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Many scholars have argued that because consumers are poorly organized, regulatory enforcement will tend to be lax and serve the interests of industry. Considering, however, that elections are one of the main mechanisms by which the public exerts control over policy, surprisingly few studies have examined how electoral incentives may spur the government to regulate vigorously on behalf of consumers. We argue that when the threat of electoral accountability is greater, regulatory activities will serve the interests of the public, even if they impose costs on industry. We test this theoretical expectation by analyzing state regulatory activity in the wake of exogenous storms and natural disasters, which provide us with important theoretical and causal leverage. We find that a more “pro-regulation” electorate and elected chief regulators acting in close proximity to elections are associated with pro-consumer regulatory action. [ABSTRACT FROM AUTHOR]

Objectives. We examined employers’ responses to San Francisco, California’s 2007 Paid Sick Leave Ordinance. Methods. We used the 2009 Bay Area Employer Health Benefits Survey to describe sick leave policy changes and the policy’s effects on firm (n = 699) operations. Results. The proportion of firms offering paid sick leave in San Francisco grew from 73% in 2006 to 91% in 2009, with large firms (99%) more likely to offer sick leave than are small firms (86%) in 2009. Most firms (57%) did not make any changes to their sick leave policy, although 17% made a major change to sick leave policy to comply with the law. Firms beginning to offer sick leave reported reductions in other benefits (39%), worse profitability (32%), and increases in prices (18%) but better employee morale (17%) and high support for the policy (71%). Many employers (58%) reported some difficulty understanding legal requirements, complying administratively, or reassigning work responsibilities. Conclusions. There was a substantial increase in paid sick leave coverage after the mandate. Employers reported some difficulties in complying with the law but supported the policy overall. [ABSTRACT FROM AUTHOR]

As implementation of the Affordable Care Act reshapes the US health insurance market, state policy makers should be prepared to revisit regulation of stop-loss coverage--a form of reinsurance--for small businesses. Aspects of the reform law could motivate small businesses to self-insure, rather than participate in state-regulated markets either inside or outside the new health insurance exchanges. If younger or healthier groups self-insure, premiums for insured plans might rise to an extent that could seriously impair the regulated market. States can influence small businesses to participate in the regulated market by making it more difficult or costly to obtain stop-loss coverage, which self-funded employers rely on to protect their businesses from catastrophic medical costs incurred by one or more insured workers. States can limit the comprehensiveness of stop-loss coverage, ban stop-loss coverage outright, or regulate it as they do primary coverage. But states need federal guidance about how to exercise this authority if they are to promote, or prevent the undermining of, important aspects of federal health care reform. [ABSTRACT FROM AUTHOR]

The Affordable Care Act changed the regulations governing small firms' health insurance premiums. However, small businesses can avoid many of the new regulations by self-insuring or maintaining grandfathered plans. If small firms with healthy and lower-cost enrollees avoid the regulations, premiums for coverage sold through insurance exchanges could be unaffordable. In this analysis we used the RAND Comprehensive Assessment of Reform Efforts microsimulation model to predict the effects of self-insurance and grandfathering exemptions on coverage and premiums available through the exchanges. We estimate that Affordable Care Act regulations restricting employers' ability to offer grandfathered plans will result in lower premiums on plans available through the exchanges and will have small negative effects on enrollment in the exchanges. Our results suggest that these regulations are essential to keeping premiums on the Small Business Health Options Program (SHOP) exchanges affordable. Our analysis also found that Affordable Care Act regulations limiting self-insurance will reduce enrollment in the exchanges somewhat, without substantially affecting exchange premiums. [ABSTRACT FROM AUTHOR]

The article provides an update on the ruling from the Fifth Circuit Court of Appeals on the status of the Affordable Care Act as of October 2019. Topics covered include reports issued by the U.S. Department of Health and Human Services on the risk adjustment program, a decline in individual-market enrollment among unsubsidized consumers since 2016, and the estimated number of people in 50 states and the District of Columbia that affectuated their 2019 Marketplace coverage as of February 2019.

The article focuses on the campaign by the Australian Traditional Medicine Society (ATMS) to reverse the decision by the federal government to remove modalities from health fund coverage as part of its package to reduce health fund premiums. Topics discussed include the modalities that the government plans to remove from health funds, messages behind the pro-active public relations (PR) and lobbying strategy by the ATMS, and an overview of the campaign.