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Nonresident alien individuals who visit the United States and play slot machines in a state where slots are legal have always been subject to tax at a thirty percent rate, unless exempted by treaty, on their U.S. source wagering gains as defined by I.R.C. § 871(a)(1)(A). This tax is enforced by a withholding system that requires casinos to withhold thirty percent of each slot jackpot of $1,200 or more and remit those funds to the United States government. The definition of wagering gains was first addressed in Barba v. United States. The Barba case instituted the per-bet rule that defined wagering gains to be equal to gross winnings taxable under I.R.C. § 871(a). Under the per-bet rule, all wagers and wagering losses were never considered in calculating the amount of tax due. The per-bet rule ignored the fact that gambling is by nature a series of individual bets and had the practical result that no foreign slot player could ever recover any of the taxes withheld by the casino on their jackpots. Between 1983 and 2011, no taxpayer ever questioned the per-bet rule and it was not until the case of Sang Park v. Commissioner,3 a case recently decided by the United States Court of Appeals for the District of Columbia Circuit, that a court revisited the issue of defining wagering gains for purposes of I.R.C. § 871(a). Sang Park v. Commissioner rejects the per-bet rule from Barba and puts an end to the Internal Revenue Service ("IRS") practice of keeping all of the taxes withheld on slot jackpots. Instead, foreign slot players should calculate their wagering gains from slot play on the same basis as domestic slot players utilizing the per-session approach that was suggested by a government ruling and approved by the Tax Court in Shollenberger v. Commissioner. Under the per-session rule, wagering gains are calculated and taxed based upon an overall result of wins and losses during a specified period of time called a session. There is still work to be done in defining what a session means and to explore whether the per-session approach might apply to games other than just slots. The Sang Park case opens the possibility of foreign slot players recalculating their tax based upon the per-session rule and filing for refund for taxes withheld in any tax year not closed by the statute of limitations. [ABSTRACT FROM AUTHOR]

Objective. To identify the degree of selection into consumer-directed health plans (CDHPs) versus traditional plans over time, and factors that influence choice and temper risk selection. Data Sources/Study Setting. Sixteen large employers offering both CDHP and traditional plans during the 2004-2007 period, more than 200,000 families. Study Design. We model CDHP choice with logistic regression; predictors include risk scores, in addition to family, choice setting, and plan characteristics. Additional models stratify by account type or single enrollee versus family. Data Collection/Extraction Methods. Risk scores, family characteristics, and enrollment decisions are derived from medical claims and enrollment files. Interviews with human resources executives provide additional data. Principal Findings. CDHP risk scores were 74 percent of traditional plan scores in the first year, and this difference declined over time. Employer contributions to accounts and employee premium savings fostered CDHP enrollment and reduced risk selection. Having to make an active choice of plan increased CDHP enrollment but also increased risk selection. Risk selection was greater for singles than families and did not differ between HRA and HSA-based CDHPs. Conclusions. Risk selection was not severe and it was well managed. Employers have effective methods to encourage CDHP enrollment and temper selection against traditional plans. [ABSTRACT FROM AUTHOR]

Objectives. There is a debate regarding the effect of cost sharing on immunization, particularly as the Affordable Care Act will eliminate cost sharing for recommended vaccines. This study estimates changes in immunization rates and spending associated with extending first-dollar coverage to privately insured children for four childhood vaccines. Methods. We used the 2008 National Immunization Survey and peer-reviewed literature to generate estimates of immunization status for each vaccine by age group and insurance type. We used the Truven Health Analytics 2006 MarketScan Commercial Claims and Encounters Database of line-item medical claims to estimate changes in immunization rates that would result from eliminating cost sharing, and we used the Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey to determine the prevalence of coverage for patients with first-dollar coverage, patients who face office visit cost sharing, and patients who face cost sharing for all vaccine cost components. We assumed that once cost sharing is removed, coverage rates in plans that impose cost sharing will rise to the level of plans that do not. Results. We estimate that immunization rates would increase modestly and result in additional direct spending of $26.0 million to insurers/employers. Further, these payers would have an additional $11.0 million in spending associated with eliminating cost sharing for children already receiving immunizations. Conclusions. The effects of eliminating cost sharing for vaccines vary by vaccine. Overall, immunization rates will rise modestly given high insurance coverage for vaccinations, and these increases would be more substantial for those currently facing cost sharing. However, in addition to the removal of cost sharing for immunizations, these findings suggest other strategies to consider to further increase immunization rates. [ABSTRACT FROM AUTHOR]