Know Your Borrower: The Four Need Cases of Small-Dollar Credit Consumers

Every year, an estimated 15 million people access small-dollar credit (SDC) products- like payday loans, pawn loans, auto title loans, deposit advance loans, and more. CFSI explores the reasons why consumers turn to these potentially high cost products in this latest report. The study, supported by funding from the Ford Foundation, identifies four primary consumer need cases in the SDC market, each representing a distinct borrower profile and different uses of small-dollar credit. The need cases are:Unexpected Expense borrowers tend to access credit infrequently for relatively larger expenses related to an unexpected or emergency event, such as a car repair.Misaligned Cash Flow borrowers take out smaller amounts somewhat frequently to pay bills and meet regular household expenses when their income and expenses are mistimed.Exceeding Income borrowers' expenses regularly exceed their income and these consumers tend to be among the most frequent users of credit, accessing small amounts for everyday expenses.Planned Purchase borrowers are a smaller but important niche group of users in the SDC market who make a relatively large, planned purchase, commonly related to a personal asset.These need cases were determined through analysis of a panel survey of more than 1,100 SDC borrowers and 31 in-depth interviews with SDC customers. They provide a new framework for exploring the challenge of when and how to responsibly extend small-dollar credit. The findings also suggest potential opportunities for the development of high-quality products, highlighting the importance of product differentiation and underwriting

Essential Health Benefits and the Affordable Care Act: Law and Process

Starting in 2014, the Affordable Care Act (ACA) will require private insurance plans sold in the individual and small-group markets to cover a roster of essential health benefits. Precisely which benefits should count as essential, however, was left to the discretion of the Department of Health and Human Services (HHS). The matter was both important and controversial. Nonetheless, HHS announced its policy by posting on the Internet a thirteen-page bulletin stating that it would allow each state to define essential benefits for itself. On both substance and procedure, the move was surprising. The state-by-state approach departed from the uniform, federal standard that the ACA appears to anticipate and that informed observers expected HHS to adopt. And announcing the policy through an Internet bulletin appeared to allow HHS to side- step traditional administrative procedures, including notice and comment, immediate review in the courts, and White House oversight. This article explores two questions. First, is the state-by-state approach a lawful exercise of HHS’s authority? Second, did HHS in fact evade the procedural obligations that are meant to shape the exercise of its discretion

Essential Health Benefits and the Affordable Care Act: Law and Process

Starting in 2014, the Affordable Care Act (ACA) will require private insurance plans sold in the individual and small-group markets to cover a roster of essential health benefits. Precisely which benefits should count as essential, however, was left to the discretion of the Department of Health and Human Services (HHS). The matter was both important and controversial. Nonetheless, HHS announced its policy by posting on the Internet a thirteen-page bulletin stating that it would allow each state to define essential benefits for itself. On both substance and procedure, the move was surprising. The state-by-state approach departed from the uniform, federal standard that the ACA appears to anticipate and that informed observers expected HHS to adopt. And announcing the policy through an Internet bulletin appeared to allow HHS to side- step traditional administrative procedures, including notice and comment, immediate review in the courts, and White House oversight. This article explores two questions. First, is the state-by-state approach a lawful exercise of HHS’s authority? Second, did HHS in fact evade the procedural obligations that are meant to shape the exercise of its discretion

Essential Health Benefits and the Affordable Care Act: Law and Process

Beginning in 2014, the Affordable Care Act (ACA) will require private insurance plans sold in the individual and small-group markets to cover a roster of “essential health benefits.” Precisely which benefits should count as essential, however, was left to the discretion of the Department of Health and Human Services (HHS). The matter was both important and controversial. HHS nonetheless announced its policy on essential health benefits by posting on its website a 13-page bulletin stating that it would allow each state to define essential benefits for itself by choosing a “benchmark” plan modeled on existing plans in the state. On both substance and procedure, the move was surprising. The benchmark approach departed from the uniform, federal standard that the statute appears to anticipate and that many informed observers expected HHS to adopt. And announcing the policy thorough an internet bulletin arguably allowed HHS to sidestep orthodox administrative procedures, including notice and comment, White House review, and preenforcement review in the courts. What are we to make of this? This chapter explores two questions. First, is the benchmark approach a lawful exercise of HHS’s authority under the ACA? Although HHS may have brushed up against the limits of its discretionary authority, we conclude that the approach likely will (and, in our view, should) be upheld in the event of a challenge. Second, did HHS’s announcement of the benchmark approach through an internet bulletin allow the agency to avoid the very administrative procedures that typically serve to constrain the exercise of agency discretion? The answer here is a flat no. The agency’s adroit use of guidance documents instead resulted in a process that was more open to public scrutiny and external oversight than conventional rulemaking would have been

Pre-Mesozoic Palinspastic Reconstruction of the Eastern Great Basin (Western United States)

The Great Basin of the western United States has proven important for studies of Proterozoic and Paleozoic geology [2500 to 245 million years ago (Ma)] and has been central to the development of ideas about the mechanics of crustal shortening and extension. An understanding of the deformational history of this region during Mesozoic and Cenozoic time (245 Ma to the present) is required for palinspastic reconstruction of now isolated exposures of older geology in order to place these in an appropriate regional geographic context. Considerable advances in unraveling both the crustal shortening that took place during Mesozoic to early Cenozoic time (especially from about 150 to 50 Ma) and the extension of the past 37 million years have shown that earlier reconstructions need to be revised significantly. A new reconstruction is developed for rocks of middle Proterozoic to Early Cambrian age based on evidence that total shortening by generally east-vergent thrusts and folds was at least 104 to 135 kilometers and that the Great Basin as a whole accommodated ∼250 kilometers of extension in the direction 287° ± 12° between the Colorado Plateau and the Sierra Nevada. Extension is assumed to be equivalent at all latitudes because available paleomagnetic evidence suggests that the Sierra Nevada experienced little or no rotation with respect to the extension direction since the late Mesozoic. An estimate of the uncertainty in the amount of extension obtained from geological and paleomagnetic uncertainties increases northward from ±56 kilometers at 36°30N to -87+108 kilometers at 40°N. On the basis of the reconstruction, the original width of the preserved part of the late Proterozoic and Early Cambrian basin was about 150 to 300 kilometers, about 60 percent of the present width, and the basin was oriented slightly more north-south with respect to present-day coordinates

Tectonic Subsidence of the Early Paleozoic Passive Continental Margin in Eastern California and Southern Nevada

Quantitative analysis of tectonic subsidence in Cambrian and Ordovician platform carbonates and associated strata exposed in the Spring Mountains (Nevada) and the Nopah, Funeral, and Inyo Ranges (California) indicates that subsidence associated with this segment of the early Paleozoic passive continental margin is exponential in form, consistent with thermal contraction of the lithosphere following extension. As in other parts of the North American Cordillera, continental separation in the southern Great Basin appears to have taken place between 590 and 545 Ma. These results are not sensitive to uncertainties in stratigraphic thickness, biostratigraphic age control, or paleobathymetry. Uncertainties in the Cambrian time scale lead to predictable variations in the inferred time of onset of thermal subsidence, but they have no effect on the inferred stratigraphic position of the rift to post-rift transition. A younger age for the base of the Middle Cambrian results in a younger inferred age of onset of thermal subsidence accompanied by greater rates of subsidence during the Cambrian, whereas a significantly older estimate of the onset of thermal subsidence can be obtained only if the base of the Middle Cambrian is substantially older than 540 Ma, a possibility that is inconsistent with available data. Results of the subsidence analysis are particularly significant because this is one of the few regions along the length of the North American Cordillera where they can be compared directly to the geologic evidence for syn-rift and post-rift deposition. Basement-involved faulting associated with the Amargosa basin ("aulacogen") ceased during deposition of the Noonday Dolomite, which is thought to be older than 700-680 Ma on the basis of stromatolites of late Riphean affinity. The overlying Johnnie Formation contains supposed Vendian stromatolites (younger than 700-680 Ma). If it is assumed that our results indicate the timing of the final rift to post-rift transition, then either the ages inferred from stromatolites are incorrect or the lithosphere was thinned regionally after deposition of the Noonday. The latter possibility is supported by limited geologic evidence for extension in latest Proterozoic and Early Cambrian time. The lack of appreciable physical evidence for crustal extension after deposition of the Noonday, however, may imply that (1) a uniform extension model for lithospheric thinning is inappropriate for this part of the margin or that (2) some or all of the localities studied are continentward of the hinge zone, and that the observed subsidence is exaggerated by flexural loading in a deeper basin to the west

What\u27s Left of the Affordable Care Act?

We assess the progress of the Affordable Care Act a decade after it became law. Although most of it remains intact, some parts have been repealed and others have not been implemented as expected. We review how and why the law has aged. Legal challenges have done less damage than is commonly appreciated, with the exception of the Supreme Court case that thwarted full expansion of Medicaid. Most of the important changes have other sources. Some parts were born to fail. Others were dismantled in response to interest-group pressure. Still others have failed to thrive for any number of reasons. Finally, the sabotage campaign by the Trump administration has had modest effects so far, but could pose a serious threat in the coming years

Good intra-operative anaesthesia is more than an “ABCD with a three, two and a one".

The adoption of checklists within healthcare leads to improvements in patient safety. Perioperative management of patients with comorbidity and polypharmacy is complex and whilst physical checklists, aviation style computerised checklists, and mnemonics can all be used to make anaesthesia safer, these cannot cover the entirety or the complexity of perioperative care, and in particular, the principles by which anaesthetists work to promote restoration of function. Restoration of function is increasingly being seen as the marker of good anaesthetic care.Wellcome Trus

Reform at Risk — Mandating Participation in Alternative Payment Plans

In an ambitious effort to slow the growth of health care costs, the Affordable Care Act created the Center for Medicare and Medicaid Innovation (CMMI) and armed it with broad authority to test new approaches to reimbursement for health care (payment models) and delivery-system reforms. CMMI was meant to be the government’s innovation laboratory for health care: an entity with the independence to break with past practices and the power to experiment with bold new approaches. Over the past year, however, the Department of Health and Human Services (HHS) has quietly hobbled CMMI, imperiling its ability to generate meaningful data on strategies for reducing spending on Medicare and Medicaid

Open Science Practices are on the Rise: The State of Social Science (3S) Survey

Has there been meaningful movement toward open sci-ence practices within the social sciences in recent years? Discussions about changes in practices such as posting data and pre-registering analyses have been marked by controversy—including controversy over the extent to which change has taken place. This study, based on the State of Social Science (3S) Survey, provides the first com-prehensive assessment of awareness of, attitudes towards, perceived norms regarding, and adoption of open science practices within a broadly representative sample of scholars from four major social science disciplines: economics, political science, psychology, and so-ciology. We observe a steep increase in adoption: as of 2017, over 80% of scholars had used at least one such practice, rising from one quarter a decade earlier. Attitudes toward research transpar-ency are on average similar between older and younger scholars, but the pace of change di˙ers by field and methodology. According with theories of normal science and scientific change, the timing of increases in adoption coincides with technological innovations and institutional policies. Patterns are consistent with most scholars underestimating the trend toward open science in their discipline