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ABSTRACT Background:  Recent changes to Medicaid policy may have unintended consequences in the education system. This study estimated the potential financial impact of the Deficit Reduction Act (DRA) on school districts by calculating Medicaid‐reimbursed behavioral health care expenditures for school‐aged children in general and children in special education in particular. Methods:  Medicaid claims and special education records of youth ages 6 to 18 years in Philadelphia, PA, were merged for calendar year 2002. Behavioral health care volume, type, and expenditures were compared between Medicaid‐enrolled children receiving and not receiving special education. Results:  Significant overlap existed among the 126,533 children who were either Medicaid enrolled (114,257) or received special education (27,620). Medicaid‐reimbursed behavioral health care was used by 21% of children receiving special education (37% of those Medicaid enrolled) and 15% of other Medicaid‐enrolled children. Total expenditures were $197.8 million, 40% of which was spent on the 5728 children in special education and 60% of which was spent on 15,092 other children. Conclusions:  Medicaid‐reimbursed behavioral health services disproportionately support special education students, with expenditures equivalent to 4% of Philadelphia’s $2 billion education budget. The results suggest that special education programs depend on Medicaid‐reimbursed services, the financing of which the DRA may jeopardize.

On August 10, 1993, President Bill Clinton signed the Omnibus Budget Reconciliation Act of 1993, one of the largest fiscal deficit-reduction packages in US fiscal history. This law raised the top individual income tax rate from 31% to 39.6%, which increased the average effective tax rate for high-income earners and shifted the federal fiscal balance from deficit to surplus by the end of the century. Given major business interest groups’ criticism of the Omnibus Budget Reconciliation Act of 1993’s heavy reliance on tax increases over spending cuts, how was the Democrat-controlled Congress able to pass this legislation? Drawing on archival evidence from the Clinton Presidential Library, this paper shows that the administration and Democratic committee chairs mobilized support from corporate CEOs, including Fortune 500 executives, asking them to lobby key legislators to support the bill. Thus, with business leaders’ support and lobbying efforts, the legislation was passed with a very slight majority.

The utilization rate of advanced diagnostic imaging (magnetic resonance imaging, computed tomography, and nuclear medicine) in Medicare outpatients rose 72.7 percent between 2000 and 2005, sparking concern among policymakers. However, analysis of discretionary use of these exams indicates that their use largely stabilized after 2005. Some have credited the Deficit Reduction Act of 2005, which sharply reduced reimbursements for advanced imaging done in physicians' offices. But the fact that the leveling was more pronounced in hospital outpatient facilities than in physicians' offices indicates that the explanation lies elsewhere. More likely, there has been a change in physicians' ordering patterns, possibly due to the influence of radiology business management companies (RBMs) and imaging guidelines promulgated by specialty societies. [PUBLICATION ABSTRACT]

The European debt crisis in 2010 resulted in the adoption of fiscal austerity measures in many European economies, and produced demands for the adoption of similar policies in the United States. This paper examines whether the implementation of immediate fiscal austerity during a fragile economic recovery is justified and whether it is the best means of achieving deficit reduction. The paper points out that although the austerity strategy can lead to deficit reduction and prevent insolvency in the case of an indebted individual, this may not necessarily be the outcome in the case of national indebtedness. The problem is accentuated when austerity measures are replicated in many interdependent economies. The paradox is in general valid when it is assumed that fiscal policy is effective and that fiscal multipliers are positive, assumptions that the New Consensus Macroeconomics theoretical framework that underpins the austerity strategy, inappropriately, rejects. The overall conclusion is that \"synchronized\" fiscal austerity cannot solve the problem of ballooning public debts that need to be tackled in conjunction with attempts to reform the international banking and financial system.

A defining feature of (at least) the last three general elections has been the emphasis placed on each political party’s fiscal credibility and their ability to deliver “sound public finances”. Applying the logic of household book-keeping, balancing the fiscal budget is said to capture such soundness. There is, however, little evidence that a balanced budget is necessarily sound. Instead, the evolution of public finances depends on (1) both the fiscal choices made on the level of spending and taxation, (2) the underlying growth of the economy which depends on far more than the fiscal decisions, and (3) interest rates on government debt and the financing needs of the government. As the economic situation changes, so too does the likely path of debt to GDP and hence the possible fiscal options open to a country. Sticking to the soundbite of “sound finances” has often distracted from the underlying menu of political choices and as such is a disruptive narrative in UK economics today.

The 2005 federal Deficit Reduction Act made proof of citizenship a requirement for Medicaid eligibility. We examined the effects on visits to Oregon's Medicaid family planning services eighteen months after the citizenship requirement was implemented. We analyzed 425,381 records of visits that occurred between May 2005 and April 2008 and found that, compared to the eighteen-month period before the mandate went into effect, visits declined by 33 percent. We conclude that Medicaid citizenship documentation requirements have been burdensome for Oregon Family Planning Expansion Project patients and costly for health care providers, reducing access to family planning and preventive measures and increasing the strain on the safety net. [PUBLICATION ABSTRACT]

Following the passage of the Federal Deficit Reduction Act in 2005, a few states, including West Virginia, redesigned their Medicaid programs to emphasize personal responsibility and consumer-driven health decisions. The West Virginia program was implemented in 2006 and was subsequently abandoned in 2010 due to changes in Federal laws and continuing criticism by advocacy groups whose expectations for enrollment in a wellness-based plan were not met. Using the results of a survey of the West Virginia members, the authors explore the public policy and implementation factors of this program. We argue that initial policy design relied on existing implementation mechanisms, while it needed specific tactics to address the novelty of the choice members were facing. With the passage of the Patient Protection and Affordable Care Act, the West Virginia results provide valuable insights for future health reform policy implementation, especially as they relate to consumer-directed health decision-making and the role of intermediaries who can play a role in assisting consumers in their choices.

The slow and jobless economic recovery, the midterm elections and the passage of healthcare reform legislation dominated the political landscape in 2010. The growing momentum behind federal deficit reduction and budget cuts provided a stark juxtaposition to the previously active federal role in stimulating the economy. Consequently, state and local budgets face significant belt-tightening. The cross-cutting impacts of these and other significant federal and state policy changes are expected to affect future cost sharing in government programs, place a higher burden on state and local governments over the long term and influence the balance of intergovernmental relations. Many of the important developments in politics, policy, and law during 2010-2011 are more notable for their potential future impact as opposed to immediate impact on American federalism.