Social and Behavioral Sciences Commons^™

An Analysis Of Political And Legal Debates Concerning Medicaid Expansion In Virginia, Rick Mayes, Benjamin Paul

Political Science Faculty Publications

The Supreme Court’s historic June 2012 ruling regarding the Affordable Care Act (ACA) in National Federation of Independent Business v. Sebelius set the stage for a massive federalism battle over Medicaid expansion in the United States. The original language of the Act was intended to nationalize Medicaid by having every state expand their program’s eligibility to all individuals up to 138% of the federal poverty level. This would have significantly reshaped Medicaid, a joint federal-state health insurance program, into a universal entitlement for all low-income citizens. Currently, Medicaid eligibility varies dramatically from state to state. The Court held that the …

Strategies For Health Care Cost Containment (1980s-Present), Rick Mayes

Political Science Faculty Publications

The U.S. health care system during the past three decades has been over two interrelated questions: first, who will control the manner in which medical care is paid for, and, second, how much will it cost? Many health care experts believe that Medicare's efforts at cost control, primarily in the form of the program's seminal transition to and continual modification of prospective payment of health care providers, has both triggered and repeatedly intensified the economic restructuring of the U.S. health care system. Medicare is an almost $600 billion public health insurance program for individuals sixty-five years of age and older; …

Neither Slavery Nor Involuntary Servitude, Monti Narayan Datta

Political Science Faculty Publications

The sex trade grabs headlines, but modern-day slavery takes many forms across the globe, spreading like a cancer in the 21st century. Scholars estimate that there are as many as 27 million slaves today; the majority are not in forced prostitution, but instead in other heinous forms of exploitation (though rape and/or other forms of torture are often tools of coercion).

Slavery permeates northern India, where children, to help pay off their family's exorbitantly high debts to corrupt local businessmen, hunch over in the dark for hours at a stretch as they weave carpets on looms until their small, delicate …

Beyond Capitation: How New Payment Experiments Seek To Find The 'Sweet Spot' In Amount Of Risk Providers And Payers Bear, Rick Mayes, Austin B. Frakt

Political Science Faculty Publications

A key issue in the decades-long struggle over US health care spending is how to distribute liability for expenses across all market participants, from insurers to providers. The rise and abandonment in the 1990s of capitation payments—lump-sum, per person payments to health care providers to provide all care for a specified individual or group—offers a stark example of how difficult it is for providers to assume meaningful financial responsibility for patient care. This article chronicles the expansion and decline of the capitation model in the 1990s. We offer lessons learned and assess the extent to which these lessons have been …

Play Fair With Recidivists, Richard Dagger

Political Science Faculty Publications

Retributivists thus face a difficult challenge. Either we must go against the social grain, and perhaps our own intuitions, by insisting that a criminal offense carry the same penalty or punishment no matter how many previous convictions an offender has accrued; or we must find a way to justify the recidivist premium. I shall take the second route here by arguing that recidivism itself is a kind of criminal offense. In developing this argument, I shall rely on Youngjae Lee's insightful analysis of "recidivism as omission." I shall complement his analysis, however, by grounding it in a conception of criminal …

Postmortems On The Affordable Care Act (Book Review), Rick Mayes

Political Science Faculty Publications

Nearly two years after the Affordable Care Act became law, books are appearing by Washington insiders who detail how the legislation came about. The two reviewed here discuss and dissect topics related to the health reform law from decidedly different points of view.

Pay-For-Performance Reimbursement In Health Care: Chasing Cost Control And Increased Quality Through "New And Improved" Payment Incentives, Rick Mayes, Jessica Walradt

Political Science Faculty Publications

Pay-for-performance (P4P) reimbursement has become a popular and growing form of health care payment built on the belief that payment incentives strongly affect medical providers' behavior. By paying more to those providers who are deemed to deliver better care, the goal is to increase quality and, hopefully restrain cost growth. This article provides a brief explanation of: (1) how previous P4P plans in the U.S. have fared, along with their special relationship to primary care, and (2) how England's experience with P4P and newer versions of these kinds of plans being pursued in places such as Massachusetts might provide valuable …

Mujeres Y Bienestar: Un Estudio Comparativo De Chile Y Uruguay, Jennifer Pribble

Political Science Faculty Publications

Es ampliamente reconocido por economistas, cientistas políticos y sociólogos que las mujeres constituyen una proporción muy alta de la pobreza mundial. A pesar de las marcadas diferencias de género entre los pobres latinoamericanos, los análisis de los Estados de bienestar de Ia región se han concentrado primordialmente en explicar las diferencias en los niveles del gasto socialo total. Este enfoque ha dejado de lado una variable importante en los regímenes de bienestar latinoamericanos: el carácter de género en las políticas sociales. Este trabajo pretende cubrir esa brecha. Mediante un análisis comparativo de Chile y Uruguay, las páginas que siguen exploran …

The Way It Was In Health Policy, And Probably Will Be: Learning Lessons By Rashi Fein (Book Review), Rick Mayes

Political Science Faculty Publications

Learning Lessons by Rashi Fein is an enjoyable memoir from a scholar and policy adviser unlike any other. Fein’s influential involvement in health care policy dates back to John F. Kennedy’s administration, and his career as a leading health economist paralleled the significant growth in the political influence of health economists following the enactment of Medicare and Medicaid in 1965. Now an emeritus professor of the economics of medicine at Harvard Medical School, Fein writes here about the lessons he learned in medicine, economics, and public policy. His view of the policy process, as a way of coming to …

The Chilean Left In Power: Achievements, Failures, And Omissions, Evelyne Huber, Jennifer Pribble, John D. Stephens

Political Science Faculty Publications

In his introduction to this volume, Weyland locates the administrations of Socialist Presidents Ricardo Lagos (2000-06) and Michelle Bachelet (2006- 2010) closest to the moderate pole among current leftist governments in Latin America. We concur and hope to contribute to the discussion by elucidating the sources of this moderation and examining the performance of these governments in the areas of political management, economic policies, and social policies and labor market reforms. The Lagos and Bachelet governments have pursued similar market-friendly economic policies to their predecessors. Although both presidents have made important progress in overcoming the political institutionallegacies of Augusto Pinochet's …

Politics, Policies, And Poverty In Latin America, Jennifer Pribble, Evelyne Huber, John D. Stephens

Political Science Faculty Publications

Why do Latin American countries exhibit stark differences in their ability to protect citizens from falling into poverty? Analysis of poverty levels measured by ECLAC in eighteen countries shows that political factors-including the democratic record, long-term weight of left-of-center parties in the legislature, and investment in human capital-are significant and substantively important determinants of poverty. These findings contribute to the growing literature that emphasizes the importance of regime form, parties, and policies for a variety of outcomes in Latin America, despite the weaknesses of democracy and the pathologies of some parties and party systems in the region.

Republicanism And Crime, Richard Dagger

Political Science Faculty Publications

These are but two of the difficult questions that arise when one examines the claim that crime is a public wrong. I take it, though, that their difficulty is an indication of the importance of thinking through the presuppositions and implications of this conception of crime, not a reason to abandon it. A thorough 'thinking through' is too large and complex a task for this chapter, but it is possible to make a case here for the right way to proceed with such an undertaking. That right way, in my view, is to look to the republican tradition of political …

Pursuing Cost Containment In A Pluralistic Payer Environment: From The Aftermath Of Clinton’S Failure At Health Care Reform To The Balanced Budget Act Of 1997, Rick Mayes, Robert E. Hurley

Political Science Faculty Publications

Following a decade in which Medicare operated as the leading ‘change agent’ within the US health care system, the private sector rose to the fore in the mid 1990s. The failure of President Clinton’s attempt at comprehensive, public sector-led reform left managed care as the solution for cost control. And for a period it worked, largely because managed care organizations were able to both squeeze payments to selective networks of medical providers and significantly reduce inpatient hospital stays. There was a lot of ‘fat’ in the nation’s convoluted health care system that could be (and was) eliminated through competitive negotiations …

Medicare And America's Healthcare System In Transition: From The Death Of Managed Care To The Medicare Modernization Act Of 2003 And Beyond, Rick Mayes

Political Science Faculty Publications

This article traces the transition-in Medicare, specifically, and in the American healthcare system, generally-from the aftermath of the Balanced Budget Act of 1997 to the passage of the Medicare Modernization Act of 2003. During this time, restrictive managed care died under an onslaught of resurgent cost pressures, legislative and legal attacks, and a vehement physician and consumer backlash. The subsequent reversion to more generous (and more expensive) health plans coincided with a recession in 2001 to trigger a return to rapidly escalating healthcare spending and yet another in the Nation's series of healthcare crises. Current trends suggest that future policymakers …

Did A Rising Tide Lift All Boats? The Nih Budget And Pediatric Research Portfolio, Daniel P. Gitterman, Robert S. Greenwood, Keith C. Kocis, Rick Mayes, Aaron N. Mckethan

Political Science Faculty Publications

This paper examines National Institutes of Health (NIH) pediatric research spending in absolute terms and relative to the doubling of the NIH overall budget between fiscal years 1998 and 2003. Pediatric spending increased by an average annual rate of 12.8 percent during the doubling period (almost on par with the NIH average annual growth rate of 14.7 percent). However, the proportion of the total NIH budget devoted to the pediatric portfolio declined from 12.3 to 11.3 percent. We offer recommendations for implementing existing commitments to strengthen the pediatric research portfolio and to protect the gains of the doubling period.

The Judicial Transformation Of Social Security Disability: The Case Of Mental Disorders And Childhood Disability, Jennifer L. Erkulwater

Political Science Faculty Publications

A full account of the judicial influence on Social Security disability programs would require a book-length, perhaps even encyclopedia-length, treatise and would take us far afield from our present concern. This article focuses narrowly on the activities of Legal Services attorneys, mental health reformers, and children's advocates. Although mental health reformer groups are only one of many antipoverty organizations involved in advocacy efforts on behalf of the disabled poor, they have been among the most persistent, the most active, and the most successful in using a litigation strategy to achieve their larger policy goals. According to one Social Security official, …