Health Care Just Keeps Getting Bigger

16446238A few health care economic facts to consider:

  • The United States spends more on health care than any other country – $3 trillion in 2014. That equals $9,523 per person or 17% of gross domestic product
  • In the six years after the recession, health care added 2.1 million jobs, more than the next three industries combined – leisure and hospitality, professional services and education
  • Employment in health care is projected to grow by 19% from 2014 to 2014, adding about 2.3 million new jobs
  • Nearly one in 11 overall jobs is in the health care field. In 2014, that was 12.2 million jobs
  • The top five states with highest percentage of jobs classified as health care jobs: West Virginia, 11.4%; Rhode Island, 11%; Maine, 10.8%; Ohio, 10.6%; and Massachusetts, 10.4%

More States Engage in For-Profit College Oversight

For-profit colleges have been under fire from Washington the last few years. Some states, including Kentucky and Illinois, are now taking a closer look at the business practices of these schools. In Indiana, the Council for Proprietary Education maintains its own board but will now be administered by the Commission for Higher Education. Stateline reports:

Rhode Island legislators are considering whether to give preliminary approval for the country’s second for-profit osteopathic medical school.

The proposed Rhode Island School of Osteopathic Medicine would become the state’s only current degree-granting for-profit college if it also wins final approval from the state’s Board of Governor’s for Higher Education. It’s the second proposal for a for-profit college in the state this session, according to Larry Berman, spokesman for the House of Representatives. The first, Utah-based Neumont University, decided to shift its focus to Massachusetts after the House didn’t fast-track the plan, Berman said.

The osteopathic medical school proposal has already drawn fire. It’s opposed by Brown University, the state’s only current medical school, Berman said, and Daniel Egan, president of Rhode Island’s Association of Independent Colleges & Universities, called the for-profit sector of education “predatory and troubled,” according to the Providence Journal.

The bill is mum on details, but one of its sponsors, Representative Joseph McNamara, says the new college would have lower tuition than most traditional medical schools and be a boon to the state and local economy, particularly because of its for-profit status.

“The fact that a medical school would come in and pay taxes for the services they are receiving in my eyes is very impressive,” McNamara said.

Rhode Island’s deliberations come as more states are taking a harder look at the fast-growing for-profit college sector.

Senators Challenge “Donor State” Issue

The term “donor” usually refers to a person who bestows something voluntarily – a vital organ to a person in need or blood to a blood bank; even someone offering money to an organization without expecting anything in return is considered a donor. 

But, Indiana’s title as a financial “donor state” in the federal transportation system has never been voluntary. (States that put more money into the federal transportation program than they receive out of it are considered donor states.) A total of 28 states have the moniker, and Indiana receives only 92 cents for every dollar given to the federal system.

To combat this inequity, Indiana Republican Dan Coats has joined with several other senators from around the nation in introducing the State Transportation Flexibility Act, legislation that would allow states to opt out of federal highway programs. The act gives states the flexibility to manage and spend the gas tax revenue collected inside each state on transportation projects without federal mandates or restrictions.

The federal gas tax is the biggest revenue generator for the federal highway trust fund. With more fuel efficient vehicles and people driving less on average, the gas tax has been pushed into a steady decline and the trust fund has been bailed out several times.

“For too long, Indiana has been a donor state and sent more gas tax dollars to Washington than it has received back,” Coats says in a press release. “This isn’t fair to Hoosier taxpayers, which is why I support the State Highway Flexibility Act. Hoosiers know our state’s transportation needs better than bureaucrats in Washington, and Indiana should be able to control its own resources.”

States that choose to opt out would have to continue to maintain the Interstate system in accordance with its current program, but all gas tax revenue gained inside its borders would be used at the state’s discretion on transportation projects without federal interference.

“Anytime you can eliminate a layer of federal bureaucracy from the state’s ability to govern, it is a good thing,” adds Sen. David Vitter (R-Louisiana) in the release. “The states know their transportation needs better than Congress, so let’s put them in the driver’s seat to manage their own gas tax.”

In 2009, Alaska received $3.28 for every dollar it put into the federal fund, the District of Columbia received $5.04 for every dollar and Montana, North Dakota, Rhode Island and Vermont had returns of greater than 200% that same year.

For more information on the federal highway transportation fund and the challenges Indiana faces with the current transportation funding system, check out the story "Stuck in Neutral" in the May/June 2011 edition of BizVoice®. 

Indiana’s Business Tax Climate: Not a Perfect One, But a Good 10

We’re No. 10! We’re No. 10! Not exactly the rallying cry one is used to hearing, but a refrain that deserves more plaudits than usual. Here’s why Indiana’s ranking in the Tax Foundation’s 2011 State Business Tax Climate Index is noteworthy:

  • It’s not easy to make substantial improvements in this area. Indiana has ranged between No.12 and No. 14 over the last five years
  • The top eight seemingly head the list by default as they do not impose one of the big three taxes (sales, income or corporate income). So, without too much of a stretch, you could say Indiana is second on the list
  • We’re far away from the bottom 10; in order from No. 50, that’s New York, California, New Jersey, Connecticut, Ohio, Iowa, Maryland, Minnesota, Rhode Island and North Carolina

The Indiana Chamber’s advocacy efforts certainly are contributing factors to the state ranking. Historic tax restructuring in 2002 (including elimination of the inventory and corporate gross receipts levies) is among the Decade of Policy Victories document reflecting major legislative accomplishments from 2000-2009. The Chamber has also achieved success in general property tax reductions and an expansion of a variety of tax credits (good for business, but not earning high marks in this report).

According to the Tax Foundation, the worst tax codes tend to have:

  • Complex, multi-rate corporate and individual income taxes with above-average tax rates
  • Above-average sales tax rates that don’t exempt business-to-business purchases
  • Complex, high-rate unemployment tax systems
  • High property tax collections as a percentage of personal income

Indiana’s rankings in the five categories are: corporate tax index, 21st; individual income tax index, 11th; sales tax index, 20th; unemployment insurance tax index, 12th; and property index, 4th.

Since this tax analysis game is not for the faint of heart, a little more from the Tax Foundation on how it all works.

The methodology of the State Business Tax Climate Index is centered on the idea of economic neutrality. If a state’s tax system maintains a “level playing field” for businesses, the index considers it neutral and ranks it highly. However, each state’s final score depends on a comparison with the other 49 states.

The overall index is composed of five specific indexes devoted to major features of a state’s tax system. Each of these five indexes is composed of several sub-indexes.

Each state’s laws and tax collections were assessed as of July 1, 2010, the first day of the 2011 fiscal year. Newer tax changes are the subject of commentary in an appendix but are not tallied in the scores and rankings.

The Tax Foundation has data charts, further analysis and a full 60-page report. By the way, you have to go west for most of the rest of the top 10 (in order): South Dakota, Alaska, Wyoming, Nevada, Florida, Montana, New Hampshire, Delaware and Utah.

And finally, going into a state budget year that will bring pressure to raise revenues, let’s all keep the vital importance of the tax climate in mind on business attraction and expansion decisions.

Third Party Candidates Shaking Up Elections

If you’re a moderate or just someone who’s not too enthused about either of the two main political parties, you may find this interesting. According to an article on Stateline, third party candidates are making serious impacts on races around the country. Granted, some of these candidates are former senators and office holders so they’re hardly outsiders, but it is rather noteworthy. (Oh, and the full article also discusses Jesse Ventura, so that alone is worth a few minutes of your time):

In this volatile election year, third-party and independent candidates are making serious bids for governor in a diverse array of states. Most of them won’t get many votes, but a fair number stand to influence the results and it’s possible that at least one may make it into office.

In Rhode Island alone, a handful of independents are running. The most prominent one is former U.S. Senator Lincoln Chafee, who served in Congress as a moderate Republican until his defeat in 2006. Polling has showed Chafee either leading the race for governor or modestly trailing Democratic nominee Frank Caprio.

In Massachusetts, state Treasurer Tim Cahill broke with his Democratic roots to run as an independent against incumbent Democratic Governor Deval Patrick. Recent polls show that he could get as much as 10 percent of the vote, which is greater than Patrick’s current margin over Republican nominee Charles Baker.

In Minnesota, Tom Horner is running under the banner of the Independence Party, the successor to the party once led by Jesse Ventura. Horner, a moderate with a Republican pedigree, is hoping to draw Democrats who see their party’s nominee, former U.S. Senator Mark Dayton, as too liberal, and Republicans who see GOP candidate Tom Emmer as too conservative. Horner has been polling at about 14 percent, which is much more than Dayton’s four-point lead over Emmer.

And in Colorado, former Republican U.S. Representative Tom Tancredo, who has been an outspoken opponent of illegal immigration, may end up outpolling the official Republican nominee, Dan Maes, a Tea Party activist who inherited the nomination after the leading GOP candidate stumbled in a plagiarism scandal. Current polls show Tancredo taking 18 percent of the vote, about the same percentage by which Democrat John Hickenlooper, the mayor of Denver, is leading over Maes.

Given the number of these credible outsider challenges, it seems appropriate to look back at recent third-party governors to see how they fared once they won office, given that they lacked a major-party infrastructure and fellow partisans in the legislature.

Hijacking the $timulus Dollars

Whether one agrees with the philosophy behind federal stimulus money, it is difficult to argue with the practice of accepting the dollars once they are offered. If you (as a state) turn away the cash, it will go somewhere else.

Another story is how to use the funds, particularly in the case of the soon-to-be-arriving education stimulus. One can make a strong argument for a cautious approach; in other words, why go out and spend now when you’re likely going to need it even more later?

State Superintendent of Public Instruction Tony Bennett put it this way when informing school districts how much they should receive come November. (The federal law says the money does not have to be spent until September 2012).

"With your staffs and budgets set for the 2010-2011 school year, I urge you to be careful with how and when you spend these funds. Please consider reserving this one-time funding until the level of resources budgeted by the General Assembly in the upcoming budget cycle become clearer."

That won’t be clear until late April in 2011, if then.

While timing may be a consideration, I suspect that taking the education dollars and using them to fill a Medicaid budget gap was not what those doing the allocating had in mind. But that appears to be the case in Rhode Island. The Providence Journal reports:

Instead, Governor Carcieri intends to use the $32.9 million Rhode Island is eligible to receive to plug an estimated $38-million deficit in this year’s budget.

His plan drew a strong protest from Education Commissioner Deborah A. Gist, Congressman James R. Langevin and representatives of teachers unions and the state’s school committees.

School districts across the state were hoping that more than 400 teaching jobs would be restored or protected after Congress passed the bill in August. Nationwide, the law allocates $10 billion for schools and $16.1 billion to prevent Medicaid cuts.

Rhode Island is eligible to receive more than $100 million, $32.9 million intended for education jobs and about $70 million for Medicaid reimbursements.

But that’s about $38 million less for Medicaid than the state was counting on when it passed the 2010-11 budget, said Carcieri’s spokeswoman, Amy Kempe.

“While I’m sure it may be technically allowable and that the governor’s office is doing the appropriate thing, I don’t think we are acknowledging the intention of President Obama, [U.S. Education Secretary Arne] Duncan or Congress had for these funds,” Gist said.

Gist said she is especially concerned because the state is facing an even worse budget gap in fiscal year 2012 and the education jobs money could be spent during that year as well. According to the state Budget Office, the overall deficit could be as large as $320 million next year.

The executive director of the National Education Association of Rhode Island also criticized the governor’s plan, particularly after Carcieri and the General Assembly reduced state education aid to schools by 3.6 percent this year, a $29-million cut.

“I voted for this bill to help keep Rhode Island teachers on the job,” Langevin said in a statement. “Properly supporting our state’s education system is the best way to reverse our current economic situation over the long term.”

Officials at the U.S. Department of Education said Tuesday that using the federal money to supplant state funding is not expressly prohibited, although they cautioned they will carefully review each state’s application to ensure it follows the guidelines.

A Bad Day to Miss Work

Seven members of Congress missed work one day last week for a variety of largely legitimate reasons — graduations, funerals, the recent birth of a baby. They also missed what has been reported as a modern-day record of 53 roll call votes.

Voting continued for eight hours as Republicans repeatedly called for extra tallies on amendments to one of the appropriations bills. The reason — protesting Democrat leaders’ move to limit such amendments.

The absences didn’t really affect the outcomes of the votes. The day was important, however, as voting records of the missing seven (six Democrats and one Republican, none from Indiana) took a considerable hit. Opponents often cite vote attendance (or a lack of the same) during election campaigns.

Ellen Tauscher of California saw her vote record drop from 100% to 87% after attending the funeral of a close friend that day.  Patrick Kennedy of Rhode Island, who announced earlier this month that he was checking himself into a treatment facility, dropped from 82% to 71%.

Miss a day (or more) and miss a lot.