Reduction In Payments Research Articles

Toward an understanding of tax amnesty take-up: Evidence from a natural field experiment

Governments often use partial forgiveness policy to induce debt repayments and increase the disclosure of hidden debts. While ubiquitous, much remains unknown about how well these amnesties work, for whom, and why. We partnered with the Dominican Republic Tax Authority to design a natural field experiment to understand whether, and what types of, nudges can increase amnesty take-up and repayment. Our field experiment, which covers 125,452 taxpayers collectively owing 5.5% of GDP in known debt, tests the impact of messages from the tax authority during an amnesty that highlight deterrence laws, beliefs about future amnesties, and tax morale messages for debt payment and disclosure. Importantly, we find large short-run effects—our most effective treatment increased payments of known debt by 25% and hidden debt by 48%—that are only slightly undone by reductions in subsequent tax payments.

Income transfer and COVID-19 pandemic in Brazil: wrong and right at the same time

Abstract To alleviate the effects of socioeconomic inequalities and of the fall in economic activity on vulnerable populations during the COVID-19 pandemic, many countries have implemented or expanded income distribution programs. Brazil, amid the political and economic 2020 crisis, exacerbated by the pandemic, established Emergency Aid (EA). This longitudinal ecological study aimed to analyze whether the availability of EA contributed to the reduction of morbidity and mortality due to COVID-19 in the Brazilian 5,570 municipalities, from March 2020 to December 2021. The theoretical model considered as control covariates socioeconomic, sociodemographic and morbidity characteristics and access to health services, including COVID-19 testing availability and vaccination. Classical variable selection methods were applied considering the theoretical model, culminating in the adjustment of Bayesian hierarchical models with the inclusion of spatial and temporal effects. First dose COVID-19 vaccine coverage and EA had a protective effect against hospitalization (RR = 0.982 and RR = 0.986) and mortality (RR = 0.978 and RR = 0.976) due to COVID-19 in Brazil, when controlled by socioeconomic variables, access to health services and spatial-temporal effects. The results highlight the important role of income transfer in morbidity and mortality due to the disease, however, the way in which EA was implemented in Brazil presented a series of problems, the main ones being discontinued payment of aid, reduction in values throughout the duration of the benefit, in addition to the use of public resources to pay people who did not meet the eligibility criteria. Such problems might not have happened if the federal government had maintained the registration structure of Bolsa Familia Program (BFP), which did not happen. Furthermore, vaccination was started late for several reasons, that is, its role in reducing morbidity and mortality could have been even greater if started as soon as it become available. Key messages • Even with planning and execution problems, income transfer and specific vaccination were important in reducing COVID-19 morbidity and mortality in Brazil during the COVID-19 pandemic. • Income transfer during the COVID-19 pandemic in Brazil was not done in the best way possible, due to discontinued payment, reduction in values and payment to not eligible people.

American Thyroid Association Policy Statement: Impact of Changes in Fine Needle Aspiration Biopsy Reimbursement on Clinical Care of Patients with Thyroid Nodules in the United States.

Introduction: The Clinical Affairs Committee of the American Thyroid Association has developed this statement to describe recent changes in the billing and coding of ultrasound-guided fine needle aspiration procedures of thyroid nodules, and to raise awareness of the adverse consequences that have arisen as a result. Review: A reduction in payment of ultrasound-guided fine needle aspiration procedures was enacted by the Centers for Medicare and Medicaid Services in 2019. The Clinical Affairs Committee has sought to examine the effects of the change in reimbursement on the care of patients with thyroid diseases. Summary: The historical background of the changes in payment structure for ultrasound-guided fine needle aspiration of thyroid nodules is discussed. The years 2019 and 2020 saw a significant decline in claims for ultrasound-guided fine needle aspiration procedures, concomitant with a shift in the performance of these procedures away from non-facility outpatient settings and a rise in costs to the health care system. Conclusion: Several negative consequences of the decrease in reimbursement for ultrasound-guided fine needle aspiration of thyroid nodules have arisen. This has led to significant concern among clinicians who care for patients with thyroid diseases regarding delays in patient access to care and diagnosis, and a diminished pool of qualified thyroid specialists to perform these procedures in the future.

Reducing 30-day Acute Care Readmissions for Heart Failure Patients Through Implementation of a Discharge Bundle.

Hospital readmissions have been a long-standing problem in the American health care system. Despite many efforts, programs, papers, and interventions identified and studied, 14% of all adult admissions result in a readmission. Readmissions are mostly considered preventable and are considered an indicator of care quality for a hospital. Due to unexpected readmissions, patients are at an increased risk for illness or injury, increased stress, financial strain, and diminished quality of life. Readmissions also negatively impact hospital systems related to decreased bed availability, stretched resources, and potential financial penalties and payment reductions. Patients with an admission related to heart failure are at an increased risk of readmission, with a national readmission rate of 23%. The quality improvement project was implemented on two telemetry units at an acute care hospital. A gap analysis identified procedural and organizational reasons for readmission in the heart failure population at an acute care hospital. Using evidence-based best practice guidelines established by the American Heart Association, American College of Cardiology, and the Heart Failure Society of America, a four-pronged proactive discharge bundle was implemented using the plan-do-study-act framework for continuous improvement. All patients admitted to the telemetry units with a primary or secondary diagnosis of heart failure received the discharge planning bundle: (1) an early assessment by the case management department, (2) patient-centered specialty heart failure education, (3) predischarge medication delivery, and (4) predischarge physician follow-up appointment scheduling within 7days of discharge. A total of 133 patients were evaluated for inclusion in the heart failure cohort. Of those, 52 patients received the evidence-based intervention. The evidence-based project was implemented over 7weeks, September through October of 2023 on the medical telemetry units. Of the 52 patients receiving the evidence-based sample, two of the patients experienced a readmission due to heart failure (3.85%). Incidentally, it was found that patients without a readmission had an average of 2.3 completed interventions, while those with readmissions had an average of 1.5 interventions. Case managers are an integral part of the care transition from the acute care setting back to the community. Often, it is the case manager leading this effort through various interventions. Findings from this quality improvement project suggest the use of the evidence-based, four-pronged approach to discharge planning for the heart failure patient population reduced the risk and rate of heart failure-related readmissions for the involved nursing units. These findings also surmise that there is a correlation between the number of interventions and the rate of readmission.

A comprehensive study on energy management, sensitivity analysis, and inertia compliance of feed-in tariff in IEEE bus systems with grid-connected renewable energy sources

The need to incorporate renewable energy generators (REGs) into the electrical grid has become increasingly crucial due to the push for a more sustainable environment. This study advocates an innovative strategy for optimizing inertia-integrated generation and transmission expansion planning (GTEP) to implement feed-in tariffs (FiT). The application of the GAMS CPLEX solver to the model, which tested on an IEEE 6/IEEE 16 system, reveals that using FiT results in a 12.1 % drop in system cost ($599 million to $526 million) and a 7.91 % rise in total system inertia. Sensitivity analysis highlights the correlation between increased REG integration and FiT payment reduction at 50 % penetration. The model outperforms soft computing optimization techniques, showcasing rapid convergence and computational efficiency. The proposed model's validated superiority in rapid convergence and computational efficiency is demonstrated by comparing its results with those obtained from other soft computing optimization techniques.

A Comparative Study of Hospitals in Yasuj, Iran, in Terms of the Implementation of the Health System Planning and the Quality of Medical Services

Background: Today, the implementation of the health system plan has led to the reduction of people's payments and to equitable access to health services and the improvement of the quality of services. Objectives: The current research was conducted with the aim of a comparative study of hospitals in Yasuj, Iran, in terms of the implementation of the health system plan and the quality of medical service. Methods: The statistical population of the present descriptive study was 380 patients at Shahid Beheshti Hospital, Yasuj, 150 patients in Shahid Rajaei Hospital and 300 patients in Imam Sajjad Hospital, all located at Yasuj, Iran. According to Morgan's table, 181 patients at Shahid Beheshti Hospital, 108 patients at Shahid Rajaei Hospital and 169 patients at Imam Sajjad Hospital were included as the statistical sample. All the participants completed the questionnaire and the implementation status of the health system plan and the quality of medical services. One-way ANOVA was used to analyze the statistical findings. All statistical operations were performed using SPSS v.18 software Results: The results of the the present study indicated that the health system implementation status of Shahid Beheshti Hospital, Imam Sajjad Hospital and Shahid Rajaei Hospital in Yasuj was favorable. These findings indicated that the health system plan in Yasuj were properly and correctly implemented. Moreover, the quality of medical services at Shahid Beheshti Hospital, Imam Sajjad Hospital, and Shahid Rajaei Hospital in Yasuj were satisfactory. Also, the results showed that there is was no significant difference in the quality of medical services in Yasuj hospitals (P = 0.44 & F = 0.81 & 455 & 2 F). Correspondingly, the results disclosed that there was no significant difference in the implementation status of the health system plan of hospitals in Yasuj city (P = 0.39 & F = 0.93 & 455 & 2). Conclusions: Medical centers should continuously evaluate the quality of their services, since improving the quality of medical services encourages patients to follow their treatment instructions correctly and on time, and also accelerate the progress of treatments and achieves the main therapeutic goal of treating patients.

Hospital Prices for Physician-Administered Drugs for Patients with Private Insurance

BackgroundHospitals can leverage their position between the ultimate buyers and sellers of drugs to retain a substantial share of insurer pharmaceutical expenditures.MethodsIn this study, we used 2020–2021 national Blue Cross Blue Shield claims data regarding patients in the United States who had drug-infusion visits for oncologic conditions, inflammatory conditions, or blood-cell deficiency disorders. Markups of the reimbursement prices were measured in terms of amounts paid by Blue Cross Blue Shield plans to hospitals and physician practices relative to the amounts paid by these providers to drug manufacturers. Acquisition-price reductions in hospital payments to drug manufacturers were measured in terms of discounts under the federal 340B Drug Pricing Program. We estimated the percentage of Blue Cross Blue Shield drug spending that was received by drug manufacturers and the percentage retained by provider organizations.ResultsThe study included 404,443 patients in the United States who had 4,727,189 drug-infusion visits. The median price markup (defined as the ratio of the reimbursement price to the acquisition price) for hospitals eligible for 340B discounts was 3.08 (interquartile range, 1.87 to 6.38). After adjustment for drug, patient, and geographic factors, price markups at hospitals eligible for 340B discounts were 6.59 times (95% confidence interval [CI], 6.02 to 7.16) as high as those in independent physician practices, and price markups at noneligible hospitals were 4.34 times (95% CI, 3.77 to 4.90) as high as those in physician practices. Hospitals eligible for 340B discounts retained 64.3% of insurer drug expenditures, whereas hospitals not eligible for 340B discounts retained 44.8% and independent physician practices retained 19.1%.ConclusionsThis study showed that hospitals imposed large price markups and retained a substantial share of total insurer spending on physician-administered drugs for patients with private insurance. The effects were especially large for hospitals eligible for discounts under the federal 340B Drug Pricing Program on acquisition costs paid to manufacturers. (Funded by Arnold Ventures and the National Institute for Health Care Management.)

Implementation of the New Medicare-Mandated Patient-Reported Outcomes After Joint Arthroplasty Performance Measure

A new mandatory hospital-level, risk-standardized performance measure for elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on patient-reported outcomes (THA/TKA PRO-PM) has been implemented by the Centers for Medicare & Medicaid Services (CMS). All THA and TKA in Medicare fee-for-service beneficiaries at inpatient facilities are included. The THA/TKA PRO-PM is the proportion of risk-standardized THA or TKA patients meeting or exceeding the substantial clinical benefit threshold between preoperative and postoperative outcomes measures (Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement, Knee injury and Osteoarthritis Outcome Score for Joint Replacement). This binary outcome (yes/no) is then divided by all eligible patients creating a percentage of patients reaching substantial clinical benefit. The percentile score among hospitals will be reported. Following 2 voluntary reporting periods, mandatory reporting will begin in 2025. The CMS requires 50% reporting rates; failure leads to annual payment reduction in fiscal year 2028. The CMS intends the THA/TKA PRO-PM to be a patient-centered, meaningful, and relatable measure of hospital performance reported to the public. For surgeons, this is an opportunity to collaborate with hospitals for developing and implementing a THA/TKA data collection system to avoid penalties for the hospital. Further implementation for outpatient surgery and in ambulatory surgery centers has been announced by CMS. Major resources will be needed to succeed in the expected capture rates.

Reductions in payments to the State Fund for the Rehabilitation of Persons with Disabilities (PFRON) as a tool to reduce non-wage labour costs in enterprises

In this study, the authors attempted to identify employment costs, with particular emphasis on non-wage employment costs in terms of payments to the State Fund for the Rehabilitation of Persons with Disabilities (PFRON) and the possibility of their reduction. The main purpose was to identify and verify the effectiveness of legal and financial solutions aimed at stimulating Polish enterprises to employ workers with reduced competitiveness on the labour market and constituting a form of compensation for their employment in the context of reducing non-wage labour costs. The following research hypothesis was formulated: applying financial penalties for not employing persons with disabilities is not severe enough for enterprises to significantly change their attitude towards employing such persons, even in the context of their systematically growing number, because the multidimensional costs of employing persons with disabilities are more severe than the penalties paid for not employing them. The conducted research and literature review allowed for identifying the basic factors and correlations between the severity of penalties and the employment level of persons with disabilities. A strong positive correlation was observed between their employment rate and the increase in the basis for imposing penalties. Employers, having noticed the increasing amounts of penalties, tried at least not to increase the basis for their calculation and systematically aimed at supplementing employment or obtaining reductions in payments as a result of a lower ratio or the amount of payments made to the Fund owing to the cooperation with the employers of people with disabilities authorised to provide them. The research covered the years from 2018 to 2022, the subjective scope included enterprises with at least 25 full-time employees and subject to the obligation of employing persons with disabilities. The following research methods were used: critical analysis of source literature and legal acts, descriptive method, statistical analysis and correlation analysis based on the Pearson correlation coefficient.

Emancipation Reform in Pavlovskoe Estate of Grand Duke Konstantin Nikolaevich

The article examines the process of emancipation of peasants and redemption operation in the estate of Grand Duke Konstantin Nikolayevich, located between Tsarskoe Selo and Pavlovsk. The article reveals economic situation in Finnish villages and Fedorovskii Posad that were part of the estate. The authors consider the content and peculiarities of the charters and redemption documents for these settlements, which are kept in the Russian State Historical Archive (RGSH). The views of Konstantin Nikolaevich, who headed the Main Committee on Peasant Affairs and the Organization of the Rural Estate, on the rules of emancipation of peasants in the royal estates are analysed. The article studies the arguments of the ministers M. N. Murav’ev and V. F. Adlerberg, who disagreed with the proposal of Konstantin Nikolaevich to liberate peasants from the Pavlovskoje estates on the basis of the Provisions of February 19, 1861. The authors conclude that the conditions of emancipation of the peasants in Pavlovskoje estate, as well as the pre-reform condition of the peasant economy, were markedly more favorable than those of the peasants in other estates of the Tsarskoselskii district. The peasants signed the charter deeds offered to them, but were in no hurry to switch over to the buyout. The delay in carrying out the redemption operation in the estate was caused by the peasants’ unwillingness to immediately switch to redemption on the terms less favorable to them offered by the owner. It was not until the early 1880s, after the reduction of redemption payments, that mandatory redemption operations were concluded.

Potential for Saving Drinking Water Through the Use of Rainwater in Social Housing in Viçosa-Brazil

[Objective] The main objective of this research was to evaluate the potential for saving drinking water by using rainwater as a source of supply for non-potable purposes in two neighborhoods with social housing in the municipality of Viçosa, Minas Gerais, Brazil. [Methodology] The consumption statistics for each month of 2020 were used for each of the homes comprising the Benjamin José Cardoso and Sol Nascente Housing Complexes, and the fraction of drinking water that is destined in homes for non-potable purposes was estimated. The information corresponding to the monthly rainfall records of the last 50 years was analyzed and the monthly volume of rainwater that could be harvested in each house was calculated. [Results] The average monthly volume of rainwater that could be captured through the roof area of each dwelling is 3.39 m3. During the rainy months of the year, it would be feasible to save a higher percentage of water than that allocated for non-potable purposes. Sizing a rainwater reservoir that exceeds the monthly needs for non-potable purposes would allow the surplus of collected water to supply the liquid during the dry season. [Conclusions] Since the average percentage of savings in drinking water for both neighborhoods exceeded 53%, the saving of the monthly consumption can contribute to the reduction of payments for the drinking water service and the consumption of the liquid in the municipality, particularly during drought months.

The effects of the national simple tax regime on the small businesses revenue and tax payment in the Ceará state – Brazil

This research examines the impact of the Simples Nacional policy on the revenue of Micro and Small Enterprises (MSEs) and their payment of taxes on goods and services (ICMS) in the State of Ceará, Brazil. The Simples Nacional is a tax collection regime created by Complementary Law No. 123/2006, with the purpose of reducing the tax burden for companies classified as Micro and Small Enterprises. The data utilized in this study was obtained from the State Treasury Department of Ceará (SEFAZ), Institute of Economic Research and Strategy of Ceará (IPECE), and Brazilian Institute of Geography and Statistics (IBGE). The difference-in-differences method was employed on a panel data structure. The results reveal an average increase in MSEs revenue ranging from 45.9% to 96.4% and an average reduction in ICMS payment between 8.5% and 11.2%. The data used in this study was not publicly accessible, thereby contributing to the literature on this subject.

Investigating Asymmetric Effects of Electronic Payment on Money Supply for India using Non-linear ARDL Model

Money supply in India is analysed using a non-linear autoregressive distributed lag (NARDL) model to see how several factors, such as electronic payments, exchange rate, interest rates and inflation, affect the money supply. The Augmented Dickey–Fuller unit root test and the Phillips–Perron unit root test are utilized to confirm that the variables are stationary. In the bounds test of the NARDL as well as Johansen–Juselius cointegration test, this study finds evidence of cointegration amongst variable used in the study. NARDL testing model is employed to investigate the dissimilar influences on variables with short- and long-run dynamics. Short-term estimates suggest that the money supply ( M1) is most responsive to positive shocks involving retail payments, the exchange rate and interest rates, but negative shocks involving card payment and prepaid payment instruments. A reduction in card payment, as well as a positive increase in retail payment, the prepaid payment instrument, the exchange rate and the interest rate, would all have major effects on M3 in short run. In addition, a long-term finding demonstrates that all of the variables have a significant influence on the money supply ( M1) in its mixed form while all of the factors, with the exception of the one involving card payments, have a considerable impact on the money supply ( M3). Wald test results confirm the existence of asymmetric influences which can have significant lessons for policymakers.

Modern pillories: Overdue debts of the poor

AbstractWe model the consequences of the soft budget constraint in the context of retail borrowers. While János Kornai formulated the term of “soft budget constraint” mainly for organizations (firms, banks, municipalities, NGOs, etc.), we show that it can be applied to individual borrowers as well. We derive the feasibility conditions for private and public debt relief programs in a utilitarian framework and find that lenders have no interest in offering payment reductions if non-performing borrowers are few, have small debts, and are difficult to reach – precisely the characteristics of the poor. In this situation, poor debtors serve better as deterrents, similarly if we put them into a pillory. We calibrate the model parameters to survey data on poor households struggling with overdue debts in small villages in a disadvantaged rural region in Hungary. We find that in normal economic circumstances, private debt relief programs are not feasible. State intervention can be justified by positive externalities and moral considerations.

Does Anesthesia Quality Improvement Participation Lead to Incremental Savings in a Surgical Quality Collaborative Population? A Retrospective Observational Study.

The Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) Collaborative Quality Initiative (CQI) was launched as a partnership among hospitals to measure quality, review evidence-based practices, and improve anesthesia-related outcomes. Cost savings and improved patient outcomes have been associated with surgical CQI participation, but the impact of an anesthesia CQI on health care cost has not been thoroughly assessed. In this study, we evaluated whether participation in an anesthesia CQI led to health care savings. We hypothesized that ASPIRE participation is associated with reduced total episode payments for payers and major, high-volume procedures included in the Michigan Value Collaborative (MVC) registry. In this retrospective observational study, we compared MVC episode payment data from Group 1 ASPIRE hospitals, the first cluster of 8 Michigan hospitals to join ASPIRE in January 2015, to non-ASPIRE matched control hospitals. MVC computes price-standardized, risk-adjusted payments for patients insured by Blue Cross Blue Shield of Michigan Preferred Provider Organization, Blue Care Network Health Maintenance Organization, and Medicare Fee-for-Service plans. Episodes from 2014 comprised the pre-ASPIRE time period, and episodes from June 2016 to July 2017 constituted the post-ASPIRE time period. We performed a difference-in-differences analysis to evaluate whether ASPIRE implementation was associated with greater reduction in total episode payments compared to the change in the control hospitals during the same time periods. We found a statistically significant reduction in total episode (-$719; 95% CI [-$1340 to -$97]; P = .023) payments at the 8 ASPIRE hospitals (N = 17,852 cases) compared to the change observed in 8 matched non-ASPIRE hospitals (N = 12,987 cases) for major, high-volume surgeries, including colectomy, colorectal cancer resection, gastrectomy, esophagectomy, pancreatectomy, hysterectomy, joint replacement (knee and hip), and hip fracture repair. In secondary analyses, 30-day postdischarge (-$354; 95% CI [-$582 to -$126]; P = .002) payments were also significantly reduced in ASPIRE hospitals compared to non-ASPIRE controls. Subgroup analyses revealed a significant reduction in total episode payments for joint replacements (-$860; 95% CI [-$1222 to -$499]; P < .001) at ASPIRE-participating hospitals. Sensitivity analyses including patient-level covariates also showed consistent results. Participation in an anesthesiology CQI, ASPIRE, is associated with lower total episode payments for selected major, high-volume procedures. This analysis supports that participation in an anesthesia CQI can lead to reduced health care payments.

Choosing annuities for a home reversion: the case of the French viager market

PurposeThe authors analyzed annuitization preferences when retired people extract cash from their homes. Based on 2,608 viager (home reversion) transactions, the authors study the relations between annuitization, negotiation, cash extraction, age, gender and marital status.Design/methodology/approachA database comprising 2,608 transactions is used. The three-stage least squares (3SLS) and moderation models are implemented, with a focus on potential adverse selection issues.FindingsThe authors found that difficulties in selling a property generally result in increased annuitization. The single men's group endures gender inequality, suffering from limitations in their possibility to extract wealth and annuitize, as well as an additional price discount during negotiation. Young single men, as compared to young single women and young couples, must consent to a substantial price reduction if they prefer a high down payment and limited price reductions if they prefer annuities. Elderly single men, as compared to young single men, have less capacity to negotiate, a concern that is reinforced when they prefer annuities.Originality/valueAmong the home equity conversion products, the academic real estate literature has intensely analyzed the reverse mortgage. The viager is distinct from a mortgage in that it consists of the true sale of a property without bank involvement. This product deserves reinforced attention in an aging continental Europe. It exists in numerous countries (France, Belgium, Germany, Italy, Spain, etc.).

Association Between Weight Reduction and Employees' Healthcare Cost.

The aim of the study is to assess the impact of ≥15% body mass index (BMI) reduction on employees' health expenditures. We retrospectively analyzed health risk assessment surveys combined with insurance claims from January 2014 to December 2019. We compared costs of employees with baseline BMI > 30 who reported ≥15% BMI reduction in subsequent health risk assessment reports with employees who lost ≤5% BMI within the same period, matching the two cohorts on demographics and costs. The study cohort of 197 lost an average of 23% of their BMI from baseline. The average age was 44 years with majority females (approximately 80%). Group health insurance payments were similar at baseline; at year 1, the study cohort had a 33% payment reduction compared with 10% reduction in the control group. A ≥15% BMI reduction was associated with a substantial medical cost savings.

Moral Hazard versus Liquidity in Household Bankruptcy

ABSTRACTThis paper studies the role of moral hazard and liquidity in driving household bankruptcy. First, I estimate that increases in potential debt forgiveness have a positive, but small, effect on filing using a regression kink design. Second, exploiting quasi‐experimental variation in mortgage payment reductions, I estimate that filing is five times more responsive to cash‐on‐hand than relief generosity. Using a sufficient statistic, I show the estimates imply large consumption‐smoothing benefits of bankruptcy for the marginal filer. Finally, I conclude that 83% of the filing response to dischargeable debt comes from liquidity effects rather than a moral hazard response to financial incentives.

Recourse as shadow equity: Evidence from commercial real estate loans

AbstractWe study the role that recourse plays in the commercial real estate loan contracts of the largest U.S. banks. We find that recourse is valued by lenders as a substitute for conventional equity. At origination, recourse loans have rate spreads that are about 20 basis points lower and loan‐to‐value ratios that are almost 3 percentage points higher than nonrecourse loans. Dynamically, recourse affects loan modification negotiations by providing additional bargaining power to the lender. Recourse loans were half as likely to receive accommodation during the COVID‐19 pandemic, and the modifications that did occur entailed a relatively smaller reduction in payments.

Growth of Medicare Advantage After Plan Payment Reductions

ImportanceVarious policy proposals would reduce federal payments to Medicare Advantage (MA) plans. However, it is unclear whether payment reductions would compromise beneficiary access to the MA program.ObjectiveTo quantify the association between MA payment reductions under the Affordable Care Act (ACA) and MA enrollment growth.Design, Setting, and ParticipantsThis retrospective cohort study examined the MA market before and after the ACA, which mandated cuts to MA benchmark payment rates. Using 2008 to 2019 county-level enrollment and payment data, a difference-in-differences analysis was conducted comparing MA enrollment changes between counties with larger vs smaller benchmark reductions, before vs after the ACA.Main Outcomes and MeasuresThe primary outcome was the MA enrollment rate, defined as the proportion of a county’s Medicare beneficiaries enrolled in MA. A secondary analysis examined MA plan payments per member per month.ResultsAmong 3138 counties with 37 639 county-year observations, ACA-induced benchmark cuts were sizeable and varied, ranging from 0% to 42.9% (mean [SD], 5.9% [6.6%]). Counties with benchmark cuts above the 75th percentile had population-weighted average benchmark cuts of 14.9% compared with 4.4% in other counties. In the 8 years following the ACA, there was no differential change in MA enrollment between counties with larger vs smaller benchmark cuts (difference-in-differences estimate, 0.02 [95% CI, −1.18 to 1.21] percentage points; P = .98). Plan payments differentially fell in counties with larger benchmark cuts by $78.35 (95% CI, $62.21-$94.48) per member per month (P &amp;amp;lt; .001).Conclusion and RelevanceThis cohort study found no evidence that the MA benchmark and ensuing payment cuts imposed by the ACA were associated with reduced MA enrollment, compromising access to MA. This evidence can inform ongoing policy debates regarding the growth of MA, concerns about excess payments to MA plans, and proposed Medicare reforms, including further reductions in MA payments.