Understanding the Impact of Health Reform on the States: Expansion of Coverage through Medicaid and Exchanges

The Affordable Care Act (ACA) expands Medicaid coverage and creates subsidized state health insurance exchanges. The implementation of the ACA will impact the states and consequently the state residents differently. We discuss the factors contributing to the variation in uninsured rates and the Medicaid population, and we predict that these underlying economic, demographic factors and state policies will continue to affect health insurance coverage. Using data from the March 2010 Current Population Survey (CPS), we examine health care coverage at the state level prior to the ACA and forecast the percentage of state residents eligible for expanded Medicaid and the exchanges. Our results suggest the percentage of state population eligible for expanded Medicaid and subsidized exchanges will vary considerably, especially for adults. Further, we show that current state Medicaid eligibility rules, the percentage of employers offering health insurance and poverty rates will continue to shape the variation in projected health insurance coverage across the states. Finally, we discuss the potential impact of the Supreme Court decision that allowed states to opt‐out of Medicaid expansion.     

The Affordable Care Act,the Medicaid Coverage Gap,and Hispanic Consumers: A Phenomenology of Obamacare

The historic health care reform of the Patient Protection and Affordable Care Act, commonly referred to as Obamacare, enabled more than 20 million Americans to gain health insurance and access to health care. However, the original mandate requiring states to expand Medicaid was ruled as optional in 2012 by the Supreme Court. Focusing on Hispanic consumers residing in a state that opted out of the Medicaid expansion, this study reports on the consumer experience of Obamacare. Findings show that study participants are in an unfavorable situational context, better understood when the cultural context is considered, and cultural resistance recognized. The findings also show that participants are confused, discouraged, and fearful of the continued unaffordability of health insurance and the lawful need to enroll or be penalized. For these participants, affordable health insurance has not been realized and this research gives an insight on those individuals falling through the cracks.     

The moderating effect of institutional context on the relationship between associational activity and new business activity in emerging economies

Varying institutional environments provide the foundation for a great deal of international business (IB) research yet relatively little empirical work has examined the association between institutional factors and new business development in emerging economies, although the importance of new business development for economic transition and growth is widely acknowledged. Drawing from social network and institutional theories, we address this gap by examining the effect of associational activity on the level of new business activity in emerging economies, and testing the thesis that associational activity becomes more instrumental for new business creation when aspiring entrepreneurs confront higher institutional burdens (i.e., obstacles derived from underdeveloped or absent institutions). On the basis of data from two cross-national research projects—the Global Entrepreneurship Monitor and the World Values Survey—we find a positive relationship between a country's associational activity and new business activity; this relationship is stronger for higher regulatory and normative institutional burdens and lower cognitive institutional burdens. This study is among the first to examine empirically the possible substitution effect between social ties and institutions to predict new business activity; it paints a nuanced picture of how social networks might be more instrumental in contexts characterized by weak institutions. We discuss the implications of these findings for IB theory and practice and offer directions for further research in the area.     

Health insurance coverage during the COVID-19 pandemic: The role of Medicaid expansion

Using data from the US Census Bureau's Household Pulse Survey, we analyzed the likelihood of loss of health insurance and enrollment into new health coverage during the early months of the COVID-19 pandemic. Loss of employment was associated with a significant increase in the likelihood of loss of health insurance and, specifically, an increase in the likelihood of employer-sponsored health insurance. However, individuals in Medicaid expansion states experienced a lower likelihood of loss of health insurance compared with individuals in nonexpansion states. At the same time, there was a statistically significant increase in Medicaid enrollment in expansion states, by 3.2 percentage points. Reemployment or acquiring employment was associated with a gain in health insurance coverage. During an economic downturn, eligibility, and coverage gaps leave many without affordable coverage options, and the pandemic will likely bring renewed attention to gaps in Medicaid coverage in nonexpansion states.     

Die Entwicklung der HSH Nordbank als Landesbank — einige Einschätzungen

Some of the German “Landesbanken” engaged in highly risky business with the acceptance of local politicians and then demanded bailouts during the financial crisis. The HSH Nordbank, the world’s largest provider of ship financing, based in northern Germany, lost almost 2.8 billion euros in 2008. The two German shareholders, the states of Hamburg and Schleswig-Holstein, had to agree on a 13 billion euro bailout plan for the bank (3 billion euros in cash and a “risk shield” of 10 billion euros). Furthermore, the German government provided the HSH Nordbank with 17 billion euros of liquidity guarantees under the Special Financial Market Stabilisation Fund (SOFFIN). In view of this situation, the following questions should be answered: What role did the merger of the Hamburger Landesbank and Landesbank Schleswig-Holstein play in the development of the HSH Nordbank? Was there a possibility to merge the HSH Nordbank with another bank to avoid the financial difficulties? Were the extensive conditions set by the EU Commission in the state aid proceedings too restrictive? What are the actual costs of the HSH Nordbank’s bailout programme for the shareholders and their governmental budgets?     

Grundsteuerreform in Deutschland: eine unendliche Geschichte?

For many years property tax in its current form has been exhibiting increasing problems. There are three reform models currently being discussed that differ in their respective tax bases using either property values or areas, or both. They create different individual tax burdens and amounts of tax revenue in each state compared to the current property tax amount which alters local tax capacity within the fiscal equalisation system among the 16 states. The calculations on regional local tax revenue prove that the value-based models which promote greater equity are being neglected by the financially strong states. This is because they would be forced to provide higher transfer payments to the financially weaker states.     

Unzureichende Ausschöpfung der Realsteuern — das Beispiel Rheinland-Pfalz

In Germany, state and local authorities repeatedly come into conflict with one another regarding the funding of municipal budgets. The sufficient fiscal endowment of local public authorities depends not only on a satisfactory provision of state grants but also requires an adequate exhaustion of existing sources of revenues at the local government level. Against this background, the paper analyses local tax policy in order to assess whether the budget finance potential is being sufficiently exploited. Taking Rhineland-Palatinate as a case study, the degree of tax exploitation (local business tax, local property tax) is empirically estimated for the time period 2009 to 2015.     

危机中的高端酒店

<正>受金融风暴冲击,当经济型酒店喜笑颜开的时候,高端酒店的巨头们纷纷愁眉不展,只能是咬着牙来自降身价。上海旅游事业委员会提供的数据显示,上海高端酒店入住率下跌是从2008年8月开始的,单月入境旅游者人数只有20万人次。受此影响,各大酒店的平均入住率下跌到54.6%,是20年来的最低。今年1~3月,上海五星级酒店出租率45.9%,同比下降13%,     

Cigarette Consumption in Different U.S. States, 1955–1998: An Empirical Analysis of the Potential Use of Excise Taxation to Reduce Smoking

The use of excise taxation as a tool for financing part of Medicaid and national health care costs as well as for discouraging smoking behavior was a major political issue in the 1980s and early 1990s. It failed to gain Congressional support despite a significant increase in both federal and most state tax rates over the past twenty years. Annual data and OLS techniques are used to analyze the demand for cigarettes in the 50 states and the District of Columbia over the period from 1955 to 1998. Results show the demand for cigarettes to be relatively price inelastic. However, the estimates indicate more elasticity for high tax states than for low tax states. The price inelastic coefficient of the aggregate demand suggests that the main impact of taxation is likely to result in increased revenues to states rather than in directly reducing tobacco usage. The ultimate impact on smoking usage depends on how these increased revenues are spent and whether they become directed at smoking reduction. Cigarette demand is also found to be income inelastic, which implies that the tobacco industry has been growing less rapidly or even declining relative to the rising trend of the per capita disposable personal income in many states.     

Wie die deutsche Einheit die Länder im Finanzausgleich belastet hat

In Germany there is a political consensus that the economic and fiscal burden of the German reunification should be shared by all three jurisdictional levels of the federal system. According to existing law, the burden-sharing between the state and local authorities has to be confined to the excess burden which follows from the financing of the German Unity Fund as well as the integration of the eastern German states into the fiscal equalisation system. State and local authorities are in conflict with each other regarding an appropriate economic estimate of the excess burden to be caused by the fiscal equalisation system. Against this background, the paper estimates the average excess burden of the western German states as a whole as well as individual excess burdens of selected German states for the time period 1995 to 2009 by applying a multivariate data analysis.     

Advertising competition in presidential elections

Presidential candidates purchase advertising based on each state’s potential to tip the election. The structure of the Electoral College concentrates spending in battleground states, such that a majority of voters are ignored. We estimate an equilibrium model of multimarket advertising competition between candidates that allows for endogenously determined budgets. In a Direct Vote counterfactual, we find advertising would be spread more evenly across states, but total spending levels can either decrease or increase depending on the contestability of the popular vote. Spending would increase by 13 % in the extremely narrow 2000 election, but would decrease by 54 % in 2004. These results suggest that the Electoral College greatly increases advertising spending in typical elections.     

Closing large open economy models

A large class of international business cycle models admits multiple locally isolated deterministic steady states, if the elasticity of substitution between traded goods is sufficiently low. I explore the conditions under which such multiplicity occurs and characterize the dynamic properties in the neighborhood of each steady state. Models with standard incomplete markets, portfolio costs, a debt-elastic interest rate, or an overlapping generations framework allow for multiple steady states, if the model features multiple steady states under financial autarchy. If the excess demand for the foreign traded good is increasing in the good's own price in a given steady state, the equilibrium dynamics around this steady state are unbounded. Otherwise, the dynamics are bounded and unique. By contrast, with Uzawa-type preferences, the steady state is always unique and the associated equilibrium dynamics are always bounded and unique. The same results obtain under complete markets.     

Antecedents of firm performance in emerging economies: Business groups,strategy, industry structure,and state support

A rich literature has investigated the antecedents of firm performance in developed economies, resulting in a consensus view that firm resources and strategy are the key determinants. Several arguments, however, suggest that in emerging economies other factors are more important for firm performance. This study analyzes the impact of firm strategy and industry structure as well as business group membership and state support on firm performance in an advanced emerging economy, Turkey. Using a data set compiled from a selection of the 1000 largest manufacturing firms in this country, the study employs several regression models to identify the main determinants of firm performance as measured by productivity and net profit margin. In contrast to studies of developed economies, the investigation finds that firm-related factors (competitive strategies) do not significantly influence performance; instead factors related to industry structure and business group membership are the strongest determinants of firm performance; further, state support interacts with business group membership and is positively related to productivity.     

Religion,social capital and business bankruptcy in the United States, 1921–1932

We consider the value of social capital that derives from membership in a church. American states with larger churchgoing populations had lower business bankruptcy rates from 1921 to 1932, and states in which the churchgoing population was concentrated in few churches had business bankruptcy rates that were lower still. Both voluntary and involuntary bankruptcy were lower in states with higher church membership. The evidence suggests that church membership acted on bankruptcy through a safety net mechanism and not solely through indicating a preference for honouring commitment.     

Justice and Financial Market Allocation of the Social Costs of Business

Regulation is often applied to business behavior to ensure that the social costs of doing business are included in the cost and pricing structures of the firm. Because the consumer benefits from the transaction that generated the social costs, asking the consumer to bear the burden imposed by the transaction is fair. However, there may be a lack of Justice m the internal and external distribution of the social costs of doing business if consumers are the only party bearing that burden, or if the costs are being shifted to employees or taxpayers when a closer stakeholder is also benefiting from the transaction – the stockowner. A social justice perspective requires that those benefiting from a transaction share in the burdens of it. We propose that a Tobin-like tax on stock transactions might be a just means of achieving greater justice in the distribution of the social cost burden.     

Some Thoughts on Moriarty and Moeller

Abstact In a recent paper in Business Ethics Quarterly Professor Jeffrey Moriarty (2005) asserted the relevance of political philosophy to business ethics. Moriarty asked whether “businesses ought to be run (more) like states” and argued why that might be beneficial. This paper on the contrary asserts that there are distinct disadvantages to businesses attempting to be run more like states. Specifically, it asserts that any such an attempt increases the likelihood of the re-emergence of a totalitarian society as businesses currently often act as an intermediary between the individual and the state. The paper contemplates Moeller’s ambitions in the Weimar period for the business to be run like a state and the historical outcome of those ambitions. The paper also distinguishes between two different kinds of rights and argues that different kinds of rights pertain to different sectors which preclude business being run like a state. Dr. Michael Schwartz is an associate professor at the Royal Melbourne Institute of Technology. He also serves as the vice-president of the Australian Association for Professional and Applied Ethics. His research in the field of business ethics has been published in Research in Ethical Issues in Organizations, the Journal of Business Ethics, Business Ethics Quarterly and Business Ethics: A European Review.     

Saints and CEOs: an historical experience of altruism, self-interest and compromise

At a time when social and ethical responsibilities of companies and CEOs are being increasingly emphasised, this paper examines conduct of social business in a different age and culture to discern features of enduring relevance for ethical business practices today.The personal correspondence of three fourth-century saints gives insights into their relationships and decision-making.Community expectations were those of sharing rather than of outright giving, with ‘fusion of interest’ prevailing over concerns for ‘con?ict of interest’. Selected incidents show two entrepreneurial bishops, Basil and Gregory of Nyssa, struggling to balance tensions between ’liberality’ and ‘fairness’.They compromised, competed robustly for revenues and were vexed over limited budgets and resources for projects while their disapproving cousin, the academic Gregory of Nazianzus, criticised their worldliness. Their historical experiences suggest four pragmatic and possibly normative ways of blending altruism and self-interest for the overall advancement of bene?cial change.     

Commercialization of eHealth innovations in the market of the UK healthcare sector: A framework for a sustainable business model

Demographic trends with extended life expectancy are placing increasing pressures on the UK state‐funded healthcare budgets. eHealth innovations are expected to facilitate new avenues for cost‐effective and safe methods of care, for enabling elderly people to live independently at their own homes and for assisting governments to cope with the demographic challenges. However, despite heavy investment in these innovations, large‐scale deployment of eHealth continues to face significant obstacles, and lack of sustainable business models (BMs) is widely regarded as part of the greatest barriers. Through various empirical methods that include facilitated workshops, case studies of relevant organizations, and user groups, this paper investigates the reasons the private market of eHealth innovations has proved difficult to establish, and therefore it develops a framework for sustainable BMs that could elimiesnate barriers of eHealth innovation commercialization. Results of the study suggest that to achieve sustainable commercialization, BM frameworks and innovation diffusion characteristics should be considered complements but not substitutes.     

An Ampirical Assessment of the Contribution of Small Business Employment to U.S. State Economic Performance

Small Business Economics - Small business proponents regularly couple their arguments for favorable government policies and reduced tax and regulatory burdens, to the presumed benefits of increased...