Employer-Based Insurance: Coverage and Cost

Explores the variation in cost by employers and enrollees, types of employers that offer coverage, access to coverage by workers, and how costs would change, especially for small businesses, if new policies required coverage for all full-time workers

Rethinking the Affordable Care Act's "Cadillac Tax": A More Equitable Way to Encourage "Chevy" Consumption

The Affordable Care Act's "Cadillac tax" will apply a 40 percent excise tax on total employer health insurance premiums in excess of $10,200 for single coverage and$27,500 for family coverage, starting in 2018. Employer spending on premiums is currently excluded from income and payroll taxes. Economists argue that this encourages overconsumption of health care, favors high-income workers, and reduces federal revenue. This issue brief suggests that the Cadillac tax is a "blunt instrument" for addressing these concerns because it will affect workers on a rolling timetable, does relatively little to address the regressive nature of the current exclusion, and may penalize firms and workers for cost variation that is outside their control. Replacing the current exclusion with tax credits for employer coverage that scale inversely with income might allow for regional adjustments in health care costs and eliminate aspects of the tax exclusion that favor high-income over low-income workers

Three Large-Scale Changes To The Medicare Program Could Curb Its Costs But Also Reduce Enrollment

With Medicare spending projected to increase to 24 percent of all federal spending and to equal 6 percent of the gross domestic product by 2037, policy makers are again considering ways to curb the program's spending growth. We used a microsimulation approach to estimate three scenarios: imposing a means-tested premium for Part A hospitalinsurance, introducing a premium support credit to purchase health insurance, and increasing the eligibility age to sixty-seven.We found thatthe scenarios would lead to reductions in cumulative Medicare spending in 2012 -- 36 of 2.4 -- 24.0 percent. However, the scenarios also would increase out-of-pocket spending for enrollees and, in some cases, causemillions of seniors not to enroll in the program and to be left without coverage. To achieve substantial cost savings without causing substantial lack of coverage among seniors, policy makers should consider benefitchanges in combination with other options, such as some of those now being contemplated by the Obama administration and Congress

Relative deprivation, poor health habits and mortality.

Abstract While a large body of evidence relates low absolute income to premature mortality, a recent and growing literature argues that relative income influences health as well. Low relative income, or being deprived relative to one's reference group, may cause stress and depression. These conditions are linked to mortality both directly (via heart disease, high blood pressure, and suicide) and indirectly (via increased smoking, poor eating habits, and alcohol abuse). Evidence from biology supports the notion that relative status may influence health outcomes. In this paper, we use restricted-use micro-level data from the National Health Interview Survey (NHIS) Multiple Cause of Death Files (MCOD) from 1988 to 1991 to examine whether relative deprivation increases the probability of dying. We define reference groups using a combination of characteristics including state, race, education, and age, and measure relative deprivation with Yitzhaki's index. Our use of individual-level data allows us to for control for characteristics that are specific to reference group. Results indicate that high relative deprivation increases the probability of dying in all age groups and for those death categories with a high behavioral component. Those with high relative deprivation are more likely to self-report poor health, have high blood pressure or disabilities, and have a host of poor health habits including smoking, not wearing safety belts, high body mass index and not exercising. For nearly all health measures, our results suggest that much of the observed statistical relationship between absolute level of income and health found in previous work is actually measuring the impacts of relative deprivation on health

Ambient Particulate Matter Air Pollution and Venous Thromboembolism in the Women’s Health Initiative Hormone Therapy Trials

BackgroundThe putative effects of postmenopausal hormone therapy on the association between particulate matter (PM) air pollution and venous thromboembolism (VTE) have not been assessed in a randomized trial of hormone therapy, despite its widespread use among postmenopausal women.ObjectiveIn this study, we examined whether hormone therapy modifies the association of PM with VTE risk.MethodsPostmenopausal women 50–79 years of age (n = 26,450) who did not have a history of VTE and who were not taking anticoagulants were enrolled in the Women’s Health Initiative Hormone Therapy trials at 40 geographically diverse U.S. clinical centers. The women were randomized to treatment with estrogen versus placebo (E trial) or to estrogen plus progestin versus placebo (E + P trial). We used age-stratified Cox proportional hazard models to examine the association between time to incident, centrally adjudicated VTE, and daily mean PM concentrations spatially interpolated at geocoded addresses of the participants and averaged over 1, 7, 30, and 365 days.ResultsDuring the follow-up period (mean, 7.7 years), 508 participants (2.0%) had VTEs at a rate of 2.6 events per 1,000 person-years. Unadjusted and covariate-adjusted VTE risk was not associated with concentrations of PM 0.05) regardless of PM averaging period, either before or after combining data from both trials [e.g., combined trial-adjusted hazard ratios (95% confidence intervals) per 10 μg/m3 increase in annual mean PM2.5 and PM10, were 0.93 (0.54–1.60) and 1.05 (0.72–1.53), respectively]. Findings were insensitive to alternative exposure metrics, outcome definitions, time scales, analytic methods, and censoring dates.ConclusionsIn contrast to prior research, our findings provide little evidence of an association between short-term or long-term PM exposure and VTE, or clinically important modification by randomized exposure to exogenous estrogens among postmenopausal women

The relationship between urban sprawl and coronary heart disease in women

Studies have reported relationships between urban sprawl, physical activity, and obesity, but—to date—no studies have considered the relationship between sprawl and coronary heart disease (CHD) endpoints. In this analysis, we use longitudinal data on post-menopausal women from the Women’s Health Initiative (WHI) Clinical Trial to analyze the relationship between metropolitan statistical area (MSA)-level urban compactness (the opposite of sprawl) and CHD endpoints including death, any CHD event, and myocardial infarction. Models control for individual and neighborhood sociodemographic characteristics. Women who lived in more compact communities at baseline had a lower probability of experiencing a CHD event and CHD death or MI during the study follow-up period. One component of compactness, high residential density, had a particularly noteworthy effect on outcomes. Finally, exploratory analyses showed evidence that the effects of compactness were moderated by race and region

The Women's Health Initiative: The Food Environment, Neighborhood Socioeconomic Status, BMI, and Blood Pressure

Using data (n=60,775 women) from the Women’s Health Initiative Clinical Trial (WHI CT)— a national study of postmenopausal women aged 50 to 79 years — we analyzed cross-sectional associations between the availability of different types of food outlets in the 1.5 miles surrounding a woman’s residence, census tract neighborhood socioeconomic status (NSES), body mass index (BMI) and blood pressure (BP)

Relative Deprivation, Poor Health Habits, and Mortality

Using individual-level data on males from the 1988–91 National Health Interview Survey Multiple Cause of Death Files, we examine the impact of relative deprivation within a reference group on health. We define reference groups using combinations of state, race, education, and age. High relative deprivation in the sense of Yitzhaki is associated with a higher probability of death, worse self-reported health, higher self-reported limitations, higher body mass index, and an increased probability of taking health risks.