To Cut Health Costs, One State Makes Patients Shop Around
California is saving millions making people compare prices for certain medical services.
Authors
Penelope Lemov |
Email : plemov@governing.comPenelope Lemov is a correspondent and part-time editor for GOVERNING. She writes two e-newsletters -- one on finance, the other on taxes and revenue -- and edits features and columns every month. She is the former Health columnist for GOVERNING and was senior editor for several award-winning GOVERNING features. She is also the founder and writer of the blog, www.grownchildren.net.
The Calming of Incarcerated Minds
Meditation can improve inmates’ mental health better than traditional care, which is why it’s being reintroduced in some prisons.
Recipe for a Successful Wellness Program
Studies are mixed on the effectiveness of incentivizing employees to get healthier. But one county is chalking up some big savings.
Why Alibaba Offers Hope for Online Sales Taxes
Will Congress be swayed by the entry of a Chinese e-commerce competitor?
A Green Bond for Public Pensions
Pension plans want to support environmental projects, but there is one thing holding them back.
Can Income Tax Cuts Boost a State's Economy?
Two researchers say the answer comes down to how a tax cut is financed.
Cut! States Are Walking Back Film Tax Credits
Many states are rethinking once-popular production incentives -- a contrast from California, which is offering more to protect one of its biggest industries.
Congress Considers Reviving Risky Bonds to Boost Small Businesses
Industrial development bonds historically have the highest default rate, but a bill in Congress would revamp them.
States Take Note: FATCA Is Here
After years of planning, the Foreign Account Tax Compliance Act is finally in effect. How will it affect your state?
The Complexities of Taxing the Cloud
Cloud sales are expected to generate billions in revenue this year, but state and local governments are unsure whether they can (and how they would) tax them.
States Search for Retirement Security Beyond Obama’s myRA
The president’s public retirement savings account only goes so far, so about a dozen states are looking for alternative ways to help their many constituents who have no nest egg.
2 Reasons to Be Upbeat About the Muni Bond Market
Although issuance is down, there have been a few good developments on the municipal bond front.
Corporate Tax Attacks in the States
At the same time states are looking to beef up corporate tax collections, they are also cutting corporate taxes.
Is it Time to Put a New Commuter Tax in Drive?
D.C.'s Tax Revision Commission has suggested an unusual way to broaden the city's tax base -- and get around the federal government.
The Time May Have Arrived for Online Sales Tax Fairness
Partially driven by a devastating alternative, Congress appears closer than ever to passing an Internet sales tax bill.
Public Pension Portfolios vs. Hedge Funds
A group of local pension plans has a strategy to fight 2-and-20 fees and lower the costs of private equity investments.
The Future of Financing Infrastructure
With the ways for funding transportation infrastructure changing, what options do Congress and the states have left?
10 Budgeting Tips for Long-Term Financial Planning
A new report lays out several fiscal planning tools that can help officials see what's sustainable.
Will the 2014 Muni Market Be Good for Issuers?
Analysts see a better year ahead, but say there are factors that could cause a 2013 repeat.
Taking a Tax Bite Out of Bitcoin
Do states and localities have a revenue interest in virtual currencies?
The Latest on the Amazon Tax in States, Courts and Congress
While Congress stalls on federal online sales tax legislation, a growing number of states are now taking advantage of the extra revenue -- but not without a fight.
Can the Threat of Defunding Education Slow Down Tax Cuts?
A tax fight in Missouri may signify the limits to cuts.
Gay Marriage and State Taxes
States that don't recognize same-sex marriage will face a few tax complications come 2014.
Turmoil and Trouble in the Muni Bond Market
A veteran issuer gives his perspective on the mounting woes over muni bonds.
Foreclosure & the Eminent Domain Solution Explained
Richmond, Calif.’s plan -- which dozens of localities are considering -- is facing legal and legislative challenges. What are the pros and cons of seizing underwater mortgages using eminent domain?
How & Why Irvine Plans to Prepay Its Pension Bill
The well-to-do city in Southern California will pay off 30 years worth of liabilities in a decade.
How Much Did Homebuyer Tax Credits Help Housing’s Recovery?
A recent Brookings report evaluates their effects on the housing market.
A New, Sometimes Not-So-Nice Outlook for the Muni Market
Despite some positive developments, it seems the SEC and IRS are cracking down on the municipal bond market.
Do the States Have a Debt Problem?
States and localities have $3 trillion in debt, but the purpose and use of debt differs significantly from the federal government.
A Third Way for Public Pensions: Adjustable Pension Plans
Defined-benefit plans put all the risk on states and localities; defined-contribution plans put it all on employees. Now there's a new approach to risk sharing.
Gun Debate Revives the Pension-Investment Dispute
When there’s public outcry over something -- whether it’s gun control or apartheid -- states and cities reevaluate what their pension plans invest in. But should they be social investing at all?
Do Tax Breaks for Senior Citizens Pay for Themselves?
Cash-strapped states are questioning the tax exemptions they offer the elderly.
What's Wrong with Kansas' Tax Reform?
According to finance experts from the left and right, it's the worst reform measure passed by a state in the last two years.
What's the Medicaid Expansion Worth to a State?
The fiscal facts on what a state gains or loses by broadening its Medicaid roles.
Gun Taxes and State Revenues
A handful of states and localities are considering gun and ammunition taxes. Is there any state and local revenue in this approach?
The Muni Bond Market in 2013
Issuers may be enjoying low-interest rates when they come to market, but that doesn't mean these are the best of times.
What to Do About the Gas Tax?
Two states, two different approaches for fixing how we pay for roads.
The State of State and Local Finances
New studies afford a state-by-state or city-by-city analysis of fiscal well being.
Cities, Bankruptcy Law and Pension Payments
As cities face extreme fiscal pressure, can Chapter 9 ease their pension obligations?
Looking Past Libor
The Municipal Securities Rulemaking Board is hoping to help arm issuers with more information before they borrow money.
States and the Federal Fiscal Cliff
The effect of higher federal taxes and sequestration cuts on state budgets and revenue.
Dissecting State and Local Finances
A look at past, present and future issues that have been swept under the fiscal rug.
Lowering the High Cost of an Agency's Real Estate Move
A private banker has an idea for "rentalizing" upfront costs when agencies consolidate and move into smaller office space.
Bonds: A New Way to Fund Clean Energy
A new initiative hopes to pair the science of alternative energies with the power of bond financing.
Checking In On the Amazon Tax Battle
States have been battling Amazon and other online retailers over sales tax collection for years. Have they finally made progress?
Can Eminent Domain Help End the Foreclosure Crisis?
Wall Street opposes the idea, but a county in California thinks it can use eminent domain to seize underwater mortgages and restructure them on behalf of homeowners.
The Very Public Private-Sector Retirement Problem
The Great Recession was hard on private workers. Will states and localities have to rescue them?
Taking Tax Cuts to a Deeper Level
Four states have already considered eliminating income or property taxes this year.
The Latest Wrinkles in the Muni Bond Market
While things appear to be looking up, new questions arise about loans, debts and borrowings from banks.
Sales Tax Zapped by Zappers
As technology improves, more and more businesses are using tax zappers to skim sales taxes.
Student Debt and the Public Purse
The student loan bubble could hurt state and local revenue.
The Case for a State-Owned Bank
One professor argues it's a way to bring revenue gushing into state coffers.
The Volcker Rule's Role in the Muni Market
A reform aimed at Wall Street is taking a shot at the bonds states and localities issue.
Fracking Tax Issues and Logistics
Hydraulic fracturing is being touted as a revenue bonanza for the 35 states that have shale gas potential, but it's not without its issues.
A Bank for Infrastructure Funding
Legislation moving through Congress could help states and localities finance public works projects.
The Pros and Cons of Internet Gambling
Will online poker be the revenue boost states are looking for?
The Muni Market in 2012
Economists and analysts are optimistic this year will be better than the last. Still, there are a few storm clouds on the horizon.
Seeking a Silver Lining to Calamities
Everyone knows the havoc disasters wreck on finances. How about the good they have?
Revenue for Road Repairs
Raise it or reform it: Is it time for states to rethink the gas tax?
The Liabilities of an NBA Lockout
Are city taxes and revenues affected if professional sports teams cancel their season?
Building a New Financial Base
Cities that retool for a global economy can set the stage for a reliable revenue stream.
States and Localities Squeeze Nonprofits
Are localities looking for revenue in the wrong place?
A Local Solution to a Bond Insurance Problem
With localities scrambling to find investors, the National League of Cities ponders jumping into the insurance business.
Death of the Mortgage Interest Deduction?
The feds are talking about ending the popular tax expenditure, which could be positive and negative for state and local economies.
The Trouble with Housing
For state and local revenues to improve, housing sales need to improve. The problem is that the outlook for housing isn't very pretty.
Sales Taxes Take A Holiday
Consumers may like back-to-school tax holidays, but are they good public policy?
Credit Rating Risks Ahead
If you thought the Great Recession was the most trying time for state and local government credit ratings, think again.
Businesses and the Property Tax
A new report scores states on how well they administer the unpopular tax.
Atlanta Pulls Off A Major Pension Overhaul
Plus, what might a lost NFL or NBA season cost your state and city?
Anatomy of a Tax Amnesty
Tax amnesties are unpopular with the public. On the other hand, they raise much-needed money in this cash-strapped climate.
The Demand for Disclosure
Municipal bond market investors want to know more about issuers -- and they want to know it on a quarterly, semi-annual and annual basis.
States Look to Collect Internet Sales Taxes
Desperate for revenue, states are trying all the tricks in the book to force Internet retailers to collect sales taxes.
What’s the Matter with the Muni Market?
Both borrowing and lending have decreased. The municipal bond market's problems run deeper than simple headline risk.
The Story Behind Tax Expenditures
They're the hottest topic in budget-balancing and deficit-cutting circles. They are also the least understood and the most controversial.
Rainy Day Funds: Did the Lifeline Work?
As revenues return, legislators and policymakers are beginning to take stock of how well their rainy day funds functioned.
Is the Hollywood Tax Credit Under Attack?
In a year when severe budget cuts are on the table, states are rethinking film tax-credit programs.
Is the Muni Bond Market Really in Dire Straits?
Some argue that the municipal bond market's recent upheaval is the fault of a single 60 Minutes segment.
Rejecting Sales Tax Exemptions on Food
Does taxing food partially or not at all make sense politically or fiscally? One University of Connecticut law professor says it doesn't.
A Measure of Financial Fitness
A new online tool in North Carolina provides a systematic approach in analyzing financial conditions for local governments.
All Fiscal Help Is Local
The list of cities in fiscal stress is growing. Will states intervene to help them work out their fiscal problems?
The Search for Lost Treasures: Dealing with Unclaimed Property
Several states not only help citizens find unclaimed property, but they also make money off of it.
Cutting Medicaid
States must make the least-worse budget cuts -- or consider dropping out of the program.
Drug Deals: A Pact to Lower State Employee Pill Prices
Driven by the effect of rising drug prices on state budgets, seven states are banding together to change the way they buy pharmaceuticals for their employee-benefit plans.
The Courts Rule on the 'Amazon Tax'
Confronting privacy and "nexus" issues, courts in several states have handed down new rulings in an escalating battle with online retailers to tax Internet transactions.
The Financial Road Ahead
The state of the union, and four positive steps states can take to improve their fiscal outlook.
The 'Amazon Tax' Battle Escalates
North Carolina is giving its online retailers an ultimatum: collect sales taxes now or risk an audit later.
Are Municipal Bankruptcies Imminent?
State and local debt is at an all time high -- governments have borrowed $2.4 trillion as of mid-2010.
Colorado Taxes Pot
Colorado didn't legalize medical marijuana to make money, but since regulations went into effect, it has raised millions.
Revenue Roulette
Is gambling a great source of revenue for states and localities, or a peril-filled recreation?
Fannie, Freddie and the Future of Housing
Three experts share their views on efforts to reform the mortgage giants, Fannie Mae and Freddie Mac, and why state and local governments should care.
Getting High on Excise Taxes
More and more states are turning to a perennial favorite, the excise tax, to weather the recession.
Budgets, Bonds and Basketball
When it comes to raising money and spending it, states and localities face formidable political obstacles.
Wallets, Recessions and Tax Commissions
In a bad economy, is a tax commission likely to have more of an impact?
Credit Rater Woes
Can new competition in the credit-rating arena reignite the municipal bond market?
The Ultimate Revenue Raiser: Asset Sales
In these budget busting times, state-owned buildings are increasingly up for sale. But states may have better options.
Bonds, Bankruptcy and Bad Luck
When a public-purpose project fails, should taxpayers pick up the bill?
Taxing Away Exemptions
Pittsburgh's proposed tax would have been a first: a 1 percent levy on all tuition paid by the city's 100,000 college students. If it had passed, it...
Is Municipal Bond Insurance Dead?
It's like a page out of the Brothers Grimm. Once upon a time -- and not so very long ago -- there were four giants....
Primary-Care System Lags Behind Other Developed Nations
The dwindling number of primary care physicians is a dagger at the heart of health care reform. If nearly all Americans have insurance, how will...
Unhealthy Economy, Sick People
Employers--and that includes states and localities--have been focusing on wellness and prevention as a means of keeping their employees healthy and thereby less costly to...
The True Cost of Treating Diabetes
Here's the problem. The number of Americans who have diabetes is growing at an alarming rate, as are the medical costs of treating the disease:...
Soda: the New Front in the War on Obesity
Put down that can. The sweet soda in front of you may be frosty and cold and just waiting to quench your thirst, but it...
For California's New Pension Chief, a Huge Burden
When he headed up the Washington State Investment Board, Joe Dear oversaw a $67 billion portfolio. Now that he's the new honcho at CalPERS, the California...
Opening Up Medicaid
There's a little joke that makes the rounds whenever Medicaid directors get together. It goes like this: If you've seen one state Medicaid program, you've...
Defining Prevention
Prevention is getting a bad rap--a growing number of health economists and providers are casting doubt on the ability of preventive medicine to squeeze costs...
The End-of-Life Imperative
The president brought it up himself. He talked seriously to a New York Times reporter in May about end-of-life health care choices--the tremendous drain they...
Diplomas Keep the Doctor Away
When it comes to surviving the swine flu, Texans, Californians and folks in other states along our southern border have fared better than their neighbors...
Full Interviews with User-Fee Experts
What will they think of next? Winter Haven, Florida, is imposing an accident response fee -- for services rendered when police officers and firefighters come...
Dialogue in the Delta
It isn't a strong economy that produces healthy people. It's healthy people that produce a strong economy." Peter Johnson is standing in a meeting room...
Rx Side Effects
Talk about impact. One day Wal-Mart is launching a small pilot program in Tampa to sell 314 generic drugs at $4 each for a 30-day supply. Two...
Medicaid's Breaking Point
Language is powerful. So when a negative word becomes linked to an idea or program, the result often is damaging. That's what I see happening...
A System in Collapse
Picture this: Pennsylvania Governor Ed Rendell comes to the nation's capital to tell a gathering of health care advocates, health industry representatives and health writers...
Health Court Advantage
Get ready for a medical malpractice crisis. The roiling stock market could drag down earnings on investment portfolios: If it does, insurance companies that issue...
Going after GASB
When public finance officers met this summer in Anaheim, their association's outgoing president kicked off the convention with an all-out assault on an accounting board....
The Coverage Conundrum
They're on the rise - again. Health insurance premiums are up 6.1 percent on average this year - a relatively modest increase - but overall they're 78...
Muni Machinations
Blame it on Orange County. Back in 1994, the huge California county filed for bankruptcy after losing billions of dollars on a risky investment in financial...
Find Me the Money
Winter Haven, Florida, imposes an accident- response fee-for services rendered when police officers and firefighters ride to the rescue. Wisconsin triples the price of its...
Creative Disruption
The current buzzword among MBA grads is "disruptive innovation." It may sound like a term to use when all hell is breaking loose. But what...
A Break in the Levy
As state and local revenue sources go, the property tax always has been the steady one. Its cousins -- the income and sales taxes --...
The HMO Laid Low
Two-thirds of managed care companies are losing money. When they get in trouble, states often get in trouble as well.
A Bond That Breaks New Ground
Massachusetts and New Mexico made news three years ago when they issued bonds for construction projects and promised to repay the loans with federal highway grants they had coming their way. Now, Chicago has come to market with a variation on the grant-anticipation theme.
Tobacco Bonds Draw a Market
New York City inhaled deeply and issued the first-ever tobacco bond in November. The $709 million bond, part of a $2.8 billion debt the city will sell in the next four years, sold out immediately.
Healing Health Care
The times may be ripe to form new--and surprising--alliances to solve the crisis in health insurance.
The Untaxables
Before Congress revisits the Internet-sales issue, states are developing a simpler and more uniform tax-collection process.
The Pros of Cons
The assault on certificates of need, put in place decades ago to control health costs, couldn't come at a worse time.
The Universal Cause
There's a dagger at the heart of any solution to the crisis in health care costs--but it's not the skyrocketing price of prescription drugs. Rather, it's the uninsured: the 41 million Americans--one in seven-- who can't afford, aren't offered or choose not to carry health insurance.
Low Grades for Deficit Financing
Sixteen states are on Moody's Investors Service negative outlook and four on negative watch, with "future credit deterioration likely," according to Robert Kurtter, senior vice president of state ratings for the credit-rating agency. Moody's had already downgraded eight states in the past two years.
Elder Scare
Health care costs for retirees are like a hurricane that's gathering strength in the ocean before it makes landfall.
The Universal Cause
Several health insurance companies have stepped up to say they intend to promote universal health care coverage.
Nascent Patient Power
A new approach to cutting health care costs may end up transferring medical risk to consumers.
From the Top: Michael Leavitt Speaks Up and Out
A few weeks ago, Governing sat down with Michael Leavitt, the U.S. Health and Human Services secretary and former governor of Utah, to talk about changes that could be in store for the Medicaid program. Here are some key points he made.
Tenncare Tensions
Governor Bredesen aims to save TennCare, but one of his fixes flies in the face of a cherished national notion.
Easing The Pain
To blunt the impact of deep Medicaid cuts, a few states are experimenting with ways to control the program's costs.
Can Schip Stay Afloat?
By touting its success, advocates hope to spare the children's health insurance program from the budget ax.
Rough Sea's
There's a new and higher level of strain in the already-tense relationship between GASB and state and local officials.
Risk Relief: Indiana Aims to Insure Good Health
A growing number of states and localities are turning to incentives to move the employees they insure into healthier lifestyles. Indiana is going one step further. It is trying to target employees who are at risk for illnesses and offering them special services to improve their odds of staying healthy.
Blocking Erisa
For decades, a federal law has obstructed state innovation on private health care coverage. That's finally changing.
Setting Limits on Medicaid
From TennCare's end to Florida's proposed new beginning, state Medicaid programs are working through difficult times.
Wellness: Carrots and Sticks
There's danger in expecting wellness programs to work miracles and abandoning them when they don't.
The Muni Market Gets a Boost
After years of benign neglect, the municipal bond market is back in the spotlight. Falling interest rates, a volatile stock market and a weakening economy created a resurgence of interest in both issuing and buying muni bonds in the first three quarters of the year.
Rolling Medicaid Rules
Several states made changes in their Medicaid and SCHIP programs that will, in effect, push children off the rolls.
Pension Pressures
These are threatening times for retirement funds and retirees.
The Weight Line
States have a fiscal link to the obesity crisis--it accounts for 5 percent of their overall medical spending.
Bad News Bear
Investment markets can falter. When they do, pension bonds can become a very risky business.
The 'Medmal' Mess
When it comes to reducing medical errors, assessing blame is less effective than identifying patterns and steps to correct problems.
The Job of Patients
Health savings accounts can spur consumers to shop for the best care at the lowest price. But these insurance plans also carry a lot of risk.
Tilting Tills: A So-So Season for Revenue
State tax collections had a strong case of the milds in the second quarter of 2007--a 6.1 percent increase in tax revenue, compared to the same quarter of 2006. That said, this nominal growth rate, as measured by the Rockfeller Institute's "State Revenue Report," was weak by long-term historical standards.
Ups and Downs in the Rating Game
If you've been to Fitch for a credit rating, you may find your bonds experiencing grade inflation.
Primary Interest
The West Virginia legislature recently gave the thumbs up to a radical experiment in health care: doctor-run pay-in-advance plans that provide a family unlimited primary and urgent care for $125 a month. No insurance coverage is involved.
Muni Days are Here Again
A reinvigorated municipal bond market is attracting investors, as well as helping issuers lower their costs.
The HIPAA Headache
It's complex, costly and confusing. Most states are still trying to figure out what the law that standardizes electronic health data is all about.
Setting Up A New Shop
Oregon's former governor is pushing a rational way to control drug costs.
More Over Nasdaq, Muni Bond Prices Are Now Online
A Web site launched in January is a big breakthrough for both investors in and issuers of municipal bonds. The site offers the closest thing yet to a real-time "ticker tape" on bond prices.
Junkyard Blues: Pittsburgh's Fiscal Problems Run It Down
Credit downgrades happen all the time: The economy turns sour, budgets are stressed, the powers that be don't want to raise taxes or slash spending.
Maine's Medical Gamble
Can broader insurance coverage bring health care costs under control? One state is betting on it.
McMedical Care
The rise of health clinics in retail stores could affect both health policy and regulation.
Common-Sense Compliance
Having worked on both sides, Coughlin is passionate in his belief in the assisted-living philosophy, and that belief drives the way he approaches regulation. A key part of assisted living, he points out, is a resident's right to autonomy, but autonomy poses safety risks.