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The Agricultural Act of 2014 replaced dairy product price supports and countercyclical income support payments with the Margin Protection Program for Dairy Producers. Using farm-level data, producer decisions and aggregate policy costs under a variety of risk environments and policy design alternatives are simulated. Fixed premium rates may result in budget outlays that are substantially higher than for equivalent variable-rate insurance subsidized at levels observed in revenue-based crop insurance policies. Due to the absence of adjusted gross income or production eligibility constraints, a significant portion of benefits may accrue to a small share of large dairy farms.

An evaluation of the risk-reducing effectiveness of the Livestock Gross Margin–Dairy (LGM-Dairy) insurance program, using historical futures price data, predicts economically significant reductions in downside margin risk (24–41%) across multiple regions. Supply analysis based on the estimated risk reduction shows a small supply response, assuming minimal subsidization. A decomposition of the simulated indemnities into milk price and feed price components shows comovements in futures prices moderating the frequency and levels of indemnities.

Producers receive program payments when the MPP-Dairy margin is below the selected coverage level for a 2-month period. Since 2002, the MPP-Dairy margin level has fallen below $8 numerous times but has only fallen below $4 on two occasions (2009 and 2012).

To better understand the financial viability of hospital emergency departments (EDs), we created national estimates of the cost to hospitals of providing ED care and the associated hospital revenue using hospital financial reports and patient claims data from 2009. We then estimated the effect the Affordable Care Act (ACA) will have on the future profitability of providing ED care. We estimated that hospital revenue from ED care exceeded costs for that care by $6.1 billion in 2009, representing a profit margin of 7.8 percent (net revenue expressed as a percentage of total revenue). However, this is primarily because hospitals make enough profit on the privately insured ($17 billion) to cover underpayment from all other payer groups, such as Medicare, Medicaid, and unreimbursed care. Assuming current payer reimbursement rates, ACA reforms could result in an additional 4.4-percentage-point increase in profit margins for hospital-based EDs compared to what could be the case without the reforms. [PUBLICATION ABSTRACT]

The 340B Drug Pricing Program, established in 1992, was designed to help safety-net healthcare providers stretch scarce resources by allowing them to purchase outpatient medications at significant discounts. However, the program’s dramatic expansion, particularly following the Affordable Care Act, and the rise of contract pharmacy arrangements have led to increasing scrutiny regarding its current function and impact. This study examines the flow of funds within the modern 340B ecosystem, with a particular focus on contract pharmacies, pharmacy benefit managers (PBMs), third-party administrators (TPAs), and vertically integrated health systems. Using a detailed mapping of financial transactions, the analysis identifies key areas where profit incentives diverge from the program’s original intent. Covered entities (CEs) often generate substantial profits by purchasing drugs at 340B-discounted rates and receiving standard reimbursements from public and private payers, including Medicare and commercial insurers. These profits are not required to be reinvested in care for underserved populations. Additionally, the use of contract pharmacies and TPAs has introduced significant complexity, increasing the risks of drug diversion and duplicate discounts, particularly with Medicaid and Medicare rebate programs. Vertically integrated PBM pharmacy chains dominate the landscape, often capturing outsized revenue. Legal and regulatory ambiguities further complicate oversight and enforcement. This paper provides an overview of the current 340B funds flow through contract pharmacies, highlighting areas of misalignment with the program’s mission. In doing so, it informs ongoing legislative and administrative reform efforts, emphasizing the need to re-center the program around its intended beneficiaries, low-income and vulnerable patients.

The coverage expansions planned under the Affordable Care Act are to be financed in part by slowing Medicare payment updates to hospitals, thereby reigniting the debate over whether low prices paid by public payers cause hospitals to increase prices to private insurers-a practice known as cost shifting. Recently, the Medicare Payment Advisory Commission (MedPAC) proposed an alternative explanation of hospital pricing and profitability that could be used to support policies that pressure hospitals to reduce overall costs rather than to only raise prices. This study evaluated the cost-shift and MedPAC perspectives using 2008 data on hospital margins for 30,514 Medicare and privately insured patients undergoing any of seven major procedures in markets where robust hospital competition exists and in markets where hospital care is concentrated in the hands of a few providers. The study presents empirical evidence that, faced with shortfalls between Medicare payments and projected costs, hospitals in concentrated markets focus on raising prices to private insurers, while hospitals in competitive markets focus on cutting costs. Policy makers need to examine whether efforts to promote clinical coordination through provider integration may interfere with efforts to restrain overall health care cost growth by restraining Medicare payment rates. Adapted from the source document.

This study demonstrates that some safety-net hospitals-those that provide a large share of the care to low-income, uninsured, and Medicaid populations-survived and even thrived before the recent recession. We analyzed the financial performance and governance of 150 hospitals during 2003-07. We found, counterintuitively, that those directly governed by elected officials and in highly competitive markets were more profitable than other safety-net hospitals. They were financially healthy primarily because they obtained subsidies from state and local governments, such as property tax transfers or supplemental Medicaid payments, including disproportionate share payments. However, safety-net hospitals now face a new market reality. The economic downturn, slow recovery, and politics of deficit reduction have eroded the ability of local governments to support the safety net. Many safety-net hospitals have not focused on effective management, cost control, quality improvement, or services that attract insured patients. As a result, and coupled with new uncertainties regarding Medicaid expansion stemming from the recent Supreme Court decision on the Affordable Care Act, many are likely to face increasing financial and competitive pressures that may threaten their survival. [PUBLICATION ABSTRACT]

Brazil nut collection is key to reconciling sustainable economic development with forest conservation in the Amazon. Whether the activity is profitable, however, remains uncertain due to the paucity of information on spatial distribution and productivity of trees as well as the costs of collection and processing. To fill this gap, this study developed and used a spatially-explicit rent model of Brazil nut production to assess yields and potential profits (rents) from the Brazil nut concessions in Madre de Dios (Peru), under three scenarios of processing and management (unshelled, shelled and shelled-certified nuts). Potential annual production in the region was estimated to be 14.1 ± 2.4 thousand tonnes of unshelled nuts; at 2008 regional sale prices this corresponded to profits of between US$ 3.1 ± 0.5 ha−1 yr−1 for unshelled nuts to US$ 8.4 ± 1.4 ha−1 yr−1 for shelled-certified nuts. Investment of c. US$ 14−17 ha−1 is required to develop certified production in Madre de Dios concessions; this would approximately triple rents in these areas. Such investment could be channelled through REDD+ projects; sustainable management of Brazil nut concessions may contribute to a 42–43% reduction in deforestation in Madre de Dios by 2050.

This paper develops methods for estimating leakage from forest-based carbon projects that seek to reduce carbon emissions from timber harvesting in tropical forests. A theoretical framework is presented in which a specific country, in this case Bolivia, is treated as a supplier to the global timber market. Leakage is measured, over a 30- to 50-year time period, as the difference in net national carbon emissions from timber harvesting between the baseline case and a scenario in which some of the land is removed from the concession base. Estimates of timber leakage are made for several different assumptions about future global sequestration policies, capital constraints, demand elasticity, and deadwood decomposition rates. The results suggest that leakage could range from 5% to 42% without discounting carbon, and from 2% to 38% when carbon is discounted. Demand elasticity and wood decomposition rates have the largest effects on the leakage calculation. Leakage is lowest when demand is more elastic and wood decomposition rates are faster, and vice-versa when these conditions are reversed. Leakage appears to be sensitive to capital constraints only when project benefits are measured over a shorter time period.

Most jurisdictions must assign conservation priorities to peripheral species. British Columbia hosts more than 1300 peripheral taxa, about 900 of which appear on the Red and Blue Lists prepared by the province to guide conservation actions. Conversely, fewer than half of the endemic taxa, or taxa for which the province has major global stewardship responsibility, appear on provincial Red and Blue Lists. We examine why we conserve and list species, concluding that the primary scientific or practical reason is to sustain genetic variability. We consider two broad kinds of peripheral species: disjunct (geographically marginal) populations and continuous peripheral populations that straggle irregularly across provincial boundaries. Populations of both groups may be ecologically marginal, with lambda < 1. We document the degree to which each group enters provincial Red and Blue Lists. Factors used to modify rankings of risk are correlated in a fashion that artificially biases continuous peripheral populations toward rankings of higher risk. Federal initiatives in recovery plans for most continuous peripheral species appear doomed to failure for sound biological reasons. We note alternative approaches to ranking species for conservation action and recommend that conservation efforts for peripheral species be focused on disjunct peripheral populations, rather than continuous peripheral populations.