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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. 5, No. 4: February 26, 2004
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Publisher: LSN Employment, Labor, Compensation & Pension Journals
a division of
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Editor: PAMELA PERUN
Urban Institute
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Copyright: SSEP, Inc. 2004. All rights reserved.
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Topic of This Issue:
Health Care
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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
"Come the Revolution: Are We Finally Ready for Universal Health
Insurance?"
California Western Law Review, Vol. 39, p. 303, 2003
SUSAN ADLER CHANNICK
California Western School of Law
"HSAs - the 'Sleeper' in the Drug Bill"
Tax Notes, Vol. 102, No. 8, February 23, 2004
HENRY J. AARON
Brookings Institution
Economic Studies
"Sources of Health Insurance and Characteristics of the
Uninsured: Analysis of the March 2003 Current Population Survey"
EBRI Issue Brief, No. 264, December 2003
PAUL FRONSTIN
Employee Benefit Research Institute (EBRI)
"Findings from the 2003 Health Confidence Survey: Americans
Increasingly Worried about Health Care Costs"
EBRI Notes, Vol. 24, No. 10, October 2003
RUTH HELMAN
Mathew Greenwald & Associates
RACHEL CHRISTENSEN SETHI
Employee Benefit Research Institute (EBRI)
WORKING PAPERS
"The Battle Over Self-Insured Health Plans, or One Good Loophole
Deserves Another"
RUSSELL B. KOROBKIN
University of California, Los Angeles
School of Law
"Macroeconomic Conditions, Health Care Costs, and the
Distribution of Health Insurance"
SHERRY A. GLIED
Columbia University
Mailman School of Public Health
National Bureau of Economic Research (NBER)
KATHRINE DIANE JACK
Indiana University Bloomington
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N E W and F O R T H C O M I N G Articles
_________________________________________________________________
"Come the Revolution: Are We Finally Ready for Universal Health
Insurance?"
California Western Law Review, Vol. 39, p. 303, 2003
BY: SUSAN ADLER CHANNICK
California Western School of Law
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=447280
Contact: SUSAN ADLER CHANNICK
Email: Mailto:schannick@cwsl.edu
Postal: California Western School of Law
225 Cedar Street
San Diego, CA 92101 UNITED STATES
Phone: 619-525-7081
Fax: 619-696-9999
ABSTRACT:
Cyclically, social, economic, and political forces catapult the
issue of health insurance to the top of the national
consciousness. Rising health care costs, a relatively long
recession, rising unemployment, and growing number of uninsured
Americans makes today just such a time. One factor that
distinguishes today's health care access crisis from others is
the impact on a vocal, visible and voting constituency - the
employed middle-class. A spate of federal and state legislation
proposing some type of universal health insurance is evidence of
public dissatisfaction with the health care access status quo.
I argue that while there may be tacit agreement that it is a
national disgrace that between 40 and 60 million Americans are
uninsured at some time during the calendar year, universal
health insurance is an improbable solution. In a time when
market models are the accepted answer to many traditionally
public sector problems, it is hard to imagine that a social
insurance model for health care could be politically successful.
Mounting federal and state budget deficits make untenable the
additional allocations of GDP necessary to fund universal health
insurance. In addition, social insurance is explicitly dependent
on the cross-subsidization of health care from the insured to
the uninsured and from the healthy to the sick. I conclude that
our culture of individual rights makes such a philosophical
shift very unlikely.
JEL Classification: D6, H4, I1
______________________________
"HSAs - the 'Sleeper' in the Drug Bill"
Tax Notes, Vol. 102, No. 8, February 23, 2004
BY: HENRY J. AARON
Brookings Institution
Economic Studies
Contact: HENRY J. AARON
Email: Mailto:Haaron@brookings.edu
Postal: Brookings Institution
Economic Studies
1775 Massachusetts Ave NW
Washington , DC 200361 UNITED STATES
ABSTRACT:
Health savings accounts (HSAs), says Aaron, may well be the most
important provision of the recently enacted Medicare
Prescription Drug, Improvement, and Modernization Act. HSAs
substantially reduce the distinctions between employer-financed
health insurance and pensions or other employer contributions to
tax-sheltered retirement saving. Tax treatment of HSAs, he
explains, is more favorable than that accorded to qualified
pensions, 401(k) plans, IRAs, or other "tax-sheltered" saving.
By reducing the barriers between health insurance and retirement
saving, HSAs should cause many employers to reexamine the form
and composition of both health and pension benefits. In
particular, many employers may find it attractive to adopt
high-deductible insurance and deposit into HSAs amounts at least
equal to the gap between the old, low-deductible and the new,
higher deductible and pay for the added cost of that shift
through cutbacks in defined-contribution pension deposits. Aaron
concludes that claims that HSAs will have a large impact on
total health care spending are overblown because only a small
fraction of total health outlays occurs during episodes of care
that are less costly than high-deductible insurance limits.
______________________________
"Sources of Health Insurance and Characteristics of the
Uninsured: Analysis of the March 2003 Current Population Survey"
EBRI Issue Brief, No. 264, December 2003
BY: PAUL FRONSTIN
Employee Benefit Research Institute (EBRI)
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=488806
Other Electronic Document Delivery:
http://www.ebri.org
SSRN only offers technical support for papers
downloaded from the SSRN Electronic Paper Collection
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them into your browser eliminating all spaces.
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
Paper Requests:
Contact Alicia Willis at Mailto:publications@ebri.org, or 2121 K
St., NW, Suite 600, Washington, DC 20037-1896.
Phone:(202)572-7422, Fax:(202)775-6312. Full-Text downloads are
available from SSRN Online for $7.50.
ABSTRACT:
This paper provides historic data through 2002 on the number and
percentage of nonelderly Americans with and without health
insurance. It discusses trends in coverage for the 1987-2002
period and highlights characteristics that typically indicate
whether an individual is insured. Based on EBRI estimates from
the U.S. Census Bureau's March 2003 Current Population Survey
(CPS), it represents 2002 data.
JEL Classification: I1, J3
______________________________
"Findings from the 2003 Health Confidence Survey: Americans
Increasingly Worried about Health Care Costs"
EBRI Notes, Vol. 24, No. 10, October 2003
BY: RUTH HELMAN
Mathew Greenwald & Associates
RACHEL CHRISTENSEN SETHI
Employee Benefit Research Institute (EBRI)
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=465940
Other Electronic Document Delivery:
http://www.ebri.org
SSRN only offers technical support for papers
downloaded from the SSRN Electronic Paper Collection
location. When URLs wrap, you must copy and paste
them into your browser eliminating all spaces.
Contact: RACHEL CHRISTENSEN SETHI
Email: Mailto:sethi@ebri.org
Postal: Employee Benefit Research Institute (EBRI)
Suite 600
2121 K Street, NW
Washington, DC 20037-1896 UNITED STATES
Phone: 202-775-6330
Fax: 202-775-6312
Co-Auth: RUTH HELMAN
Email: Mailto:RUTHHELMAN@GREENWALDRESEARCH.COM
Postal: Mathew Greenwald & Associates
4201 Connecticut Ave., NW
Suite 620
Washington, DC 20008 UNITED STATES
Paper Requests:
Contact Alicia Willis at Mailto:publications@ebri.org, or 2121 K
St., NW, Suite 600, Washington, DC 20037-1896.
Phone:(202)572-7422, Fax:(202)775-6312. Full-Text downloads are
available from SSRN Online for $7.50.
ABSTRACT:
The sixth annual Health Confidence Survey (HCS) finds that
almost one-half of Americans continue to be extremely or very
satisfied with the quality of medical care they receive.
However, they are increasingly dissatisfied with the costs of
health insurance and the costs of care not covered by insurance,
and continue to lose confidence in certain aspects of health
care as they look to the next 10 years and to the future of the
Medicare system. They also continue to identify health care as
one of the nation's most critical issues.
Keywords: Health care attitudes and opinions
JEL Classification: J32
______________________________
W O R K I N G P A P E R Abstracts
_________________________________________________________________
"The Battle Over Self-Insured Health Plans, or One Good Loophole
Deserves Another"
BY: RUSSELL B. KOROBKIN
University of California, Los Angeles
School of Law
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=503482
Paper ID: UCLA School of Law Research Paper No. 04-2
Date: February 12, 2004
Contact: RUSSELL B. KOROBKIN
Email: Mailto:Korobkin@law.ucla.edu
Postal: University of California, Los Angeles
School of Law
405 Hilgard Avenue
Box 951476
Los Angeles, CA 90095-1476 UNITED STATES
Phone: 310-825-1994
Fax: 310-206-7010
ABSTRACT:
One of the most perplexing consequences of the Employee
Retirement Income Security Act's (ERISA) preemption provisions
is the differential regulatory treatment afforded to
employer-sponsored health care benefits provided directly to
employees by the employer's self-insured plan and to benefits
provided by a third party that sells an insurance policy to the
employer. Under ERISA's savings clause, states may regulate
insurance contracts, thus allowing regulators to guarantee
insured employees a menu of state-mandated health-insurance
benefits. But under ERISA's deemer clause, self-insured plans
are immune to such requirements. Since ERISA's passage three
decades ago, there has been an explosion in the number of
employers choosing to self-insure their health benefits plans
and then purchase stop-loss insurance for the plan in order to
avoid both state mandates and insurance risk. Critics cry foul
at the use of this regulation-avoidance tactic.
This Article defends employers' exploitation of the deemer
clause loophole on the grounds that it is consistent with
ERISA's clear language, structure, and delicate balance of
underlying goals. But it argues that ERISA contains a
complementary savings clause loophole that state regulators can
exploit by regulating stop-loss insurance companies, thus using
a self-help remedy to close the deemer clause loophole
substantially. One good loophole deserves another.
______________________________
"Macroeconomic Conditions, Health Care Costs, and the
Distribution of Health Insurance"
BY: SHERRY A. GLIED
Columbia University
Mailman School of Public Health
National Bureau of Economic Research (NBER)
KATHRINE DIANE JACK
Indiana University Bloomington
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=457551
Paper ID: NBER Working Paper No. W10029
Date: October 2003
Contact: SHERRY A. GLIED
Email: Mailto:sag1@columbia.edu
Postal: Columbia University
Mailman School of Public Health
Division of Health Policy and Management
600 West 168th St., 6th Floor
New York, NY 10032 UNITED STATES
Fax: 212-305-3405
Co-Auth: KATHRINE DIANE JACK
Email: Mailto:kdjack@indiana.edu
Postal: Indiana University Bloomington
Bloomington, IN 47405 UNITED STATES
Paper Requests:
Full-Text downloads are available from SSRN Online for $5.
ABSTRACT:
Prior studies have examined the relationship between
macroeconomic factors and health insurance for the adult
population and have evaluated changes in the composition of
health insurance across the income distribution. We combine
these types of analysis and examine how labor market
fluctuations, health care costs, income, and economic structure
are related to the distribution of health insurance coverage
across educational groups. We find that there are substantial
differences in how these factors affect insurance coverage for
different groups. Variations in unemployment are more important
in determining insurance coverage for more educated people. The
price of medical care, by contrast, is a much more important
determinant of private coverage for the least educated than for
the most educated. This finding is consistent with differences
in the valuation of cost-increasing health care technologies
across education groups.