Category Archives: Health

New Article: “Separate and Unequal: The Dimensions and Consequences of Safety Net Decentralization in the U.S. 1994-2014”

New Article: Sarah K. Bruch, Marcia K. Meyers, Janet C. Gornick, “Separate and Unequal: The Dimensions and Consequences of Safety Net Decentralization in the U.S. 1994-2014,” Institute for Research on Poverty (Aug. 2016).

In this paper, we examine the dimensions and consequences of decentralized social safety net policies. We consider the adequacy of benefits and inclusiveness of receipt for eleven federal-state programs that constitute the core of safety net provision for working age adults and families: cash assistance, food assistance, health insurance, child support, child care, preschool/early education, unemployment insurance, state income taxes, cash assistance work assistance, disability assistance, and housing assistance. In the first part of the paper we examine the extent of cross-state inequality in social provision. We find substantial variation across states; variation that is consistent with policy design differences in state discretion; and at levels equal to or greater than variation across the European countries that have been recognized as having different welfare regimes. In the second section, we turn to an analysis of change over time (1994 to 2014) examining four dimensions of convergence: degree, location of change, direction of change, and scope. We find both decreases (retrenchment) and increases (expansions) of provision, a handful of cases of convergence (decreasing inequality) and divergence (increasing inequality), and a great deal of synchronous change and persistence in the magnitude of cross state inequalities.

News Article: “The Failure to Talk Frankly About Poverty”

News Article: New York Times Editorial Board, “The Failure to Talk Frankly About Poverty,” New York Times, Sept. 13, 2016.

New Report: “Income, Poverty and Health Insurance Coverage in the United States: 2015” – Census Bureau

New Report: U.S. Census Bureau, Income, Poverty and Health Insurance Coverage in the United States: 2015 (Sept. 13, 2016).  News coverage from the L.A. Times here.

New Article: “Reconciling the Premium Tax Credit: Painful Complications for Lower and Middle-Income Taxpayers”

New Article: Francine J. Lipman & James E. Williamson, Reconciling the Premium Tax Credit: Painful Complications for Lower and Middle-Income Taxpayers, 69 SMU L. Rev. __ (forthcoming 2016).  Abstract below:

The Patient Protection and Affordable Care Act (ACA) makes available to certain middle and lower-income individuals a refundable tax credit, the Premium Tax Credit (PTC), designed to help them pay the premiums on their qualified health care plans. To achieve Congress’s goal of making health insurance affordable, the PTC is most often provided directly to an individual’s insurance provider each month in advance of actually claiming the PTC on the individual’s year-end annual tax return. Of the almost twelve million individuals who have enrolled in health insurance through the federal and state health exchanges in 2015, 85% of these individuals receive the advanced PTC (APTC). In the federal health exchange, the APTC averaged $268, covering 72% of the $374 average monthly premium, resulting in $105 net monthly payments per individual or $1,260 annually.

The amount of the APTC is based upon an estimate of an individual’s household income to be earned for that tax year in which she is entitled to claim the credit. However, the allowable PTC that any individual may receive is based upon the individual’s actual “household income” for that tax year. An individual’s household income is in turn dependent upon her “modified adjusted gross income” from the tax return upon which she is claiming the credit. Therefore, the amount of the PTC an individual is entitled to for any given year cannot be determined until the individual has completed her federal income tax return for that year. For example, the amount of an individual’s PTC for 2014, the first year the credit was available, is determined by the income as shown on an individual’s 2014 federal income tax return, which is not prepared until early 2015.

In most cases, the estimated APTC used to subsidize health insurance premiums during the tax year will differ from the actual PTC as finally determined when the individual files her annual income tax return. Through the end of October 2015, taxpayers filed 143 million 2014 income tax returns, including 3.5 million 2014 income tax returns of the 4.8 million expected tax returns with 2014 PTC. These tax returns reported $11.3 billion of the $15.5 billion 2014 APTC. If the actual PTC is less than the APTC, taxpayers will have to pay the difference when they file their tax return, which would increase the amount of tax owed or decrease the amount to be refunded. Approximately 51% of the 2014 returns, or 1.8 million returns filed, reported APTC in excess of the actual PTC by an average of $860 for the year. About 61% of these taxpayers still reported a refund. If the actual PTC is greater than the APTC, the difference will be refunded or applied against other taxes that the taxpayer might owe. Approximately, 40% of the 2014 returns filed, or 1.3 million returns, reported PTC in excess of any APTC by an average amount of $600.

While the PTC is a fully refundable tax credit and can be paid directly to insurance providers in advance, it can also be applied like more traditional income tax credits. Most tax credits are claimed on an individual’s year-end income tax return, serving as a reimbursement of expenses paid by the taxpayer months, or even more than a year, before the credit is received. Similarly, qualifying individuals have the option of paying their monthly health insurance premiums in full without any subsidy and waiting until they file their federal income tax return to claim any PTC. This approach is consistent with most other refundable and nonrefundable federal income tax credits including the child tax credit, dependent-care credit, adoption expense credit, lifetime learning credit, HOPE scholarship and American Opportunity tax credits, and earned income tax credit. If the taxpayer owes no other taxes, the government will refund the PTC in full. If the taxpayer owes other taxes, the PTC will offset any tax liability due, and the taxpayer will receive a refund of any balance in excess of the tax liability.

This Article will explain the details of the PTC focusing on the unusual and complicated reconciliation process for individuals receiving the APTC. Given the recent implementation of the PTC and the first reconciliation experience for taxpayers in 2015, there is a dearth of scholarship on this topic. Despite the enactment of the ACA in 2010, academics have neither presented nor analyzed the detailed complexity of this unusual prepaid refundable tax credit for middle and lower-income taxpayers. This Article will fill this void by describing the many details of PTC using a variety of examples to expose the significant complexities inherent in this critical health care subsidy. This deconstruction of the PTC and its requisite reconciliation will serve as a platform for subsequent scholarship that will serve to enhance the PTC to better achieve Congress’s goal of providing access to affordable health care for all Americans.

New Article: “Health Care and the Myth of Self-Reliance”

New Article: Nichole Huberfeld & Jessica L. Roberts, Health Care and the Myth of Self-Reliance, 57 B.C. L. Rev. 1 (2016).  Abstract below:

King v. Burwell asked the Supreme Court to decide if, in providing assistance to purchase insurance “through an Exchange established by the State,” Congress meant to subsidize policies bought on the federally run exchange. With its ruling, the Court saved the Patient Protection and Affordable Care Act’s (“ACA”) low-income subsidy. But King is only part of a longer, more complex story about health care access for the poor. In a move toward universal coverage, two pillars of the ACA facilitate health insurance coverage for low-income Americans, one private and one public: (1) the subsidy and (2) Medicaid expansion. Although both have been subject to high-profile Supreme Court cases, the Court upheld one but gutted the other. This Article hypothesizes that the preference for private “hidden” government assistance over public “visible” government assistance stems from the American myth of self-reliance. Yet this analysis reveals that the line between hidden and visible benefits breaks down on both theoretical and empirical levels. Drawing from vulnerability theory and demographic data, this Article demonstrates that all Americans lead subsidized lives and could move from the private to the public system. It concludes that a single government program for the poor would be more economically and administratively efficient.

Op-Ed: Blame HUD for America’s Lead Epidemic – The New York Times

Op-Ed: Emily Benfer, Blame HUD for America’s Lead Epidemic – The New York Times, Mar. 4, 2016

New Book: “The Poverty Industry” (forthcoming 2016)

poverty industryNew Book: Daniel L. Hatcher, The Poverty Industry: The Exploitation of America’s Most Vulnerable Citizens (forthcoming 2016).

[Editor’s Note: I recently saw Prof. Hatcher present just a small part of the work related to this book at the poverty law conference and I think it is safe to say that this is a very promising book, to be published soon, covering matters that are not yet part of the standard refrains about poverty programs.]

New Article: “NFIB v. Sebelius and the Right to Health Care: Government’s Obligation to Provide for the Health, Safety, and Welfare of its Citizens”

New Article: Jack M. Beermann, NFIB v. Sebelius and the Right to Health Care: Government’s Obligation to Provide for the Health, Safety, and Welfare of its Citizens, 18 NYU J. on Leg. & Pub. Pol’y 277 (2015).

New Article: “The Neuroscience Of Poverty”

New Article: “The Neuroscience of Poverty” – Proceedings of the National Academy of Sciences.

New Article: “No Immunity: Race, Class, and Civil Liberties in Times of Health Crisis”

New Article:  Michele Goodwin & Erwin Chemerinsky, No Immunity: Race, Class, and Civil Liberties in Times of Health Crisis, 129 Harv. L. Rev. 956 (2016).  Abstract below:

This Essay takes up the metaphor of the polluted body, its menacing effect on society, and what this metaphor means for law. It turns to civil liberties in times of health crisis in light of recent immigration debates and the United States’ panic about Ebola. We argue that historically, fears of contagion and infection were as much rooted in racial and class fear and animus as genuine threat of health. For example, many people of color and vulnerable minority groups have been caused great harm in the name of advancing and protecting the public’s health. Unfortunately, during such periods in American history, too frequently courts have failed to protect basic civil liberties, and people have suffered as a result. The Supreme Court sanctioning forced sterilizations of poor Americans provides a powerful example of government abuse of power in this regard, but sadly it is one among many forgotten or lesser known cases even among lawyers. Indeed, children, men, and women have been interned, sterilized, banned from entering the United States, detained, subjected to horrific human research, and otherwise injured by government abuse of power under the cover of protecting or promoting health.

As we explain, the relationship between public health, on the one hand, and race, poverty, and ethnicity discrimination, on the other, is neither new nor distinctly American. In the United States, the intersection between minority rights and public health has a long and shameful history, dating back hundreds of years. On close inspection, the metaphor of the polluted body and its menacing effect in American society persists, no doubt due to its origins rooted so long ago in American slavery, “Yellow Peril,” and early twentieth-century anti-immigration policy.

When analyzed from a distance, law’s vulnerability to prejudice packaged as public health concern crystallizes. For example, judges may make poor judgment calls conditioned on spurious or misinterpreted science, politicians may manipulate the public’s fear for political gain, even scientists and doctors may conflate or exaggerate data, and consequentially, civil liberties may be compromised and constitutional rights trampled. We take up these issues through our review of Eula Biss’s On Immunity.