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Research Roundup: Health Exchanges, Medicaid Cuts, E-Verify, Pensions and Paid Sick Days

In this week’s research roundup: reports by the Center on Budget and Policy Priorities examining specific protections states can adopt to limit adverse selection in the state health care exchanges, surveying proposed or enacted state exchange legislation from 2011 legislative sessions and analyzing how cuts in state budgets jeopardize the economic recovery, studies by the Center for American Progress noting how states are leading the charge in enacting tuition equity legislation and identifying the true costs of the controversial E-Verify immigration program,  a study by Families USA on the economic devastation that would result for states from severe federal cuts to Medicaid, a brief by the Minnesota Budget Project comparing the two very different budget proposals before the state, an analysis by the National Institute on Retirement Security of critical aspects of six state pension systems that remained well-funded through the economic downturn, and a paper by the Economic Policy Institute on how a national paid sick days policy would promote workers’ financial stability and the economic security of their families.

States Should Take Additional Steps to Limit Adverse Selection Among Health Plans in an Exchange — This report by the Center on Budget and Policy Priorities examines specific protections states can adopt to limit adverse selection in the state health care exchanges provided for in the Affordable Care Act that are scheduled to go live in 2014. These include establishing consistent Essential Health Benefits, creating a menu of cost-sharing options for each coverage level, requiring insurers that want to operate in an exchange to offer products in all exchange coverage levels, and conducting strong and ongoing enforcement and oversight.

Analysis of State Health Insurance Exchange Legislation: Establishment Status and Governance Issues — This analysis by the Center on Budget and Policy Priorities surveys the states and summarizes all the of proposed or enacted state health exchange legislation from 2011 legislative sessions, including a specific focus on provisions relating to governance and conflict of interest. As of the end of June, 32 states and Washington, D.C. had introduced legislation to implement exchanges, 10 states had seen such bills passed by the legislature or enacted into law, 9states and D.C. have legislation that remains pending in legislatures, and 13 failed to pass legislation prior to the close of their sessions.

Jobs at Risk: Federal Medicaid Cuts Would Harm State Economies — This timely report from Families USA highlights the economic devastation that would result in the states from severe federal cuts to Medicaid, and concludes that cuts similar to those in the House majority budget proposal would “cause serious and quantifiable harm to state economies.” The report also notes how “every federal Medicaid dollar that flows into a state stimulates business activity and generates jobs,” and highlights how the “loss of the ‘economic multiplier effect’ that states would experience as a direct result of federal Medicaid cuts would be large and much greater than the amount of the dollar cuts themselves.”

Keeping the DREAM Alive: States Continue the Fight to Give Undocumented Students Access to Higher Education — This report from the Center for American Progress highlights how states are leading the charge in enacting tuition equity legislation in the absence of Congressional action. Surveying the action in the states, the analysis finds that bills that grant in-state tuition to undocumented students, or “state-level DREAM Acts,” have succeeded in 13 states over the past decade and that “state legislatures from California to Connecticut have defended and even augmented laws that make the pursuit of higher education a reality for a greater portion of their residents.”

A Tale of Two Visions: Comparing Governor Dayton's and the Legislature's FY 2012-13 Budgets — On the eve of a potential state government shutdown in Minnesota, this crucial analysis from the Minnesota Budget Project compares the two “very different” budget proposals at the heart of the showdown: one that favors a balanced approach that would ensure the economic security of the state, and the other an economically reckless plan focused on cuts to schools and other essential services. In addition to noting the popularity of Governor Dayton’s balanced approach with voters, the report also concludes that “it’s clear that both plans will raise revenues to meet the state’s needs” and that “the question is whether these revenues are raised at the state level transparently and based on ability to pay, or whether those revenues will come from higher local property taxes.”

Seen and (Mostly) Unseen: The True Costs of E-Verify — This brief by the Center for American Progress identifies the true costs of the controversial E-Verify program.  It explains the system’s known costs, such as lost tax revenue and monetary burdens on small businesses, and estimates the cost of additional fiscal burdens — to individuals verified through the system, to employers utilizing the system, and to the federal government in running the system.

New Fiscal Year Brings Further Budget Cuts to Most States, Slowing Economic Recovery — In this report, the Center on Budget and Policy Priorities (CBPP) reviews tax and budget developments at the state level this past session. CBPP overwhelmingly finds that states have pursued massive budget cuts at the expense of economic and social vitality. The authors conclude, “States will continue to struggle to find the revenue needed to support critical public services like education, health care, and human services for a number of years. Among other impacts, this means that state actions will continue to be a drag on the national economy, threatening hundreds of thousands of private- and public-sector jobs and reducing the job creation that otherwise would be expected to occur.”


Lessons Learned from Well-Funded Public Pensions: An Analysis of Six Plans that Weathered the Financial Storm — The National Institute on Retirement Security (NIRS) released this timely analysis of the design, implementation, and critical aspects of six pension systems that remained well-funded through the economic downturn: the Delaware Public Employees Retirement Systems’ State Employees Pension Plan, Idaho Public Employee Retirement Systems’ Public Employee Retirement Fund Base Plan, Illinois Municipal Retirement Fund, New York State Teachers’ Retirement System, North Carolina’s Teachers and State Employees’ Retirement System, and the Teacher Retirement System of Texas. The authors find six main features of each plan that have contributed to affordability and sustainability, including “1. Employer pension contributions that pay the full amount of the annual required contribution (ARC), and that maintain stability in the contribution rate over time, that is, at least equal the normal cost; 2. Employee contributions to help share in the cost of the plan; 3. Benefit improvements such as multiplier increases that are actuarially valued before adoption, and properly funded upon adoption; 4. Cost of living adjustments (COLAs) that are granted responsibly, for example through an ad hoc COLA that is amortized quickly, or an automatic COLA that is capped at a modest level; 5. Anti-spiking measures that ensure actuarial integrity and transparency in pension benefit determination; 6. Economic actuarial assumptions, including both the discount rate and inflation rate, that can reasonably be expected to be achieved over the long term.”

The Need for Paid Sick Days — This briefing paper by the Economic Policy Institute (EPI) looks at economic security for working families, and shows how a national paid sick days policy — providing a few federally protected paid days off each year that workers can use to recover from illness, care for sick family members, or seek medical care — would promote workers’ financial stability and the economic security of their families.