Len Nichols

Len Nichols
George Mason University | GMU · Center for Health Policy Research and Ethics

Ph.D.

About

63
Publications
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1,119
Citations

Publications

Publications (63)
Article
The issues before the Supreme Court, arising as they did out of multiple cases and divergent appellate court rulings, were quite complex, and its final decision will be parsed rather differently by lawyers, health policy wonks, and economists (or metaphysical philosophers, in Chief Justice John Roberts's memorable phrase). This essay will focus on...
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This essay makes the affirmative case for health reform by expounding on three fundamental points: (1) one moral case for expanding access to coverage and care to all is grounded in scriptural concepts of community and mutual obligation which continue to inform the American pursuit of justice; (2) the structure of PPACA springs from an appreciation...
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Obesity is a particularly vexing public health challenge, since it not only underlies much disease and health spending but also largely stems from repeated personal behavioral choices. The newly enacted comprehensive health reform law contains a number of provisions to address obesity. For example, insurance companies are required to provide covera...
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Lost in the rhetoric about the supposed government takeover of health care is an appreciation of the inherently federalist approach of the Patient Protection and Affordable Care Act. This federalist tradition, particularly with regard to health insurance, has a history that dates back at least to the 1940s. The new legislation broadens federal powe...
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Voters are angry and distrustful of Washington. Democrats have lost their nerve. Republicans, sensing weakness, are closing in for the kill. We have seen this health care reform horror movie before. Our leaders in Congress and the White House face a fateful fork in the road. They can follow the public's fear and confusion down the path of perpetual...
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The United States appears headed toward another national debate about health system reform. Worry about access and health system deficiencies has reached critical mass, and polls indicate that health care leads the domestic agenda for the 2008 elections. This debate, like previous debates, will succeed or fail in Congress. We highlight key elements...
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Expanding insurance coverage is a critical step in health reform, but we argue that to be successful, reforms must also address the underlying problems of quality and cost. We identify five fundamental building blocks for a high-performance health system and urge action to create a national center for effectiveness research, develop models of accou...
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Before the crucial upcoming debate over reauthorization of the State Children's Health Insurance Program (SCHIP) and all of the 10,000 general health reform questions that this discussion will engender, we should consider one fundamental moral question, for our answer will reveal the kinds of policies we actually want to pursue: Who should be allow...
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This paper asserts that America's health care system is broken and cannot be repaired with timid half-measures. It suggests that we need both universal coverage and a more efficient delivery system and that these are not competing objectives: Each is necessary to make the other possible. It further states that if we do not make health care more aff...
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Examination of the extent to which federal surveys provide the data needed to estimate the coverage/cost impacts of policy alternatives to address the problem of uninsurance. Assessment of the major federal household surveys that regularly provide information on health insurance and access to care based on an examination of each survey instrument a...
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Unsustainable health care cost growth has forced payers to reexamine goals for hospital payment systems. Employers want simplicity and transparency, with comparative performance data available in the public domain. Insurers favor simplicity but prefer to keep the analysis of comparative performance data and pricing private. Thirty-five pay-for-perf...
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Previous research has not found a strong association between Medicaid reimbursement levels and enrollees' access to medical care, even though higher fees increase the acceptance of Medicaid patients by physicians. This study shows that high Medicaid acceptance rates by physicians in a community are more important than fee levels per se in affecting...
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A specific focus for state regulations of the small group insurance market was to increase offers and stabilize premiums for firms with high-risk workers. We examine the effect of reforms implemented from 1993 through 1996 on the likelihood of employer sponsored insurance coverage. We find that packages of reforms that included both guaranteed issu...
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After slow growth during much of the 1990s, Medicaid physician fees increased, on average, by 27.4 percent between 1998 and 2003. Primary care fees grew the most. States with the lowest relative fees in 1998 increased their fees the most, but almost no states changed their position relative to other states or Medicare. Physicians in states with the...
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Our paper draws lessons for policymakers from twelve communities as we identify the power and limits of general market-based strategies for improving the efficiency of health systems. The vision of market forces driving our system toward efficiency attracted politicians, policy analysts, and practitioners in the 1990s. Today some policy advocates p...
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The persistently large number of uninsured, roughly 40 million per year since 1993, continues to elicit bipartisan policy interest. Coverage-expansion proposals without mandates, by far the most common since the defeat of the Clinton plan, must address risk-pooling realities in private markets. Insurers have strong financial incentives to segment r...
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Individual health insurance is more administratively costly and more prone to adverse selection (especially in the presence of community rating) than group health coverage is. In this paper we show that the individual market has been shrinking over time but that it might be stimulated if tax credits for such insurance were made available. The prima...
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Rapidly rising health insurance premiums are prompting Little Rock employers to shift more costs to workers, who are finding coverage increasingly difficult to afford, according to this new Community Tracking Study report.
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Compared with the hospital and health plan contract disputes and financial woes of two years ago, the Boston health care market has stabilized as hospitals and plans regained their financial footing, according to a new report from the Community Tracking Study.
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A roadmap through the areas of agreement and disagreement in a critical debate on how to solve the problem of too many uninsured Americans. by Mark V. Pauly and Len M. Nichols ABSTRACT: Individual health insurance is more administratively costly and more prone to adverse selection (especially in the presence of community rating) than group health c...
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This paper focuses on one key question: can a widespread shift to defined contribution health plan arrangements (DC health) lower the growth rate of health care costs? The answer to this question is in two parts: (1) What are the root causes of health care cost inflation? (2) What will be the price responsiveness of workers with structured incentiv...
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This paper uses data from the 1997 National Health Interview Survey to compare workers who decline employers' offers of health insurance (decliners) with comparison groups of workers who take up offers of employer coverage and those who do not have such offers. Uninsured decliners fare much worse than coverage takers on every mental health measure....
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Studying worker health insurance choices is usually limited by the absence of price data for workers who decline their employer's offer. This paper uses a new Medical Expenditure Panel Survey file which links household and employer survey respondents, supplying data for both employer insurance takers and declines. We test for whether out-of-pocket...
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Premium rebates allow beneficiaries who choose more efficient Medicare options to receive cash rebates, rather than extra benefits. That simple idea has been controversial. Without fanfare, however, premium rebates have become a key area of agreement in the debate on Medicare reform. Moreover, in legislation in late 2000, it became official policy:...
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There is much policy talk about making Medicare more competitive, like private markets. But when reform proposals near implementation, local opponents of competition are often able to stop reform experiments. This paper reports on one recent example, the Competitive Pricing Advisory Committee, created by the 1997 Balanced Budget Act (BBA) to bring...
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Of all the different health insurance venues in the United States, small group and individual markets consistently engender the most complaints. Compared to large group purchasers, small groups and individuals suffer more from administrative diseconomies of scale, difficulties in spreading risk among themselves, and the absence of bargaining power...
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To describe the contributions of nonprofit hospitals and health plans to healthcare markets and to analyze state policy options with regard to the conversion of nonprofits to for-profit status. Secondary national and state data from a variety of sources, 1980-present. Policy analysis. Development of a conceptual economic framework; analysis of empi...
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The Health Insurance Portability and Accountability Act of 1996 (HIPAA; PL 104-191), popularly known as the Kassebaum-Kennedy legislation, contains a broad array of provisions with collective implications for a large segment of the population. The legislation contains provisions affecting the private insurance markets, the federal tax code, and str...
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The Health Insurance Portability and Accountability Act (HIPAA) of 1996 has been praised and criticized for asserting federal authority to regulate health insurance. We review the history of federalism and insurance regulation and find that HIPAA is less of a departure from traditional federal authority than it is an application of existing tools t...
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As managed care has spread, so has legislation to force plans to contract with any willing provider (AWP) and give patients freedom of choice (FOC). Managed care organizations' selective networks and provider integration reduce patient access to providers, along with provider access to paying patients, so many providers have lobbied for AWP-FOC law...
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Health insurance reform is complex, and discussions about preferred reforms are often marked by confusion. This paper focuses on the fundamental issue: how best to address adverse selection. We develop four reform packages that could improve insurance market performance without aggravating risk selection problems. We then compare the principles app...
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The recent health care reform debate has questioned whether the health insurance market effectively pools risks and transfers income across states of health. We use data from the 1987 National Medical Expenditure Survey to examine how net health insurance benefits are distributed in the employment-related insurance market. We find this market to tr...
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A model for estimating the cost of underutilizing nurses in advanced practice is proposed. Numerical requirements for implementing the model are detailed and examples are provided.
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This paper tests hypotheses on the sources of scope economies in a large sample of U.S. manufacturing firms. Federal Trade Commission Line of Business data are used to construct a new measure of scope economies that is appropriate for cross-section data. The measure and the LB data are capable of distinguishing between production and distribution e...
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In this paper we test Keynesian and neoclassical assumptions concerning the existence of second-hand markets for physical capital. These alternative views of the dynamic profit maximizing firm lead to distinct equilibrium price equations. We use a sample of 4-digit SIC consumer goods and capital goods industries over 1967–1975 to test the relative...
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Type: Nonprofit integrated delivery system. BHCS owns a 450-physician medical group subsidiary and is affiliated with 3,000 independent physicians who deliver care at 15 Baylor-owned, leased, or affiliated hospitals and six "short-stay" hospitals.      ABSTRACT: Baylor Health Care System is a nonprofit integrated delivery system based in the D...
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Everyone interested in solutions to our health system's problems (and who isn't) is looking to Massachusetts in the wake of its recent landmark legislation. Like the Rorschach ink blot test, many commentators see what they want to see, not what is actually there. Pessimists emphasize the uniqueness of Massachusetts and rush to proclaim that it can...
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The Health Insurance Portability and Accountability Act (HIPAA) of 1996 has been praised and criticized for asserting federal authority to regulate health insurance. We review the history of federalism and insurance regulation and find that HIPAA is less of a departure from traditional federal authority than it is an application of existing tools t...
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Full-text available
Health insurance is the gateway to health and to our health care system, yet over five million Californians are uninsured, 1 about 800,000 of whom are children. 2 Having health insurance facilitates access to affordable care from a network of health care providers and shields families from financial ruin in the case of a catastrophic medical emerge...