Budget Office Research Articles

The Secretary Shall ... : Implementing the Affordable Care Act's Private Insurance Expansions.

The federal bureaucracy played a critical role in implementing most aspects of the Affordable Care Act's private insurance coverage expansion. Through brief case studies, the authors review three dimensions of this role: the development of the Center for Consumer Information and Insurance Oversight, rulemaking in the formulation of the essential health benefits package, and the implementation of the federal website. They relate these to themes in the public administration literature. Politics-both through state decisions and through continuing congressional action (and inaction)-pervaded the implementation process. The challenges of staffing and situating the new bureaucracy effectively changed vertical boundaries within the Department of Health and Human Services, with long-lasting consequences. Finally, the complex design of the policy itself made passage of the legislation easier but implementation much more difficult. Ultimately, however, implementation was remarkably successful, achieving improvements in coverage consistent with the Congressional Budget Office's projections.

Limited‐Income Customers: How Utilities Can Bridge the Energy Affordability Gap and Build a Financially Stable Customer Base

While many traditional economic indicators demonstrate the US economy continues to be strong, there is evidence the disparity of income and overall prosperity is growing. This growing economic inequality is a significant concern in the United States, where one in nine (38.1 million) Americans are living in poverty, ranking the United States as having the second‐highest poverty rate of the 35 Organisation for Economic Co‐operation and Development countries. Not only are many Americans struggling to live, but studies show these families have fewer assets and more debt than years before. A recent Congressional Budget Office report found that from 1989 to 2013, American families in the bottom percentile lost wealth over this period, while all other groups gained wealth, especially families holding the top 10 percent of wealth as shown in Figure 1.

Investigating the inefficiency of the CBO’s budgetary projections

This paper evaluates the efficiency of budgetary projections issued by the Congressional Budget Office (CBO) from 1984 to 2016 and investigates the cause of their inefficiency. The efficiency of both its budgetary and macroeconomic projections is rejected in many cases, especially for revenue projections. A comparison of forecast evaluations suggests that the inefficiency of revenue projections is likely due to the inefficiency of the underlying macroeconomic projections. By adjusting budgetary projections by the CBO in real time using macroeconomic forecasts by the Survey of Professional Forecasters, the accuracy of the former projections can be significantly improved in some cases, by up to 26% in terms of the root-mean-square prediction error.

Investigating the Inefficiency of the CBO's Budgetary Projections

In this paper, I evaluate the efficiency of the Congressional Budget Office's (CBO) budgetary projections from 1984 to 2016 and investigate the causes of the projections' inefficiency. The efficiencies of both the CBO's budgetary and macroeconomic projections are rejected in many cases, especially for revenue projections. The comparison of forecast evaluations suggests that the inefficiency of revenue projections is likely due to the inefficiency of the underlying macroeconomic projections. By adjusting the CBO's budgetary projections in real time using the Survey of Professional Forecasters' macroeconomic forecasts, I find that the accuracy of the projections can be significantly improved in some cases, with a magnitude up to 26% in root-mean-square prediction error.

Budgetary bias in the Finnish public hospital system

PurposeThe purpose of this paper is to analyze the dynamics of budgetary biasing in the context of public hospitals.Design/methodology/approachThe study applies theories of accounting and budgeting behaviors in the specific institutional context of health care systems. Based on the theoretical framework, data from interviews with hospital budget officers were analyzed using qualitative content analysis.FindingsA typology of biases is provided. It proved to be useful and highlighted the central empirical assumptions and preliminary results of biasing dynamics.Practical implicationsUnderstanding the logic of budgeting actors and the drivers of bias may help explain why bias so often appears in health care budgeting. It further contributes to understanding whether the bias is functional or dysfunctional.Originality/valueThe concepts of budgetary bias are rarely used in the context of health care budgeting, so the study fills a gap in research knowledge.

Kenya

This report updates the Fiscal Transparency Evaluation (FTE) of Kenya that was prepared in 2014 and published in 2016. The report is the first full update to be carried out in any country, a recent update of the Russian FTE having a more selective focus. Kenya has experienced a lot of structural and economic changes since 2014. At that time, the 2010 Constitution and the associated Public Financial Management (PFM) Act of 2012 were relatively new, and a radical reform of local government was in the process of transition. The Constitution and the PFM Act placed a strong emphasis on economic and fiscal transparency and accountability, for example, through the establishment of the National Treasury (NT), fiscal responsibility principles, the Parliamentary Budget Office, and enhanced powers of the Auditor General. The present report, like the 2014 assessment, focuses on the first three pillars of the Code. The authorities did not request the Fund to make an evaluation of Pillar IV (Resource Revenue Management) since the development of the oil sector in Kenya is at an early stage, with the volume of reserves uncertain and first oil not expected before 2022 at the earliest.

The ACA’s Medicaid Expansion: A Review of Ineligible Enrollees and Improper Payments

Enrollment in state-optional Medicaid expansions has significantly exceeded even the most optimistic forecasts. The open-ended federal financing of new adult Medicaid enrollees at elevated match rates — in excess of 90 percent — creates incentives for states and healthcare providers to improperly enroll new beneficiaries and inadequately monitor costs and eligibility. Several sources find that many states have done a poor job ensuring Medicaid enrollment only of those who meet eligibility requirements. First, several federal audits find massive problems with both incomplete and incompetent reviews and large-scale improper eligibility determinations. We summarize recent work that estimates causal effects of Medicaid expansions on enrollment. Using the publicly available American Community Survey, we demonstrate large increases in potentially improper enrollment from 2012 to 2017 in many expansion states across the United States. The evidence points to egregious eligibility errors in many states, including Arkansas, California, Colorado, Kentucky, Louisiana, Montana, New Mexico, New York, Oregon, Rhode Island, Washington, and West Virginia. Other expansion states have had much lower rates of improper enrollment. We offer recommendations to Congress, the Centers for Medicare and Medicaid Services, and the Congressional Budget Office on ways to confront improper enrollment in Medicaid, including both fundamental reform of program financing and meaningful federal oversight.

Stop Regulating Government Paperwork With More Government Paperwork

The Paperwork Reduction Act (PRA) is an often-ignored law with a large impact. Federal agencies cannot ask the same questions of more than nine people or entities without submitting a proposed information collection to the White House Office of Management and Budget for review, a process that can take up to a year to complete. In an attempt to regulate the amount of paperwork foisted on the public, the PRA has created an enormous amount of paperwork for federal agencies—without any meaningful reduction in the paperwork burden faced by the public. Yet, likely because the burden of the PRA is borne primarily within agencies themselves, this law has gone relatively understudied by legal academics. This note considers the PRA—its history, purpose, functions, benefits and costs—and concludes that the PRA should be largely eliminated.

Understanding and Interpreting Law School Enrollment Data

The Law School Admission Council (LSAC) has a long-standing commitment to diversity, equity, and inclusion in legal education and in the legal profession. In line with its mission to promote quality, access, and equity in legal education, LSAC is providing a report, Understanding and Interpreting Law School Enrollment Data: A Focus on Race and Ethnicity, to help law schools, admission professionals, and other legal education stakeholders understand how we are measuring who is in the pipeline. The purpose of the report is to inform conversations about diversity, equity, and inclusion in law school and recruitment efforts. The report outlines the history of the Office of Management and Budget (OMB) data reporting standards, how these differ from LSAC data collection and reporting practices, and the social and cultural implications of different race and ethnicity data collection and reporting methods. The report includes examples of how the different methods affect conclusions that can be drawn from analyses of subgroup trends over time.

A Future for Federal Regulatory Budgeting?

For decades, a strong case has been made for comprehensive reform of the U.S. federal government’s regulatory processes (for early contributions, see Weidenbaum & DeFina, 1978; Lave, 1981; Breyer, 1982; Harrison & Portney, 1983; Litan & Nordhaus, 1983; Viscusi, 1992; Breyer, 1993; Sunstein, 1996; Graham, 1996, 1997). Establishment of centralized Office of Management and Budget (OMB) oversight through the Office of Information and Regulatory Affairs (OIRA) was an important achievement, but Congress has not yet passed comprehensive regulatory reform legislation.

Understanding the Revenue Potential of Tax Compliance Investment

In a July 2020 report, the Congressional Budget Office estimated that modest investments in the IRS would generate somewhere between $60 and $100 billion in additional revenue over a decade. This is qualitatively correct. But quantitatively, the revenue potential is much more significant than the CBO report suggests. We highlight five reasons for the CBO’s underestimation: 1) the scale of the investment in the IRS contemplated is modest and far short of sufficient even to return the IRS budget to 2011 levels; 2) the CBO contemplates a limited range of interventions, excluding entirely progress on information reporting and technological advancements; 3) the estimates assume rapidly diminishing returns to marginal increases in investment; 4) the estimates leave out the effect of increased enforcement on taxpayer decision-making; and 5) the use of the 10-year window means that the long-run benefits of increased enforcement are excluded. We discuss these issues, present an alternative calculation, and conclude that a commitment to restoring tax compliance efforts to historical levels could generate over $1 trillion in the next decade.

Office of Information and Regulatory Affairs: Past, Present, and Future

AbstractThis article has three sections, each of which deals with an Executive Order. The first section, “Office of Information and Regulatory Affairs (OIRA) Past,” emphasizes the critical role that Executive Orders played in the formation of OIRA. More specifically, OIRA owes its initial existence to the establishment of a centralized regulatory review system, the Quality of Life Review, which initiated Office of Management and Budget (OMB) review of environmental regulations through the issuance of a directive from OMB. Every subsequent President expanded OMBs powers through the issuance of Executive Orders which culminated in the Iconic Executive Order 12291. The section concludes with the recommendation that a select class of Executive Orders, and OMB Directives, be designated as “Iconic” by the National Archivist in consultation with the OIRA, and then given substantial deference by incoming Administrations. The second section, “OIRA Present,” describes an Executive Order issued during the Kennedy Administration which remains in effect but was promulgated prior to the establishment of OIRA and therefore recommends that a new Executive Order be issued which gives OIRA specific authority to participate in the conduct of interagency reviews of Executive Orders. The third section, “OIRA Future,” describes an Executive Order which implements a regulatory budget (RB) and institutionalizes a mechanism for controlling the size of the administrative state. This final section of the article recommends that the aforementioned Executive Order be reviewed and modified based upon the outcome of a request for public comments, and rules with demonstrated positive net benefits should no longer be accorded an automatic entitlement for issuance as a final rule absent their inclusion in an RB.

Health Financing and Budgeting Practices

This article presents the findings of the OECD Survey of Senior Budget Officials on Budgeting Practices from a 2017 survey covering the Asia and Oceania, and Central, Eastern and South Eastern European regions. The survey is part of the ongoing engagement between health and budget officials in the OECD’s regional networks and provides an comparable set of data to analyse and benchmark good practices in health budgeting. The results of the survey point to an increasing use of budgeting tools from developed countries and support continued engagement to improve budget activities and to meet future challenges of health systems. JEL codes: H51, I13, I18Keywords: Budgeting practices, health sector, Asia, Europe

Budgeting practices to improve health system performance

This article presents the main findings of two OECD Surveys of Senior Budget and Health Officials conducted in the Latin American and Caribbean region. The surveys help to understand the approaches to budgeting, and take account of the prominent role of agents in the health system across the region, including social health insurance agencies and subnational governments. The focus, however, is on the application of performance-orientated reforms to budgeting, and the extent to which countries in the region have adopted such reforms to improve the efficiency of health expenditure to achieve universal health coverage. The findings point to the use of performance and results-based budgeting in the region, along with new models of provider payment systems integrating performance measures.

Demand adjusted capital input and potential output in the context of U.S. economic growth

Two alternative measures of demand adjusted capital input for the U.S. non-farm private business sector are derived and their differential impacts on the potential supply of output are compared to those obtained using the unadjusted index of capital input published by the Congressional Budget Office (CBO). The results show that, allowing for the demand pressure on the fixed assets of firms, leads to three effects. It raises the level of estimated potential output well above CBO’s estimates; with the exception of the 1990s, the estimated growth rates turn out to be higher than those computed by CBO; and, lastly, the long term trend of the growth rates with and without the demand adjustment to the capital input is sloping downwards. The latter finding was not unexpected since aggregate demand, as reflected in the utilization rate of fixed assets by firms, has been trending downwards throughout the postwar period. Drawing on these findings it is concluded that the path to secular stagnation that the U.S. economy is following in the postwar period is not due solely to headwinds on the supply side. To some degree, perhaps significant, the deceleration in the expansion of productive capacity as well as in the intensity of its utilization is due to the declining long term aggregate demand.

A Comparative Study of Digital Government Policies, Focusing on E-Government Acts in Korea and the United States

The first enactment of a single national e-government act took place in Korea in 2001. Subsequently, the United States enacted its electronic government act in November 2002. Unified e-government acts in Korea and the United States have since been established and enforced for nearly two decades, and provide interesting case studies for examining the long-term influences of the e-government act on national e-government and digital government policies. The e-government act of the United States is much more comprehensive than the e-government act of Korea. The US e-government act focuses on strengthening the federal government’s ability to regulate the Office of Management and Budget (OMB)’s role in e-government implementation. The OMB has overall jurisdiction over the e-government promotion process and will continue to consult with ministries on appropriate budget support for each project. In contrast, the e-government law in Korea is based on electronic document processing as the basic viewpoint and has been downgraded to a level that supports document reduction and electronic processing of documents, rather than a comprehensive law that can support e-government projects. The comparative case study of e-government acts in Korea and the United States revealed that, from the standpoint of digital government transformation using information technology, it is most important to promote digital government policy directly from the ministry that manages the budget, or to establish a dedicated organization under the ministry to secure strong coordination while linking it with the budget.

APA Joins Other Medical Groups to Call for Balance in ‘Surprise’ Medical-Billing Legislation

APA Joins Other Medical Groups to Call for Balance in ‘Surprise’ Medical-Billing Legislation

ÖZERK MALİ OTORİTELER VE ÇEŞİTLİ ÜLKE UYGULAMALARI: TÜRKİYE İÇİN OLASI BİR ÇIKARSAMA

In the study, information is provided about the general characteristics of the formations named “financial council”, “financial court” and “parliamentary budget offices”, which has been active since the past in some of the developed countries, especially in the European countries after the 2008 - 2009 Global Contraction process, and becoming common also in developing countries. United States, Sweden and Slovenia being examined under separate headings and for Turkey evaluations are made such a possible formation should have in the context of the innovations brought by Law No. 5018 on Public Financial Management and Control. In parallel with the changes in the fiscal policy, autonomous structures are becoming widespread along with numerical rules and some general expectations are brought up, although they do not show full homogeneity. In particular, their budgets, personnel structures, procedures for appointment of senior management and term of office are considered as key elements for these structures. Although their organization and functions are different, the legitimacy of their existence, especially in terms of democratic culture, is closely related to these characteristics. Even though they are named by different names, it is seen that these dominant features are taken into consideration especially in developed countries during the establishment stages. Turkey also made innovations in the area of fiscal policy and continue to try, though in terms of financial rules and structures must take into account some basic features

Pride and pain coexist during American Pharmacists Month

It's October again, which makes this my 11th American Pharmacists Month as CEO of APhA. We can all be proud of how far we've come over these past 11 years, although each victory has a shadow. I'm incredibly proud of pharmacists’ now-established role as immunizers, but I know that for some, administering immunizations can be just another metric to hit in a challenging workflow. Across the country, pharmacists are demonstrating the value of pharmacist-delivered patient care services; in some states private and public payers recognize pharmacists as providers. But on the federal level, we're still fighting to show Congress that covering pharmacists’ patient care services for certain underserved patients is worth what the Congressional Budget Office says it could cost. It's no secret that this is a challenging moment for pharmacy. Intense education and specialized skills are supposed to inoculate against the insecurity that many of you feel. Yet, new opportunities continue to present themselves or are invented every day. At the risk of sounding Pollyanna-ish, I hope you all will take time this month to celebrate being a pharmacist and the good you do for your patients and community. Your pride in what you do is key to our eventual success in becoming fully recognized and utilized as health care providers. APhA's American Pharmacists Month campaign focuses on public outreach by spreading the message that pharmacists are easy to reach and ready to help. We still want pharmacists and pharmacy technicians to feel honored and appreciated, but we also need to recruit patients to demand that our services remain readily—not freely—available. That's why we're emphasizing pharmacists’ accessibility and working to change the public perception of what pharmacists can do and publicize the services we have to offer. Meanwhile, we continue to advocate for pharmacists and their patients with our state association partners and on Capitol Hill to tell the stories of the impact you are having on patient lives. Visit pharmacistsmonth.com to access promotional materials for your pharmacy, including downloadable graphics, a media kit you can use to further spread the message on social media, and more. Encourage your patients to use the hashtags #APhM2019, #PharmacistsCare, and #PharmacistMonth to share images and stories of times a pharmacist helped them make a medication-related decision, gave them advice, or made a difference in their health and well-being. Pharmacists, you do the same with your own stories of the many times you went above and beyond for your patients and communities. I extend my deepest gratitude and my endless support on behalf of YOUR profession and the patients you serve. Take pride in your ever-changing, essential roles as pharmacists during this American Pharmacists Month. Thank you!

Statutory delegation, agency authority, and the asymmetry of impact analysis

ABSTRACTRequirements for regulatory impact analysis in the United States vary greatly. Executive branch regulatory agencies in the United States are required to conduct regulatory impact analysis before issuing regulations, and statutes sometimes require agencies to conduct some economic analysis. But when Congress considers legislation that mandates prescriptive regulations, legislators are under no obligation to conduct or even consider impact analysis. This paper documents the diverse degrees of discretionary authority Congress grants US executive branch agencies. It then presents a case study that systematically compares the quality of impact analysis that informed legislative and regulatory decisions on positive train control, a technology mandated by statute in 2008. The legislation was adopted with virtually no consideration of impact analysis. Given that major regulations are often required by statute, we conclude that regulatory legislation should be subject to the same kinds of impact analysis that US presidents have required regulatory agencies to conduct for almost four decades. Congress could develop this capability by creating a regulatory analysis division of the Congressional Budget Office (CBO) to evaluate the social benefits and costs of bills, similar to the way CBO scores the federal budgetary consequences of bills.