Health Care

COSTS: California Tobacco Control Program Saves Money -- and Lives

Joanne Kenen — Wed, 27 Aug 2008 15:05:00 -0400

You hear a lot these days about all the miles Americans aren't driving because of $4 gas. How about all the cigarettes they aren't smoking because of some sensible anti-smoking investments? And the money saved on health care (not to mention the improved health of ex-smokers). New research finds that California's anti-tobacco program has yielded a 50-to-1 return and prevented 3.6 billion--yes, billion with a "b"--packs of cigarettes from being smoked in 15 years.

The report in the Aug. 25 issue of PLoS Medicine by a University of California, San Francisco team found that between 1989 and 2004 the $1.8 billion program saved $86 billion (in inflation-adjusted 2004 dollars).

"The benefits of the program accrued very quickly and are very large," senior author Stanton Glantz, director of the UCSF Center for Tobacco Control Research and Education, was quoted as saying. The California program showed rapid health care costs savings because it was directed at adults, not youths, so the impact on heart and lung disease, even cancer, could be seen.

These savings occurred despite a substantial diversion of funding during the mid-1990s. In fact, the researchers estimated, if the funding had been maintained at the same intensity as it had in the program's early years, the savings would have nearly doubled to $156 billion.

Hat tip to Health News Daily for bringing this research to our attention, and if you want details of California's approach, click here...

Arizona Initiative to Prohibit Universal Coverage Is Back On Nov. Ballot, For Now

Joe Mathews — Wed, 20 Aug 2008 14:55:00 -0400

Arizona's direct democracy is a mess. Signature gathering firms there are struggling to get valid signatures on initiative petitions. Three measures were knocked off the ballot because of low validity rates.

Now one of those initiatives -- a measure that would preemptively bar legislation such as that passed in Massachusetts (and pursued in California) for expanded health care coverage -- has received new life. A superior court judge ruled that some signatures marked invalid were, in fact, valid. When the new tally from a random sample was calculated, the initiative, Prop 101, had enough signatures to make the ballot, the Arizona Daily Star reports. This may not be the last world. Opponents could appeal.

Tax Reform and Health Care Reform

Annette Nellen — Wed, 18 Jun 2008 17:06:00 -0400

We hear lots of talk about tax reform and lots about health care reform, but rarely hear about the two together. While there are proposals to change the exclusion for employer-provided health care, such as President Bush's proposal to remove it and provide a standard deduction for health insurance, they typically don't consider either the entire health care or tax reform picture.

There are significant dollars in the tax code that should be on the table in reforming health care. All of the government dollars should be in the picture in looking at how to fund any change, such as universal coverage. The largest federal tax expenditure is the one where employees are not required to include in taxable income the value of the health insurance their employer provides to them. The estimated cost of this expenditure in 2007 was $134 billion. There are other health care tax breaks as well such as the itemized deduction for medical care and health savings accounts.

The employer-provided health care exclusion is a tremendous benefit to employees. For example, Susan's employer provides health insurance to employees. Susan pays about 20% of the cost and the employer pays the rest - about $10,000 per year. Susan's marginal federal and state tax rate is 30%. Thus, she saves $3,000 of taxes from the exclusion. BUT, if the exclusion were removed, she'd end up getting $10,000 of coverage for $3,000 - still a good deal!! And, she'd likely find that she really doesn't need as much insurance as she selected from her employer. She'd also know how much it costs (today, most employees don't have any idea of what their health insurance costs). And removal of the exclusion would mean that more Social Security and Medicare taxes would be collected.

For employees in a lower tax bracket, perhaps some tax relief could still be provided.

For more information on the topic of the intersection of health care and tax reform, see a recent short article of mine from the AICPA Taxation Insider - Pot of Gold in the Employer-Provided Healthcare Exclusion (6/08). It has more of the details as well as links to various proposals and reports.

New America recently released a report about the challenges businesses face with employer-provided health care particularly given increasing costs of this fringe benefit.

There is a lot of money in the employer-provided health care exclusion (a pot of gold!). It is time to make a significant modification to it in order to better target the government dollars in this tax break, remove the adverse impact it has on health care spending, recognize the changed ways of living and working such that expectations of getting health insurance from your employer rather than on your own are outdated and too costly in our global economy, and to improve the federal income tax by broadening the base and lowering the rates.

Wednesday Round Up: $10 Minimum in Eureka?

Joe Mathews — Wed, 23 Apr 2008 13:43:00 -0400

ANTI-GAY MARRIAGE MEASURE HEADED FOR CALIFORNIA BALLOT: Or so its supporters say. This tracks though with information first reported here over the weekend that the initiative, at $2 per signature, had made the ballot. This is in spite of a well-organized blocking campaign by opponents. One wonders, however, why backers are spending their money. Some polls suggest that Californian is close to having a majority of citizens who support same-sex marriage, and the Republican governor has vowed to fight this.

$10 PER HOUR IN EUREKA: Signature gathering is about to begin on a new minimum wage ballot initiative that would guarantee $10 per hour to anyone working in the city of Eureka on California's northern coast.

MOMENTUM FOR COLORADO RIGHT TO WORK: That's according to its supporters, who are lining up endorsements. Business groups are backing it, but they should be wary. A frontal attack on labor is likely to unite the state's unions and turn out to be a setback for business interests. Exhibit A: California, the year 2005.

MICHIGAN HEALTH: Health care groups are getting behind a Michigan ballot initiative that would enshrine health insurance as a right in the state constitution.

BUT IN ARIZONA. Supporters of a similar health care ballot initiative are giving up. The sponsors blame John McCain for supposely suppressing fundraising for progressive causes in Arizona. Or something. It might be more accurate to blame Barack Obama; progressive donors may be thinking that a Democratic president would tackle health care nationally, and thus are saving their bucks for that fight.

ANTI ABORTION MEASURES:: The Wall Street Journal has a summary of anti-abortion ballot initiatives, focusing on the difference in approach between pro-life advocates who seek to put restrictions on abortion and others who prefer "personhood" initiatives that grant embryos the rights of human beings in an effort to ban abortion all together.

WORKING THE REFEREES: Sponsors of anti-illegal immigration initiative in Arkansas are accusing the attorney general of not playing fair. The a.g. blocked their first attempt at an initiative.

A WATER WAR IN UTAH: Residents of a Utah county want a referendum as a way to stop a state water pipeline. The pipeline would divert Colorado River water to support development in several counties. Look for more of these kinds of measures as the Western drought deepens.

Thursday Round Up: A Look at a Petition Firm

Joe Mathews — Thu, 17 Apr 2008 18:59:00 -0400

DEPARTMENT OF MOON HOWLING: The Las Vegas Review & Journal takes a long look at one of the country's more important signature firms, National Voter Outreach and its CEO Rick Arnold. I've interviewed Arnold in his Carson City home, and found him to be one of the more thoughtful people in the petition trade, critical of its problems and clear-eyed about its limitations. This story is built heavily around criticism from the liberal/progressive Ballot Initiative Strategy Center, which is quick to lable signature gathering as corrupt (at least in cases where it opposes the cause in question). There is a "shocked, shocked" quality to this criticism. The signature gathering business has plenty of problem workers, many of them poorly trained folks who, for lifestyle reasons, have taken a job that usually pays them in cash. But BISC and other critics invariably propopse to criminalize the process of gathering signatures, as in Oklahoma. In supporting these restrictions, liberals are hurting themselves, by establishing precedents restricting political speech that can be used by their political opponents. And such restrictions don't stop direct democracy. They merely slow it down, adding to the costs (and thus the influence of interest groups) that progressives love to denounce. The more you regulate, the more firms like National Voter Outreach will benefit.

BLOOMIE AND ARNOLD: Mike Bloomberg, deepening his involvement in California initiative politics, hosts a fundraiser tonight on behalf of Gov. Schwarzenegger's redistricting ballot initiative. It's still gathering signatures on the street.

MICHIGAN POT: Medical marijuana initiative makes the ballot in Michigan after legislature declines to adopt the measure itself. (hat tip to Ballotpedia).

INDIVIDUAL MANDATE: A ballot initiative to establish an individual mandate for health care in Michigan is now circulating on the street.

NO ANIMAL CONFINEMENT MEASURE IN COLORADO: Colorado's ballot will be a little less crowded, as animal rights advocates drop their farm animal confinement measure. The state legislature passed legislation similar enough to satisfy the initiative's backers.

OAKLAND YOUTH: Here's an interesting report on a city of Oakland (Calif.) ballot initiative to double funding for a youth services program.

NEVADA NEUTRALITY: School superintendents, never fan of teachers' union, are staying out of a coming mega-ballot war in Nevada over the union's effort to raise taxes on gaming to generate more funds for education.

MAINE DEBATE: A referendum question has been submitted in Maine that would remove "sexual orientation" from human rights and discrimination law, and bar same-sex marriage and adoption by gay couples.

PARENTAL NOTIFICATION: Here's a description of another attempt, via California blalot initiative, to require parental notification for minors seeking abortions. A similar initiative went down in the 2005 special election. Over the past week, I found this initiative was a low priority for the state's signature gatherers. It's pay $1 or less a signature, half the price being paid by sponsors of redistricting, crime victims' rights, and alternative fuel measures.

FROM OVERSEAS: Croatians won't get to vote on their country's decision to join NATO.

Easter Round Up: Watchdogs and Wolves

Joe Mathews — Sun, 23 Mar 2008 13:00:00 -0400

Odds and ends from the past week...

TELL US WHAT YOU REALLY THINK: Steve Maviglio, Democratic political operative and aide to Speaker Fabian Nunez, unloads on the Foundations for Taxpayer and Consumer Rights, now called Consumer Watchdog. The group is putting together a ballot initiative on health care.

EMINENT DOMAIN MEASURES: As the California press corps withers, Capitol Weekly gets stronger. This past week, the newspaper has an excellent account of the back-and-forth over two competing eminent domain measures on the June ballot, Propositions 98 and 99. In brief, backers of Prop 98 (supported by an anti-tax group) are accusing backers of Prop 99 (supported by California cities) of "astro-turfing," the practice of using deceptively-named organizations with no real members.

WOLVES!!! A new development in the wolf wars in Alaska. A judge says the government can continue to shoot wolves from the air, though he invalidated the practice in certain parts of the state. The question of such aerial hunting -- to reduce the wolf population and protect caribou and other species -- goes to voters in the Last Frontier in August.

MISSED THIS: Last week, the Supreme Court approved Washington state's open primary, which was approved by voters as Initiative 872. The ruling offers important guidance, because the courts have struck down open primaries in California and other states. Open primaries allow voters to select from candidates of any party on a ballot; previous challenges have argued that such primaries infringe the rights of political parties to choose their own nominees. The Washington initiative appears to have passed muster because it did not specifically choose nominees. It merely set up a first round with all the candidates on the ballot; the top two, regardless of party, advanced to the general election.

LOOPHOLE? Are Washington state legislators scheming to find a way around an initiative establishing a two-thirds supermajority for tax increases?

SOUTH DAKOTA: Signatures are turned in on an initiative that would prohibit taxpayer-financed lobbying and most campaign donations from government contractors to public officials. Such prohibitions have been challenged successfully on First Amendment grounds elsewhere.

BUSINESS ON BUSINESS: Yet another business vs. business fight at the ballot: a lawsuit seeks to knock off the ballot an initiative that would treat private rental homes in Big Bear more like businesses. (Hoteliers have complained about the competition.)

THE KIDS LOVE HIGH SPEED RAIL: College students, under the auspices of CalPIRG, do a California tour in support of an oft-delayed high-speed rail bond scheduled for the November ballot.

Friday Round-Up: Doing for Health What They Did for Cars?

Joe Mathews — Fri, 14 Mar 2008 13:02:00 -0400

DOING FOR CALIFORNIA HEALTH WHAT THEY DID FOR CALIFORNIA CARS: Advocate Harvey Rosenfeld, author of 1988's Prop. 103 initiative on car insurance, and his organization, the Foundation for Taxpayer and Consumers Rights, is putting together an initiative on health care that aimed for the 2010, Capitol Weekly reports. It's a complicated measure and not yet fully cooked. But the insurance commissioner -- a post that has been heavily politicized (and a source of scandal in California in recent decades) -- would get new powers to oversee HMOs and regulate insurance and co-pays. It also would be easier to sue, which shouldn't surprise anyone. Rosenfeld is close to the trial lawyers.

TOO BIG A CONSTITUTION: One characteristic of states that have the initiative and use it often -- California, Oregon, Colorado -- is that they have very long constitutions. The people have the right to add to and change the constitution and so they do. (It goes with the territory; Switzerland, birthplace of direct democracy, has one of the longest constitutions in the world.) In Colorado, a special legislative committee is studying the state constitution to see if it can be cleaned up a bit. Face the State, a Colorado news and opinon web site, takes a look at the clean-up effort, and is skeptical.

WILL ONE INITIATIVE KILL OFF ANOTHER? The Chronicle web site has a piece asking if one eminent domain initiative on the June 3 ballot in California will kill off the other. The answer is likely yes. It's a time-honored tactic. If you oppose an initiative, qualify one of your own and confuse voters. Those confused voters often vote no on both. The pharmaceutical industry did this expertly to fight off a drug discount initiative on the special election ballot in 2005. (The industry also spent nearly $90 million on its effort--folks in Sacramento had a good Christmas that year).

ANTI-GAY MARRIAGE OUTLOOK: Paul Karr at GLAAD has a reliable overview of the various ballot measures opposing same-sex marriage and/or civil unions heading to the ballot in Oregon, Arizona, California, Arkansas and Florida.

Big Defeat in Hungary Referendum

Joe Mathews — Mon, 10 Mar 2008 17:20:00 -0400

At one point, it appeared that Californians might vote this fall on a plan to finance changes in the health care system. But the accompanying reform plan failed to pass the Senate.

Well, it turns out the Golden State is not the only place where health care taxes... er, fees are unpopular. This weekend, Hungarian voters overwhelmingly approved a referendum striking down a plan to charge $1.72 in fees for doctor and hospital visits. The Reuters story is here.