Republicans’ planned bill to repeal the Affordable Care Act (ACA), which is expected to be similar to the repeal bill that President Obama vetoed in January 2016, would give an immediate windfall tax cut totaling billions to the highest-income Americans by eliminating two Medicare taxes — the additional Hospital Insurance tax and the Medicare tax on unearned income — that both fall only on high-income filers, as we explain in two new papers.
Republican plans to repeal the Affordable Care Act (ACA) are expected to repeal taxes on drug companies, health insurers, and medical device manufacturers — even as they would eliminate tax credits that about 7 million families use to help pay for health coverage and leave tens of millions of people newly uninsured. Cutting the ACA-related taxes that these companies pay would reduce revenues by $180 billion over 2016 to 2025, according to the Congressional Budget Office (CBO) estimate of the repeal bill vetoed by President Obama in January 2016.
The share of the nation’s workers that the federal government employed in 2016 equaled its lowest level ever recorded.
Tazra Mitchell is a Policy Analyst with the Center’s Family Income Support team. Before joining CBPP, she worked in Raleigh at the North Carolina Budget & Tax Center as a part of the Center’s State Policy Fellowship — a program designed to expand the diversity of voices that speak with authority in state policy debates across the country.
Here, we talk with Tazra about her experience as a Fellow.
With CNN hosting a town hall tonight at which House Speaker Paul Ryan will discuss the House Republican “Better Way” agenda released last year, here are the reports and posts we’ve issued on those proposals.
It’s no secret that American children have gotten fatter in recent decades.
Now a new study joins earlier research showing the consequences: A sharp rise in insurance claims for youth with Type 2 diabetes, high blood pressure and other conditions more often associated with older adults.
Claims for Type 2 diabetes — formerly known as “adult-onset” diabetes — among young people aged 0 to 22 years old more than doubled between 2011 and 2015, according to an analysis of a large national database of claims paid by about 60 insurers.
At the same time, claims for prediabetes among children and youth rose 110 percent, while high blood pressure claims rose 67 percent. Sleep apnea, a condition where a patient temporarily stops breathing while sleeping, rose 161 percent.
The findings “not only raise quality-of-life questions for children, but also the … kind of resources that will be necessary to address this emerging situation,” said Robin Gelburd, president of the nonprofit Fair Health, a national clearing house for claims data that offers free medical cost comparison tools to consumers and sells data to insurers and health systems.This KHN story also ran on NPR. It can be republished for free (details).
To be sure, the analysis is certainly not the first to note a rise in obesity or Type 2 diabetes in this age group; nor does it explore the possible reasons behind the apparent increase in claims. One factor in the rise could simply be increased awareness and testing for the problem, while variations between states could reflect differences in patient ethnicities, how doctors practice, insurance rules or all of those factors.
“We try to give a big picture and welcome others to look under there hood for details,” acknowledged Gelburd.
But the analysis is different than some earlier research because it uses a database of actual claims for about 150 million people, all of whom have private insurance. The study focused on a subset of youth: Those who had a diagnosis of obesity or Type 2 diabetes. Researchers analyzed claims data tied to those patients to determine what other conditions they experienced and the medical services provided to them.
Claims data is considered a good research tool because it reflects services actually provided. But, conversely, the Fair Health analysis is also limited because it does not include claims submitted by Medicaid or other government programs, so it doesn’t represent a true cross section of the population.
Even with those limitations, the findings “are frightening,” said Stephen Pont, a pediatrician and medical director of the childhood obesity center at Dell Children’s Medical Center in Austin, Texas, who did not work on the analysis.
“The vast majority of kids should never have high blood pressure or diabetes or sleep apnea. Now we’re seeing those consequences in kids,” he said. “That will result in shorter lives and lower quality of life.”
The solution, he added, cannot be found solely in the doctor’s office, but many insurers hamstring efforts to help children by limiting medical coverage of efforts to combat obesity. Most don’t cover related costs such as those for weight management programs until a complication such as high blood pressure is developed, he said.
To keep the Fair Health statistics in perspective, it’s important to note that Type 2 diabetes only affects a small number of children. The Centers for Disease Control and Prevention estimates that only 0.25 percent of all children suffer from the condition. But when it does hit, patients must go on medication, often for life, and can suffer serious health problems, including blindness and kidney failure.
The Fair Health analysis found that during the four years that were analyzed, the number of claims tied to an obesity diagnosis among youth aged 0 to 22 also rose, jumping 94 percent in infants and toddlers to as much as 154 percent among 19 to 22-year-olds.
That contrasts with CDC findings that the prevalence of obesity among children and youth aged 2 to 19 years old remained relatively stable from 2011 to 2014. Fair Health researchers suggested a possible reason for the difference is that its dataset does not include Medicaid, the state-federal health program for low-income residents. (Diabetes disproportionately affects low-income populations.)
Geographically, the study found a range of claims among the states, which also surprised some outside researchers. States with a high prevalence of claims for Type 2 diabetes included Ohio, Pennsylvania, North Dakota, Utah and South Dakota.
Some states on the lower end of the scale didn’t seem to reflect their overall health statistics. Louisiana and Alabama, for example, appeared to have a lower number of claims for Type 2 than many other states, despite generally appearing at the bottom of state rankings across a variety of health measures.
“How does one interpret the difference between a low claim state like Louisiana and a high claim state like Ohio? Something is happening here,” said Dennis Bier, professor of pediatrics in Houston at Baylor College of Medicine, who also did not work on the study. “Does that mean doctors in Louisiana are not making enough claims for diabetes?”
Gelburd said the Fair Health data was adjusted for each state, but the analysis did not have access to ethnicity or socioeconomic data, so those variables were not factored in.
How demographic and other variables impact the findings is worth exploring, said Bier. Has there been a sudden change in the development of Type 2 diabetes? Or, conversely, does the uptick in the Fair Health data reflect a change in medical practice or awareness of the condition? Perhaps there are state insurance rules in one state that require more medical coverage for obesity than others, driving the differences.
But no matter the underlying causes of the increase noted in the analysis, Bier said it is well known that the longer children remain obese, the more likely they are to get diabetes.
Chiefly, the country needs to find more effective ways to prevent obesity from occurring in children in the first place, which he said is difficult: “We’re pretty poor at getting people to change their behavior.”
The following is a guest post by Janice Hyde, assistant law librarian for the Law Library’s Global Legal Collections Directorate. Janice has previously contributed to this blog with posts such as: Crossing State Lines to Settle Squabbles – Pic of the Week, Archived Legal Materials from Official Gazettes Now Available Through Law.gov and A View of the Parliamentary Library of Québec – Pic of the Week.
Four years ago, my colleague, Donna Sokol, provided a snapshot of the inaugural platform being constructed on the west front of the Capitol. Several weeks later, the nearly completed platform was chronicled by Robert Brammer in his post. My, how time flies, as Washington is once again making preparations for a presidential inauguration to take place on January 20, 2017. Every four years Washington plays host to this major event, even though there is no legal requirement for inaugurations to be held here (more on this below). Since the capitol moved to Washington, D.C. in 1800, there are only four instances in which presidents were sworn in outside of the city, all vice presidents who succeeded to the presidency upon the assassination or death of the president.
- Chester A. Arthur, Vice President under James Garfield, succeeded to President upon the death of James Garfield who was shot by Charles J. Guiteau on July 2, 1881 in Washington, D.C. Garfield died on September 19, 1881. The oath of office was administered to Chester Arthur by Justice John R. Brady of the New York State Supreme Court on September 20, 1881 at Arthur’s residence at 123 Lexington Avenue, New York.
- Theodore Roosevelt became President following the assassination of William McKinley, who was shot by Leon F. Czolgosz in Buffalo, New York, on September 6, 1901. McKinley died on September 14, 1901. Roosevelt had been camping in the Adirondacks when he learned that McKinley was not expected to survive. Roosevelt was rushed to a train station and, upon his arrival in Buffalo, learned that McKinley had died. With no formal instruction about how to proceed, he accepted an invitation to stay at the home of his friend, a prominent attorney named Ansley Wilcox. The swearing in ceremony took place at the Wilcox home with Federal Judge John R. Hazel administering the oath before a large party of dignitaries and other witnesses.
- On August 23, 1923 following the death of Warren G. Harding, who was on a speaking tour in the western states, Calvin Coolidge was sworn in as president at the Coolidge family home in Plymouth Notch, Vermont. The oath was administered by his father, John Calvin Coolidge Sr., a Vermont notary public and justice of the peace.
- Those of us born before 1963 can personally recall Lyndon Baines Johnson taking the oath of office on Air Force One in Dallas, Texas following the assassination of John F. Kennedy. In addition to being the only president to assume office in an airplane, it is also the first time that a woman, U.S. District Judge Sarah T. Hughes, administered the oath of office.
What aspects of presidential inaugurations are mandated by law? Article II, Section 1 of the U.S. Constitution specifies the actual language of the oath or affirmation (incoming presidents can “swear” or “affirm”) including the phrase “preserve, protect, and defend the Constitution of the United States,” which has caused the occasional slip of the tongue and confusion over word order. The starting date of the presidential term (“inauguration day”) is also set by the twentieth amendment to the Constitution as January 20th. Beyond this, everything else surrounding presidential inaugurations is based on custom. As noted by Michael Nelson in Guide to the Presidency and the Executive Branch (p. 365):
Ritual acts pervade politics in recognition that the symbolism of public rites reassures and binds together diverse peoples. In keeping with this understanding, each presidential election is capped by a ceremony of grand proportions: the inauguration of the new president. This ceremony is an overt political ritual intended to instill patriotism, unite the nation behind its leader, and provide for an orderly transition of power…. Yet almost nothing of that ceremony is required by law. Most of it has evolved by way of tradition.
Other conventions commonly upheld at presidential inaugurations include the administration of the oath of office by the Chief Justice of the U.S. Supreme Court, and taking the oath upon a bible, a practice begun by George Washington.
Since Washington, D.C. has become the customary site of presidential inaugurations there are now well-established institutions and provisions in place to support the massive quadrennial undertaking. For example, Section 8 of the Code of the District of Columbia is devoted to appropriations, infrastructure support, use of public spaces, and similar issues related to presidential inaugurations. The Joint Congressional Committee on Inaugural Ceremonies is responsible for planning and executing presidential inauguration ceremonies. The inaugural platform mentioned in the first paragraph is erected by the Architect of the Capitol, which has its own traditions surrounding the event including a “first-nail ceremony” marking the start of platform construction.