are less likely to enroll in offered
coverage and we estimate the subsidy necessary to compensate such
workers for the utility loss were they to enroll. Our results
suggest a dual approach to expanding coverage that includes both
subsidies and educational efforts to inform targeted groups among
the uninsured about the value of health insurance.
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"How Readable are Summary Plan Descriptions for Health Care
Plans?"
EBRI Notes, Vol. 27, No. 10, October 2006
Contact: COLLEEN MEDILL
University of Nebraska at Lincoln - College of Law
Email: cmedill2@unl.edu
Auth-Page: http://ssrn.com/author=575069
Co-Author: RICHARD WIENER
University of Nebraska at Lincoln - College of Law
Email: rwiener2@unl.edu
Auth-Page: http://ssrn.com/author=336235
Co-Author: BRIAN BORNSTEIN
University of Nebraska at Lincoln - Department of
Psychology
Email: BBORNSTEIN2@UNL.EDU
Auth-Page: http://ssrn.com/author=292770
Co-Author: E. KIERNAN MCGORTY
University of Nebraska at Lincoln
Email: kmcgorty@yahoo.com
Auth-Page: http://ssrn.com/author=694916
Full Text: http://ssrn.com/abstract=938147
ABSTRACT: The summary plan description (SPD) is the primary
source of information for workers who participate in an
employment-based health care plan. This paper investigates
whether private-sector employers' SPDs are written so that an
average plan participant can identify and read important
information contained in the document, as required by federal
law. Summary plan descriptions for 40 health care plans from a
diverse national sample were collected and tested and subjected
to content and readability analyses. The data from this study
provide quantifiable evidence about whether summary plan
descriptions cover the necessary topics that participants need to
know about their health plans, and the educational level required
to read them.
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"Sources of Health Insurance and Characteristics of the
Uninsured: Analysis of the March 2006 Current Population Survey"
EBRI Issue Brief, No. 298, October 2006
Contact: PAUL FRONSTIN
Employee Benefit Research Institute (EBRI)
Email: FRONSTIN@EBRI.ORG
Auth-Page: http://ssrn.com/author=255140
Full Text: http://ssrn.com/abstract=938130
ABSTRACT: This paper provides historic data through 2005 on the
number and percentage of nonelderly individuals with and without
health insurance. The data are based primarily on the March 2006
Current Population Survey (CPS), with some analysis based on
other Census surveys. The report focuses on the nonelderly
population (under age 65) because this group can receive health
insurance coverage from a number of different sources. The
estimates presented in this report differ from those published by
the Census Bureau because the focus here is solely on the
nonelderly since Medicare covers nearly all of the elderly
population. As a result of this difference between EBRI and
Census Bureau estimates, this paper shows a higher percentage of
uninsured in the United States.
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"Federalism, Federal Regulation, or Free Market? An Examination
of Mandated Health Benefit Reform"
U of Missouri-Columbia School of Law Legal Studies Research
Paper No. 2006-32
University of Illinois Law Review, 2007
Contact: AMY MONAHAN
University of Missouri at Columbia - School of Law
Email: monahana@missouri.edu
Auth-Page: http://ssrn.com/author=383034
Full Text: http://ssrn.com/abstract=931497
ABSTRACT: Every state regulates the substance of health insurance
contracts issued to its residents, requiring the coverage of
certain treatments, services, and providers. These state mandated
health benefit laws apply only to insured health plans, while
self-insured plans (typically sponsored by a large employer) are
exempt. The disparate application of state mandated benefit laws
is criticized as contributing to an unjust and expensive system
of health care in the United States. As a result, state mandated
benefit laws are under attack and the subject of numerous federal
reform efforts. This article explores three possible approaches
to mandated benefit reform: (1) exclusive state regulation of
mandated benefits, (2) deregulation of mandated benefits, and (3)
positive federal regulation of mandated benefits. The article
concludes that there are compelling arguments against both
exclusive state regulation and deregulation. While federal
regulation is far from perfect, it has significant advantages
over the status quo and represents the best way forward for
mandated benefit reform. Current and proposed mandated benefit
reforms are analyzed in light of these conclusions. The article
exposes these reform efforts as coordinated movements toward
deregulation, an option that, while respecting individual rights,
will harm the sick while improving the position of the healthy.