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Nathan Benefield

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Nathan BenefieldNathan Benefield is the Director of Policy Research with the Commonwealth Foundation, an independent, non-profit public policy research and educational institute located in Harrisburg, Pennsylvania.

Nathan has researched and written on public policy issues including taxation, government spending, education reform, transportation funding, health care policy, and economic development.  Nathan has had editorials featured in the Philadelphia Inquirer, the Pittsburgh Tribune Review, the Allentown Morning Call, and dozen of other papers across Pennsylvania.  Nathan has provided testimony to Pennsylvania House and Senate Committees related to the state budget and transportation funding. 
 
Nathan is a graduate of DePaul University in Chicago, Illinois, also earning a masters degree in public service management from DePaul.  He is currently working to complete his doctoral dissertation in political science from Loyola University of Chicago.
 
Nathan is a resident of Camp Hill, Pennsylvania.


Monday, August 4, 2008

Fixing Medicaid in PA 

By Nathan Benefield

Categories:  Medicaid, Pennsylvania

The Commonwealth Foundation released a report by Michael Bond on reforming Medicaid in the Keystone state in May (I am tardy in blogging on the subject).  Bond writes:

Over the last 25 years, Pennsylvania’s Medicaid spending increased approximately 8% annually, versus approximately 6% for overall medical spending.  In 1980, Medicaid represented around 12% of the state budget. As of 2007, that total had increased to almost 26%. At this rate of growth, Medicaid will consume 94% of the Pennsylvania budget in the year 2075.
 
Unfortunately, the enormous fiscal problems facing Medicaid often overshadow its other major flaw: a well deserved reputation as a low-quality provider of health care. The program delivers episodic treatment, provides poor preventive care, and offers low-quality services to many beneficiaries. The plan produces some tragic health outcomes for America’s most vulnerable populations. It is routinely abused by both providers and beneficiaries. This ranges from Medicaid “mills” to outright theft. There have been estimates that as much of 40% (over $100 billion) of Medicaid spending involves abuse and fraud.
 
States should create insurance and provider exchanges for the provision of services to beneficiaries. Unlike the current price control system, those eligible for Medicaid will receive risk-adjusted credits to purchase services from competing plans. This would turn Medicaid into a real market in which buyers act in their own interest and providers compete to enroll beneficiaries and would also produce gains in efficiency that would make Medicaid sustainable in federal and state budgets and, just as importantly, improve the quality of health care that beneficiaries receive.

Click here for the full report (PDF file).

Wednesday, July 9, 2008

The Church of SCHIP 

By Nathan Benefield

Categories:  SCHIP

Michael Cannon pulls a troubling quote from an advocate of SCHIP expansion, who admits his support is based on faith, not evidence.

Of course Cannon is a well-known heathen.

Thursday, July 3, 2008

New Health Care Mandates in the Keystone State 

PA passes autism mandates, pushes "slacker mandate"

By Nathan Benefield

Categories:  Insurance Regulation, Pennsylvania

The Pennsylvania General Assembly just passed a bill to require insurance companies to cover autism services, along with colorectal cancer screening. Despite the fact these mandate are known to drive up the cost of insurance, and the number of uninsured, the bill was passed with a nearly unanimous vote (49-1 in the Senate and 203-0 in the House).  Another bill, creating a "slacker mandate", would mandate coverage of adult children up to age 30, with no dependants of their own, on their parents' plans. 

Read the Commonwealth Foundation's commentary on these new mandates.

Thursday, June 12, 2008

An American Cure for Reforming Health Care 

By Nathan Benefield

Tom Coburn presents his proposal to reform our health care system at the Manhattan Institute. Here is the core of his argument:

How do we create a real insurance market? We create a national market so that you can buy insurance from any state you want. You can buy whatever you want, and we incentivize reinsurance or high-risk pools so that no insurance company would find it beneficial to game the system if you have a chronic disease. If they choose not to cover you, they will have to cover you as a participant in a reinsurance or high-risk pool. So all of a sudden they have an economic incentive to manage your chronic disease rather than duck your chronic disease. This would restore true spreading of risk.

My position is that we don’t have real health insurance in this country. What we have is prepaid health care, for which 18 percent of our premiums go to the administrative costs of having the bills paid.

Look at the 10Ks of any of the major players in health care today. Whether you’re invested in them or not, look at the total revenues, then go look at the EBITDA, look at their overhead above that, and look at what percentage of revenues don’t go toward providing direct services in the health-care market.

Can we create a more efficient, transparent market where individuals can participate for their own benefit? We can set it up by creating a refundable tax credit, equalizing the tax benefit under the code so that, no matter what you earn, you’re treated the same. If you make more than $180,000 a year and keep your Cadillac health-care plan, you might see slightly increased taxes. If you shift to a higher-deductible plan that doesn’t offermore than about $14,000 a year in benefits, you will see no increase in taxes.

Tuesday, May 6, 2008

Who saves from McCain's proposal? 

By Nathan Benefield

With the re-release of John McCain's health care plan came a lot of criticism (along with praise) over who benefits from his tax credit.

McCain would offer tax credits of $2,500 for individuals and $5,000 for families, but would tax employer-provided benefits for health insurance (employers would still be able to deduct health care benefits as a business expense). There has been some speculation that there would be winners and losers—i.e. some who would pay more in taxes on employer health benefits than the amount of the tax credit—but my back-of-the envelope analysis reveals that those would only be higher income-earners with very costly employer benefits. All of the projected scenarios in my calculation (see here) benefited from the tax credit (my highest income/benefit was a $125,000 income with a $20,000 family or $10,000 individual health care benefit.)

My analysis also shows that

  • Those without employer benefits would benefit most (receiving the full $2,500/$5,000 credit)
  • The credit would be progressive—lower income-earners would benefit more, as would those with lower employer benefits
  • Generally, families would receive a greater tax deduction than individuals.  

 

McCain's plan also includes support for state high risk pools and gives individual freedom to buy health insurance from any state - reforms we don't need to wait on the federal government to adopt in individual states.

For more analysis of McCain's plan, check out Michael Tanner's assessment on the Cato Daily Podcast and in an editorial.

Thursday, May 1, 2008

PA Senate GOP offers alternative health care plan 

By Nathan Benefield

Categories:  Pennsylvania

The Pittsburgh Post-Gazette summarizes a hearing on health care affordability in Pennsylvania.  Rick Dreyfuss of the Commonwealth Foundation was among those to testify (his testimony is here).

The focus was on a number of market-based solutions, proposed by Senator Folmer, vs. Governor Rendell's proposed expansion of existing subsidies for government insurance programs.

Monday, April 21, 2008

State Heath Policy Q&A 

By Nathan Benefield

Categories:  Individual Mandates

The NCPA has a new report on State Health Care Reform: Key Questions and Answers, highlighting many of the key policy questions, including "Does universal health coverage lower health care costs?" and "Do we need individual health insurance mandates?".

Friday, April 18, 2008

The Health Insurance Mafia 

Doctors Against Health Insurance

By Nathan Benefield

Here is a great editorial in the Wall Street Journal on how the health insurance industry acts like the Mafia:

Most discussions about the rising cost of health care emphasize the need to get more people insured. The assumption seems to be that insurance – rather than the service delivered by doctor to patient – is the important commodity.

But perhaps the solution to much of what currently plagues us in health care – rising costs and bureaucracy, diminishing levels of service – rests on a radically different approach: fewer people insured.

The Los Angeles Times also featured a "doctor against health insurance" editorial on Wednesday (HT to John Goodman):

When doctors break free from the shackles of insurance companies, they can practice medicine the way they always hoped they could. And they can get back to the customer service model in which the paramount incentive is providing the best care. Only then can doctors reclaim the simple dignity of any businessman: These are my doughnuts; only I and my customers can determine their worth. (At the end of each week, I will donate some to the needy, but I will not let a third party set the price.)

And when patients are the customers, doctors will listen when they ask for services not on the insurance company menu. If an urgent need arises after hours, patients want to be able to call their own doctor. Patients want to be able to e-mail their doctor with non-urgent questions and to fax them interesting articles. They want to be educated, not just medicated. They want to know they can get in to see their doctor the same day if needed, and that their doctor will be the one taking care of them if they are hospitalized. If doctors had fewer patients, meeting all of these needs would be easy.

Thursday, March 27, 2008

RendellCare lobbyist push community rating 

By Nathan Benefield

Categories:  Insurance Regulation, Pennsylvania

The lobbyists charged with pushing RendellCare InsurePANow has fired off another missive advocating more of Pennsylvania Governor Ed Rendell's health care agenda. They tout a bill that they proclaim will "make insurance companies work for you". Huh?

The legislation they are lobbying for imposes a modified "community rating" on all insurance providers. Community rating means that insurance companies can't charge different rates for different individuals. While this sounds good on the surface, what it means is that younger, healthier workers would pay higher premiums, while the old and sick may pay less.

In addition, insurance companies wouldn't be able to charge smokers more (which seems odd given the anti-smoking campaign of RendellCare), nor would they be able to offer discounts for "healthy behavior" - i.e. wellness or fitness programs.

Community ratings drive up the number of uninsured, and discourage younger, healthier customers from buying health insurance (even when health insurance is mandated, as in Massachusetts). Read more about community rating in the ALEC/CAHI State Legislator's Guide to Health Care.

The RendellCare lobbyists claim that community rating would "help small businesses" and protect us from the big bad insurance companies. But small businesses oppose community rating, and many insurance companies favor it (including many of the big carriers), as they simply shift their cost to some people more while charging others less.

Instead, here are some actual reforms that reduce the cost of health care for everyone - insured and uninsured, employer-provided and individual purchasers, young and old, sick and healthy, smokers and the physically fit.

Monday, March 24, 2008

State Legislators' Guide to Health Insurance 

By Nathan Benefield

The Council for Affordable Health Insurance (CAHI) and American Legislative Exchange Council (ALEC) have published a 2008 version of their guide to health insurance solutions, including recommendations and a glossary of frequently-used, but rarely understood, terms.

Another recent CAHI publication update is their Health Insurance Mandates in the States, which identifies the benefits, providers, and covered persons that states require any insurance policies to cover - driving up the costs of insurance (and the number of uninsured).

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