Effects of employer-sponsored health insurance costs on Social Security taxable wages.

The increasing cost of employer contributions for employee health insurance reduces the share of compensation subject to the Social Security payroll tax. Rising insurance contributions can also have a more subtle effect on the Social Security tax base because they influence the distribution of money wages above and below the taxable maximum amount. This article uses the Medical Expenditure Panel Survey to analyze trends in employer health insurance contributions and the distribution of those costs up and down the wage distribution. Our analysis shows that employer health insurance contributions increased faster than overall compensation during 1996-2008, but such contributions grew only slightly faster among workers earning less than the taxable maximum than they did among those earning more. Because employer health insurance contributions represent a much higher percentage of compensation below the taxable maximum, health insurance cost trends exerted a disproportionate downward pressure on money wages below the taxable maximum.

[Social security law and evidence-based health care in Germany]. / Sozialrecht und evidenzbasierte Gesundheitsversorgung in Deutschland.

The present contribution examines whether German Social Security Law requires or allows the German health care system to follow the principles of evidence-based health care. The discussion will be based on the relevant example of statutory health insurance (Book of Social Code V-SGB V). According to Sect. 2 SGB V health care provision has to follow medical standards, acknowledging medical progress. It has to be effective and efficient. Special therapies are not outlawed, but also have to follow these principles. Efficiency is defined (Sect. 12 SGB V) by the benefits being sufficient and necessary. The responsibility for achieving these goals and supplying the benefits for all people according to need lies with the health care insurance funds along with the physicians' associations (Kassenirztliche Vereinigung) and the hospitals (Sect. 70 SGB V). These organisations cooperate in the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA, Sect. 92 SGB V), where they have to hear organisations of patients and of the disabled also. The G-BA is allowed by law to exclude therapies not meeting the SGB V criteria. The Institute for Quality and Efficiency in Health Care (IQWiG) advises the G-BA and is also responsible for generating evidence. A major political and constitutional controversy has been triggered on the legitimation of the Federal Joint Committee. In its statute the G-BA recurs on evidence-based health care. It examines therapies according to the degree of available evidence and the usability of the evidence in the respective supply setting. The Federal Social Court (Bundessozialgericht, BSG) decided that the decisions of the G-BA could not be challenged for being medically incorrect. In 2005, the Federal Constitutional Court (Bundesverfassungsgericht-BVerfG) decided that a stricter control over the G-BA by the social courts was needed and that in the case of serious disease a lower evidence level might be sufficient. BSG and G-BA will continue to accept the results and methods of Evidence-based Medicine.

[Can total loss of ability to paid work mean a simultaneous maintenance of ability to paid work at wages exceeding 100%?]. / Czy calkowita utrata zdolnosci ci do pracy zarobkowej moze oznaczac równoczesnie zachowanie zdolnosci do zarobkowania w ponad 100%?

To illustrate and evaluate the efficiency of presently enforced limits of earning for pensioners and the percentage of working pensioners whose earnings are within the limits, the authors compared data from 2001 and 2005 that described declared income from paid work of pensioners with different grades of inability established by the Pita Branch of the Social Insurance Institute (ZUS). It was demonstrated that only 14.75% of all pensioners in the ZUS Pita Branch declared income from paid work, with 96.55% declaring income below 70% of the average national monthly earnings, 2.12%--between 70-130% of the average monthly earnings, and only 1.32% of individuals declaring income over 130% of the average salary. As it follows from the above analysis, the legal limits of allowable income were applicable to 3.34% of all working pensioners only, imposing limits on their earnings. If the number of professionally active pensioners nationwide subject to income restrictions due to earnings in excess of 70% of the average national monthly salary was compared to the total number of pensioners in the ZUS Pita Branch, the percentage of the latter was only 0.51% in 2005.

Raising the Social Security Entitlement Age.

An aging America presents challenges but also brings social and economic capital. We quantify public revenues from, and public expenditures on, Americans aged 65 and older, the value of their unpaid, productive activities and financial gifts to family. Using microsimulation, we project the value of these activities, and government revenues and expenditures, under different scenarios of change to the Old Age and Survivors Insurance eligibility age through 2050. We find the value of unpaid productive activities and financial gifts are US$721 billion in 2010, while net (of tax revenues) spending on the 65 years and older is US$984 billion. Five-year delay in the full retirement age decreases federal spending by 10%, while 2-year delay in the early entitlement age increases it by 1.5%. The effect of 5-year delay on unpaid activities and transfers is small: US$4 billion decrease in services and US$4.5 billion increase in bequests and monetary gifts.

Office of the Secretary--Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); double coverage; correction. Correction to final rule.

The purpose of this correction to the regulations on implementation of the Civilian and Medical Program of the Uniformed Services (32 CFR Part 199) is to reinsert at section 199.14, Double Coverage, paragraph (d) (3), Title XVIII of the Social Security Act, as Amended: Medicare.

Old-age, survivors, and disability insurance and supplemental security income for the aged, blind, and disabled; substantial gainful activity amounts. Social Security Administration. Final rules.

We are revising the rules for determining when earnings demonstrate the ability to engage in substantial gainful activity (SGA). This rule change applies to Social Security disability benefits provided under title II of the Social Security Act (the Act) and Supplemental Security Income (SSI) benefits based on disability under title XVI of the Act. (Eligibility for benefits under titles II and XVI also confers eligibility for related Medicare and Medicaid benefits under titles XVIII and XIX of the Act.) Specifically, we are raising from $500 to $700 the average monthly earning guidelines used to determine whether work done by persons with impairments other than blindness is SGA. We are raising this level as part of efforts to encourage individuals with disabilities to attempt to work, and to provide an updated indicator of when earnings demonstrate the ability to engage in SGA. This increase reflects our assessment of the amount that roughly corresponds to wage growth since the last increase in 1990.

Obamacare: what the Affordable Care Act means for patients and physicians.

The Affordable Care Act's core achievement is to make all Americans insurable, by requiring insurers to accept all applicants at rates based on population averages regardless of health status. The act also increases coverage by allowing states to expand Medicaid (the social healthcare program for families and people with low income and resources) to cover everyone near the poverty line, and by subsidizing private insurance for people who are not poor but who do not have workplace coverage. The act allows most people to keep the same kind of insurance that they currently have, and it does not change how private insurance pays physicians and hospitals. Although the act falls short of achieving truly universal coverage, nine million uninsured people have received coverage so far. Market reforms have not hurt the insurance industry's profitability, prices for individual insurance have been lower than expected, and government costs so far have been less than initially projected. The act expands several ongoing pilot programs in Medicare that reform how doctors and hospitals are paid, but it does not directly change how private insurers pay healthcare providers. Nevertheless, it has set into motion market dynamics that are affecting medical practice, such as limiting insurance networks to fewer providers and requiring patients to pay for more treatment costs out of pocket. In response, many hospitals and physicians are forming closer and larger affiliations. Further time and study are needed to learn whether these evolutionary changes will achieve their goals without harming the doctor-patient relationship.