Healthcare Issues/title> </head> <body> ______________________________ <div style="direction:ltr"> <wbr>______________________________<wbr>_____<br/> <br/> SOCIAL SCIENCE RESEARCH NETWORK<br/> <br/> EMPLOYEE BENEFITS, COMPENSATION & PENSION LAW ABSTRACTS<br/> Sponsored by Pension Governance, LLC<br/> Vol. 8, No. 23: June 22, 2007<br/> <br/> Editor: PAMELA J. PERUN<br/> Policy Director, Aspen Institute - Initiative on<br/> Financial Security<br/> <a href="mailto:PAMELA@PLANETNOW.COM">PAMELA@PLANETNOW.COM</a><br/> ______________________________<wbr>______________________________<wbr>_____<br/> <br/> BROWSE all abstracts in this subject:<br/> <a href="http://www.ssrn.com/link/benefits-compensation-pension-law.html" target="_blank">http://www.ssrn.com/link<wbr>/benefits-compensation-pension<wbr>-law.html</a><br/> <br/> SEARCH entire eLibrary at: <a href="http://ssrn.com/search" target="_blank">http://ssrn.com/search</a><br/> <br/> If this document is misaligned, please set type face to a<br/> non-proportional font such as Courier 10.<br/> ______________________________<wbr>______________________________<wbr>_____<br/> <br/> Pension Governance, LLC is an independent information and<br/> business consulting services and research/analysis company for<br/> the pension community. News, interviews, white papers, surveys,<br/> training and industry events provide pension decision-makers,<br/> their attorneys, actuaries, auditors, consultants, money managers<br/> and third party administrators with information that is<br/> straightforward and created with investment fiduciary best<br/> practices in mind. To learn more, please visit<br/> <a href="http://www.pensiongovernance.com/" target="_blank">http://www.pensiongovernance<wbr>.com</a>,<br/> <a href="http://www.pensionriskmatters.com/" target="_blank">http://www.pensionriskmatters<wbr>.com</a> (blog) and<br/> <a href="http://www.pensionlitigationdata.com/" target="_blank">http://www.pensionlitigationda<wbr>ta.com</a>.<br/> <br/> Topic of This Issue:<br/> Healthcare Issues<br/> ______________________________<wbr>______________________________<wbr>_____<br/> <br/> T A B L E O F C O N T E N T S<br/> <br/> "Global Perspectives on Financing Long-Term Care"<br/> KIM DAYTON<br/> William Mitchell College of Law<br/> <br/> "Health Insurance Coverage Among Youth and Young Adults with Work<br/> Limitations"<br/> BONNIE O'DAY<br/> Cornell University Institute for Policy Research (CUIPR)<br/> DAVID C. STAPLETON<br/> Cornell University Institute for Policy Research (CUIPR)<br/> ANN E. HORVATH-ROSE<br/> Cornell University Institute for Policy Research (CUIPR)<br/> <br/> "Sources of Health Insurance and Characteristics of the<br/> Uninsured: Updated Analysis of the March 2006 Current Population<br/> Survey"<br/> PAUL FRONSTIN<br/> Employee Benefit Research Institute (EBRI)<br/> <br/> "Benefit Limits for Behavioral Health Care in Private US Health<br/> Plans"<br/> DOMINIC HODGKIN<br/> Brandeis University<br/> CONSTANCE HORGAN<br/> Brandeis University<br/> DEBORAH GARNICK<br/> Brandeis University<br/> ELIZABETH MERRICK<br/> Brandeis University<br/> <br/> "Tax Expenditures and Employee Benefits: Estimates from the FY<br/> 2008 Budget"<br/> KENNETH J. MCDONNELL<br/> Employee Benefit Research Institute (EBRI)<br/> <br/> "ERISA Pre-emption and Health Care Reform: A History Lesson"<br/> MICHAEL S. GORDON<br/> Author - Deceased<br/> <br/> "Tax Benefits for Health Insurance: Critiques and Proposals"<br/> DOUG JONES<br/> Affiliation Unknown<br/> ______________________________<wbr>______________________________<wbr>_____<br/> <br/> "Global Perspectives on Financing Long-Term Care"<br/> <br/> Contact: KIM DAYTON<br/> William Mitchell College of Law<br/> Email: <a href="mailto:kdayton@wmitchell.edu">kdayton@wmitchell.edu</a><br/> Auth-Page: <a href="http://ssrn.com/author=594862" target="_blank">http://ssrn.com/author=594862</a><br/> <br/> Abstract: <a href="http://ssrn.com/abstract=939830" target="_blank">http://ssrn.com/abstract<wbr>=939830</a><br/> <br/> ABSTRACT: The vast majority of the world's nations will<br/> experience a dramatic change in the structure of their<br/> "population pyramids" over the next forty years. Longer life<br/> expectancies and decreasing birth rates in all but a handful of<br/> countries will result in an enormous increase in the number and<br/> percentage of elderly persons relative to the non-elderly<br/> population, with elderly populations tripling or quadrupling<br/> between 2000 and 2050 in many nations. In less than twenty-five<br/> years, some 1.5 billion of the world's 8 billion persons will be<br/> 65 older, compared to fewer than 500 million today. The number of<br/> persons 80 and over will increase by more than 500% during that<br/> period. Sixty-two percent of these "oldest old" will be women.<br/> <br/> As the world's population ages, and its old get even older,<br/> industrialized and developing nations alike must re-evaluate<br/> social, economic, and cultural institutions that historically<br/> have had little need to account for particularly large elderly<br/> populations. Global aging has the potential to generate a crisis<br/> with regard to the financing of long term care for elderly<br/> individuals who are disabled or significantly compromised by<br/> disease or frailty. Although most elderly persons do not need<br/> long term care at the level typically provided in a skilled<br/> nursing home or similar residential institutions, as a group they<br/> suffer disproportionately from conditions and diseases that mean<br/> they will need assistance to live independently. Some will become<br/> debilitated enough that they must in institutional facilities<br/> such as "aged care" or "nursing" homes that can provided intense,<br/> around-the-clock assistance and medical care.<br/> <br/> Until recently, very few nations have been confronted with<br/> significantly large enough populations of elderly persons in need<br/> of long term care to perceive long term care financing as a<br/> matter imperative - a lack of immediacy has kept the issue under<br/> the radar of laypersons and politicians alike. But as the number<br/> and percentage of elderly has crept upward in both the<br/> industrialized and developing world, the need to address<br/> deficiencies in the way in which long term care is financed and<br/> delivered has become paramount. Long term care is a product that,<br/> until very recently, has not been bought or sold. Family<br/> caregiving of the elderly is the norm in virtually all of the<br/> developing and developed world, and in nations where it is not<br/> existing resources have until recently been largely adequate to<br/> serve the relatively small elderly population. It is only in the<br/> last fifteen years or so that the demographic "sea change"<br/> described above has begun to threaten public resources and<br/> private lives so significantly as to merit closer scrutiny of the<br/> inability of social welfare and insurance systems to support long<br/> term care for the elderly under current funding schemes.<br/> <br/> This paper describes how three particular nations - Japan, the<br/> United States, and Italy - currently deliver and pay for the<br/> principal components of "long term care" for those elderly who<br/> may need it, and suggests how these mechanisms may or may not<br/> offer solutions to the world's future need to provide quality of<br/> life to all its citizens, including the oldest of them. It<br/> proposes what should be regarded as the minimum components of an<br/> economically sustainable, gender-neutral, and<br/> inter-generationally just system of providing long term care to<br/> the disabled elderly.<br/> ______________________________<br/> <br/> "Health Insurance Coverage Among Youth and Young Adults with Work<br/> Limitations"<br/> <br/> Contact: BONNIE O'DAY<br/> Cornell University Institute for Policy Research<br/> (CUIPR)<br/> Email: <a href="mailto:bo29@cornell.edu">bo29@cornell.edu</a><br/> Auth-Page: <a href="http://ssrn.com/author=526249" target="_blank">http://ssrn.com/author=526249</a><br/> <br/> Co-Author: DAVID C. STAPLETON<br/> Cornell University Institute for Policy Research<br/> (CUIPR)<br/> Email: <a href="mailto:dcs28@cornell.edu">dcs28@cornell.edu</a><br/> Auth-Page: <a href="http://ssrn.com/author=382491" target="_blank">http://ssrn.com/author=382491</a><br/> <br/> Co-Author: ANN E. HORVATH-ROSE<br/> Cornell University Institute for Policy Research<br/> (CUIPR)<br/> Email: <a href="mailto:aeh8@cornell.edu">aeh8@cornell.edu</a><br/> Auth-Page: <a href="http://ssrn.com/author=600159" target="_blank">http://ssrn.com/author=600159</a><br/> <br/> Full Text: <a href="http://ssrn.com/abstract=984232" target="_blank">http://ssrn.com/abstract<wbr>=984232</a><br/> <br/> ABSTRACT: This paper explores health insurance coverage trends<br/> for youth (age 15-18) and young adults (age 19-29) with work<br/> limitations using data from the Current Population Survey. In<br/> 2000 those in the young work-limited population were<br/> substantially more likely to have insurance coverage than their<br/> counterparts in the not work-limited population. They were much<br/> more likely to have public coverage and much less likely to have<br/> only private coverage. Insurance coverage for this population<br/> increased substantially between 1989 and 2000, in contrast to a<br/> decline for the not work-limited population. We discuss the<br/> probable contributions of policy reforms and the decline in<br/> employment of people with work limitations to these trends.<br/> ______________________________<br/> <br/> "Sources of Health Insurance and Characteristics of the<br/> Uninsured: Updated Analysis of the March 2006 Current Population<br/> Survey"<br/> EBRI Issue Brief, No. 305, May 2007<br/> <br/> <br/> Contact: PAUL FRONSTIN<br/> Employee Benefit Research Institute (EBRI)<br/> Email: <a href="mailto:FRONSTIN@EBRI.ORG">FRONSTIN@EBRI.ORG</a><br/> Auth-Page: <a href="http://ssrn.com/author=255140" target="_blank">http://ssrn.com/author=255140</a><br/> <br/> Full Text: <a href="http://ssrn.com/abstract=987902" target="_blank">http://ssrn.com/abstract<wbr>=987902</a><br/> <br/> ABSTRACT: On March 23, 2007, the Census Bureau announced that it<br/> had revised its estimates for the number of people with and<br/> without health insurance after discovering a coding error that<br/> affected a small number of individuals. This paper updates data<br/> originally published October 2006 in EBRI Issue Brief no. 298,<br/> based on the earlier Census Bureau data, because of the<br/> subsequently corrected Census Bureau estimates of health<br/> insurance coverage. The first part of this paper examines how the<br/> Census Bureau correction has affected the estimated number of<br/> people without health insurance by various demographic and job<br/> characteristics. The second part of this paper presents the<br/> updated figures from the October 2006 report. The Current<br/> Population Survey is discussed in more detail in the appendix.<br/> ______________________________<br/> <br/> "Benefit Limits for Behavioral Health Care in Private US Health<br/> Plans"<br/> <br/> Contact: DOMINIC HODGKIN<br/> Brandeis University<br/> Email: <a href="mailto:hodgkin@brandeis.edu">hodgkin@brandeis.edu</a><br/> Auth-Page: <a href="http://ssrn.com/author=505504" target="_blank">http://ssrn.com/author=505504</a><br/> <br/> Co-Author: CONSTANCE HORGAN<br/> Brandeis University<br/> Email: <a href="mailto:horgan@brandeis.edu">horgan@brandeis.edu</a><br/> Auth-Page: <a href="http://ssrn.com/author=505506" target="_blank">http://ssrn.com/author=505506</a><br/> <br/> Co-Author: DEBORAH GARNICK<br/> Brandeis University<br/> Email: <a href="mailto:garnick@brandeis.edu">garnick@brandeis.edu</a><br/> Auth-Page: <a href="http://ssrn.com/author=505496" target="_blank">http://ssrn.com/author=505496</a><br/> <br/> Co-Author: ELIZABETH MERRICK<br/> Brandeis University<br/> Email: <a href="mailto:merrick@brandeis.edu">merrick@brandeis.edu</a><br/> Auth-Page: <a href="http://ssrn.com/author=505525" target="_blank">http://ssrn.com/author=505525</a><br/> <br/> Abstract: <a href="http://ssrn.com/abstract=993200" target="_blank">http://ssrn.com/abstract<wbr>=993200</a><br/> <br/> ABSTRACT: Rationale: In the US, most private health plans cover<br/> treatment for mental health and substance abuse, but they have<br/> traditionally imposed special limits on that coverage. These<br/> include annual and/or lifetime limits on visits, episodes or<br/> dollars, separate from any limits applied to medical care. In<br/> 1997 the federal government banned dollar limits on mental health<br/> care that differed from medical limits. In addition various<br/> states have passed parity laws constraining insurers' use of<br/> limits, although many large employers are exempt. Some analysts<br/> have argued that health plans may in any case have less need to<br/> use limits now than previously, as the spread of managed care has<br/> provided them with other tools with which to constrain<br/> utilization, such as gatekeeping, provider incentives and<br/> preauthorization.<br/> <br/> Objectives: (1) Describe the prevalence of benefits limits for<br/> behavioral health care in private health plan coverage. (2)<br/> Compute the out-of-pocket exposure facing high users of<br/> behavioral health care in different products, as a function of<br/> copayments and limits. (3) Examine how the use and stringency of<br/> limits relates to other plan practices, such as gatekeeping and<br/> the number of visits allowed before the provider must seek<br/> reauthorization from the plan.<br/> <br/> Data: Our 2003 Survey on Alcohol, Drug Abuse and Mental Health<br/> Services collected detailed data on administrative and clinical<br/> aspects of behavioral health care delivery from 368 commercial<br/> health plans in 60 US market areas, yielding national estimates<br/> of plan features (83% response rate). This paper relies on<br/> respondents' answers to questions about benefits in their three<br/> most commonly purchased packages within each insurance product.<br/> <br/> Methods: Out-of-pocket exposure for a high user is computed as<br/> the amount a consumer would pay for 30 outpatient visits in a<br/> year, assuming that providers charge $100 per visit. Bivariate<br/> tests are used to verify the significance of associations between<br/> use of special limits and other plan features. We also estimate<br/> multivariate models to predict the extent of out-of-pocket<br/> exposure across plans, as a function of utilization management<br/> approaches and various plan characteristics.<br/> <br/> Results: 86% of plans had special annual limits for outpatient<br/> mental health care, mostly limits on visits (mode: 20 visits).<br/> 80% of plans had had special annual limits for inpatient mental<br/> health care, mostly limits on days (mode: 30 days). One-third of<br/> plans had a separate annual limit for outpatient substance abuse<br/> care (typically limiting visits), and these included some plans<br/> that did not limit mental health care. Lifetime limits were much<br/> less common than annual limits.<br/> <br/> Among the plans studied, the mean out-of-pocket cost for 30<br/> visits would be $951 (median: $900). However, in 35% of plans the<br/> cost would only be $450. Preliminary analyses indicate that the<br/> projected out-of-pocket cost is highest in preferred provider<br/> organizations (PPOs). Plans whose benefits imposed more<br/> out-of-pocket costs tended to also authorize fewer sessions<br/> initially through their utilization review process (correlation=<br/> ?0.63).<br/> <br/> Conclusions: Despite the universality of managed care, most US<br/> health plans continue to maintain benefit limits introduced in<br/> the pre-managed era. For high users of behavioral health care,<br/> these limits could result in substantial financial burden.<br/> ______________________________<br/> <br/> "Tax Expenditures and Employee Benefits: Estimates from the FY<br/> 2008 Budget"<br/> EBRI Notes, Vol. 28, No. 6, June 2007<br/> <br/> <br/> Contact: KENNETH J. MCDONNELL<br/> Employee Benefit Research Institute (EBRI)<br/> Email: <a href="mailto:MCDONNELL@EBRI.ORG">MCDONNELL@EBRI.ORG</a><br/> Auth-Page: <a href="http://ssrn.com/author=297121" target="_blank">http://ssrn.com/author=297121</a><br/> <br/> Full Text: <a href="http://ssrn.com/abstract=993267" target="_blank">http://ssrn.com/abstract<wbr>=993267</a><br/> <br/> ABSTRACT: The federal government supports the provision of<br/> employee benefits through preferential tax treatment in the<br/> Internal Revenue Code. There are three types of tax treatments<br/> for employee benefits: tax exemption, tax deferral, and other<br/> preferential treatment. The Congressional Budget Act of 1974<br/> (P.L. 93-344) requires that a list of "tax expenditures" (federal<br/> tax revenue forgone due to preferential provisions) be included<br/> in the budget. This paper includes a listing of the employee<br/> benefit tax expenditures, as published in President Bush's Fiscal<br/> Year 2008 budget, prepared by the White House Office of<br/> Management and Budget, using a methodology that is controversial<br/> but mandated by Congress.<br/> <br/> The PDF for the above title, published in the June 2007 issue of<br/> EBRI Notes, also contains the fulltext of another June 2007 EBRI<br/> Notes article abstracted on SSRN: "Labor-Force Participation: The<br/> Population Age 55 and Older."<br/> ______________________________<br/> <br/> "ERISA Pre-emption and Health Care Reform: A History Lesson"<br/> EBRI Notes, Vol. 28, No. 5, May 2007<br/> <br/> <br/> Author: MICHAEL S. GORDON<br/> Author - Deceased<br/> Auth-Page: <a href="http://ssrn.com/author=818529" target="_blank">http://ssrn.com/author=818529</a><br/> <br/> Full Text: <a href="http://ssrn.com/abstract=988412" target="_blank">http://ssrn.com/abstract<wbr>=988412</a><br/> <br/> ABSTRACT: This paper was originally published in EBRI Issue Brief<br/> No. 135, March 1993, during the last major debate on health care<br/> reform. It was based on a speech delivered by Michael S. Gordon<br/> before the George Washington University National Health Policy<br/> Forum's conference on "The Role of Federal Standards in Health<br/> Systems Reform: How Much Leash Should ERISA Give the States?"<br/> held November 18, 1992. Gordon, now deceased, served under the<br/> late Sen. Jacob Javits (R-NY) from 1970-1975 as minority counsel<br/> for pensions on the Senate Labor and Public Welfare Committee and<br/> assisted in the drafting and enactment of the Employee Retirement<br/> Income Security Act (ERISA). Now that the issue of national<br/> health care reform has been revived as a topic of debate on<br/> Capitol Hill - and along with it the issue of ERISA pre-emption<br/> of state health insurance regulation - the Employee Benefit<br/> Research Institute is reprinting Gordon's article. Now, as then,<br/> his observations provide both historical and fresh perspective on<br/> the conflicts over ERISA and federal pre-emption.<br/> <br/> The complete original publication, "Health Care Reform: Managed<br/> Competition and Beyond," EBRI Issue Brief No. 135, March 1993, is<br/> available online.<br/> <br/> The PDF for the above title, published in the May 2007 issue of<br/> EBRI Notes, also contains the fulltext of another May 2007 EBRI<br/> Notes article abstracted on SSRN: "Income of the Elderly<br/> Population Age 65 and Over, 2005."<br/> ______________________________<br/> <br/> "Tax Benefits for Health Insurance: Critiques and Proposals"<br/> Federal Bar Association Section of Taxation, Forthcoming<br/> <br/> <br/> Contact: DOUG JONES<br/> Affiliation Unknown<br/> Email: <a href="mailto:dougjones771@hotmail.com">dougjones771@hotmail.com</a><br/> Auth-Page: <a href="http://ssrn.com/author=720051" target="_blank">http://ssrn.com/author=720051</a><br/> <br/> Full Text: <a href="http://ssrn.com/abstract=990976" target="_blank">http://ssrn.com/abstract<wbr>=990976</a><br/> <br/> ABSTRACT: The aim of this paper is to discuss the flaws in the<br/> current system of excluding employer provided health insurance<br/> from income and to critique various proposals to reform the<br/> system. While the tax system may not be the most efficient way to<br/> ensure that all or most Americans have health insurance, the tax<br/> system is the most politically feasible way for the federal<br/> government to get involved in achieving such a goal. In light of<br/> this, this paper adopts the thesis that a supplemental system of<br/> refundable tax credits whose benefits are aimed at those with low<br/> incomes is the best system for achieving the goal of insuring as<br/> many Americans as possible. It should be noted that this paper<br/> will argue for such a system to work in tandem with the current<br/> system. It is simply too risky to completely overhaul a system<br/> under which 75 percent of all Americans are insured. This paper<br/> adopts the view that reform should build upon existing coverage<br/> as opposed to eroding it.<br/> <br/> Part II will examine the strengthens and weaknesses of the<br/> current system of encouraging health insurance through the<br/> exclusion of employer provided health insurance from income and<br/> will conclude that while reform is needed, the current system<br/> should not be abolished. Part III will critique the system of<br/> Health Savings Accounts ("HSAs") which the second President Bush<br/> proposed. This part concludes that the HSA system is bad policy<br/> because it will actually increase the number of uninsured and its<br/> benefits are inappropriately aimed at the healthy and the<br/> wealthy. Finally, Part IV examines a reform proposal of a system<br/> of refundable tax credits - designed to work in tandem with the<br/> current system - whose benefits are aimed at those with low<br/> incomes. This part argues for such a reform proposal because it<br/> will greatly decrease the number of uninsured and because its<br/> benefits are appropriately aimed at those who actually need help<br/> with purchasing health insurance.<br/> ______________________________<wbr>___