Joseph R. Antos

Sex differences in union membership

This study investigates determinants of the male-female unionization differential. Logit analysis is used to estimate three union membership equations, using data taken from the May 1976 Current Population Survey. Standard human capital measures, plus location, race, and sex, are first included as explanatory variables, and then occupational and industry status are added sequentially. The results indicate that sex differences in occupational and industrial status account for over half of the male-female unionization differential. The authors also conclude, however, that increasing the female unionization rate to equal the male rate would only modestly diminish the sex difference in wages. (Authors abstract.)

Bending the Cost Curve through Market-Based Incentives

In order to reduce health care spending, the authors suggest two market-based approaches. To reduce federal Medicare spending, they suggest a premium-support model (defined contribution); in the private insurance market, they suggest reducing the tax exemption for employer-sponsored health insurance. Both approaches change the incentives for health care spending.

Reforming health care reform in the 112th Congress.

The results of the midterm elections have created a tougher political climate for implementing health care reform. Yet even though the Republican gain of 63 seats in the House marks a sea change in policy perspective, it may not produce major substantive changes in law.

Union effects on white-collar compensation

This paper uses two new data sources, each of which combines information on worker and establishment characteristics with detailed information on the components of employee compensation, to examine union/nonunion pay differentials for white-collar workers. Estimates reveal that nonunion wages and total compensation are more responsive than union pay levels to worker productivity differences, such as education and work experience. Also, large firms pay 10 to 15 percent more to their white-collar employees than small firms in the nonunion sector but only 5 percent or less in the union sector. Overall, the white-collar union wage differential appears to be 3.5 to 4.0 percent, rising to 7.1 percent when fringe benefits are included in the dependent variable. Significant spillovers to nonunion white-collar workers, which appear to erode the measured union/nonunion pay differentials, are also found.

The Wyden–Ryan Proposal — A Foundation for Realistic Medicare Reform

Under the Wyden–Ryan proposal, instead of guaranteeing to pay for services as they are rendered, Medicare would give beneficiaries a subsidy to purchase coverage from one of multiple health plans, which would compete by providing necessary services cost-effectively.

The Medicaid Expansion Is Not Such a Good Deal for States or the Poor

In the wake of the Supreme Court decision, states should not rush to expand eligibility for Medicaid. They cannot be certain that the federal support promised in the Patient Protection and Affordable Care Act will remain available, and a better deal might be possible after the election. Adding millions more to Medicaid rolls will exacerbate existing problems of access to providers. A more humane policy would give everyone--even the poor --a choice of health plans.

The Obama Plan: More Regulation, Unsustainable Spending

The health reform plan put forth by Sen. Barack Obama (D-IL) focuses on expanding insurance coverage and provides new subsidies to individuals, small businesses, and businesses experiencing catastrophic expenses. It greatly increases the federal regulation of private insurance but does not address the core economic incentives that drive health care spending. This omission along with the very substantial short-term savings claimed raise serious questions about its fiscal sustainability. Heavy regulation coupled with a fallback National Health Plan and a play-or-pay financing choice also raise questions about the future of the employer insurance market.

Lessons From The Clinton Plan: Incremental Market Reform, Not Sweeping Government Control

The Clinton health reform attempt in the mid-1990s and the U.S. experience since then suggest some clear lessons for the next U.S. president. Public confidence in a major reform proposal must be won, and congressional support must be garnered, even if the election is a landslide. Insisting on universal coverage as a precondition may undercut the ability to enact other policies needed to improve the health system. Excessive regulation and price controls are likely to exacerbate underlying problems. The next president should take full advantage of market incentives to promote a high-value health system.

Symptomatic Relief, but No Cure — The Obama Health Care Reform

Barack Obama has laid out a vision for reform that promises health insurance for (nearly) everyone, with coverage as good as that enjoyed by members of Congress. Joseph Antos argues that the Obama plan offers a host of policy proposals that address the symptoms but not the underlying disease that afflicts the health care system.

Replacing the Affordable Care Act and Other Suggested Reforms

Agroup of health policy analysts (the 3 of us plus 7 others listed below in the Editor’s note) have collaborated on a set of proposals for replacing the Affordable Care Act (ACA) and also reforming other major portions of health care delivery, such as the tax treatment of employersponsored health insurance, Medicaid, Medicare, and Health Savings Accounts (http://bit.ly/1RSrnsl). Because so much attention has been paid to the repeal of the ACA by those who have opposed it, we believe it is important to focus on a serious proposal that could both replace this law and provide additional measures of reform, especially to the health care entitlement programs. We believe our reform agenda represents such a proposal. Furthermore, none of us regards the pre-ACA health care system as an acceptable alternative. Although the ACA has reduced the number of uninsured (by about 3 percentage points from 2013 to 2014), the primary source of new coverage is Medicaid, which provides more restricted access to care than most private insurance (http://1 .usa.gov/1JhH9Dw). Moreover, the law is showing increasing signs of instability. Insurance expansion is clearly proceeding more slowly than anticipated, and is likely to fall well short of the Congressional Budget Office’s initial expectations of 30 million newly insured individuals in 2015 (http: //wapo.st/1VUCvrv). UnitedHealth, the nation’s largest health insurer, has threatened to withdraw from the program because of concerns over stability of the risk pool (http://n.pr/1IFhLhY). And national health spending rose 5.3% in 2014, indicating that health costs may not continue to slow as much as ACA supporters thought they would (http://bit.ly/1IFhfL3). Our objective is to offer a reform approach that would reduce the number of uninsured, bring greater cost discipline through market principles, return power and control to individuals and the states, and improve the long-term fiscal outlook.