Health Reform: A Four-Tranche System : Updated and Revised

Updated and RevisedStephanie Rennane, C. Eugene Steuerle

This package of tables considers interactions between four different provisions of government support for health care that exist under the new Health Reform law (the Patient Protection and Affordable Care Act, or PPACA): Medicare, Medicaid, Insurance Subsidies offered through the Exchange, and Employer Sponsored Insurance (ESI). The summary table estimates the value of health benefits to families and singles at various income levels under the four options, and the charts show how these benefit levels change as income rises. Estimates for Medicare benefits are from CMS; estimates of Medicaid premiums are from the Health Policy Center. Backup tables work through the calculations for the value of the exchange subsidy and the tax subsidy for ESI.

The backup tables provide a comparison of health subsidies in the employer-provided system and the subsidy exchange in the Health Care and Education Reconciliation Act that was signed into law on March 30, 2010. This is an update to tables that compared health subsidies under the employer-provided system and the subsidy exchange in the earlier versions health reform proposals. The main provisions of the law are found in the Patient Protection and Affordable Care Act (PPACA), originally passed by the Senate on December 24, 2009. The changes in the latest Reconciliation Act that are relevant to this analysis include: (1) premium contributions range from 2% of income for people earning up to 133% of the federal poverty line to 9.5% of income for earners in the 300%-400% FPL range; (2) the employer penalty for not providing coverage in 2014 is $2,000 per full time worker and is indexed in subsequent years; and (3) cost share subsidies ensure an actuarial value of the health premium of 94% for those under 150% FPL; of 85% for 150-200% FPL; of 73% for 200-250% FPL and of 70% for 250% and higher.

We made several assumptions when calculating these estimates. First, we assume that the employer provides only cash wages and health insurance benefits (where applicable), and pays the appropriate employer payroll taxes. Secondly, our starting point was to set the employee's cost to the employer equal under the subsidy and ESI scenarios; this represents the amount of extra or less subsidy to be shared by employee or employer by adding or removing employer-provided insurance. In a simple case where the employer gives the employee the extra benefits from switching to the exchange, for instance, those benefits would be net of any employer penalty that had to be paid. Finally, the two earner scenario assumes that both employees either: (1) both have ESI available; or (2) are both eligible for the exchange. In the exchange situation, we assume that both employers incur a penalty that is passed on to the employee. A family with two earners where only one worker's employer incurs a penalty would resemble the one-earner situation at an equal income level.

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Dutch education system climbs up in the Universitas 21 rankings 2013

Universitas 21, a worldwide consortium of leading research universities, has issued the rankings of countries, which offer higher education for international students. Second year in a row these rankings evaluated various criteria of national education systems as well as their progress and global impact.

Compared to last year result, in 2013 the Netherlands improved its overall position by 2 places and was ranked 7th with 78.2 points, ahead of United Kingdom, Austria, Belgium, Germany, and France. United States and Sweden retained their first and second positions while Canada moved down by 1 place and let Switzerland to the 3rd place.

During this research Universitas 21 assessed education systems of 50 countries by 22 attributes, which were grouped into four main categories: resources (25%), environment (20%), connectivity (15%), and output (40%). First place in each category scored 100 points and the results of other countries were calculated as a fraction of the first place result.

Expenses of the government, private companies, and tertiary institutions spent on higher education define the resources category, which is calculated as an amount of funds per student. Among all categories this one has the highest impact on the output of higher education in a country. Here the Netherlands remained on the 9th place with 82.8 points, higher than France, Germany, and UK, while first three places belonged to Denmark (100), Canada (96.9), and Sweden (96.3).

In the environment category the Netherlands repeated last year success and became the top country in the ranking list. This category identifies how favourable policy and regulations are in a country and how efficiently national education draws assigned funds. Gender balance of students and staff is also taken into balance. The results are very compact here, containing 17 countries in a range from 90 to 100 points with New Zealand and United States on the 2nd and 3rd places.

Compared to 2012 value of the connectivity category in overall rankings was increased by 5% at the cost of even reduce of the environment’s value to include assessing of internet usage. Most important parameters here are still the number of overseas students and frequency of research publications, written in cooperation with international authors.

In the connectivity category Holland improved the result by 24 points since 2012 and was ranked 8th with 76.6 points, just after UK and ahead of US and most of European countries. Switzerland (100), Australia (96.7) and Singapore (94.4) became the first three leaders in this ranking.

Output category embodies such variables as quality and impact of academic research, presence of international universities, level of proficiency of staff and graduates, and employment rate. In this category the Netherlands concluded the first ten with the same scores (51.9) and position as in the last year ranking. Unquestionable leader here is the US, only two-third of this country’s points received UK(63) and Canada (60).

See the overall ranking list of the first 25 countries.

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