- Associated Press - Tuesday, October 13, 2015

St. Louis Post-Dispatch, Oct. 11

Democrats could kill Obamacare by repealing ‘Cadillac tax’:

It’s unusual when Democratic presidential candidates Hillary Clinton and Bernie Sanders are on the same page as they compete for primary voters. It’s even more unusual when labor unions and the U.S. Chamber of Commerce are singing the same song.

But the Affordable Care Act’s so-called “Cadillac tax” is bringing these and many more disparate political bedfellows into unison. And people complain that President Barack Obama’s policies are divisive.

Ordinarily, a coalition this diverse might be on to something. If so many people from so many perspectives hate this tax on high-cost, high-benefit health plans, the policy must be misguided. Right?

Not really. Not if facts matter more that politics. Health care economists and policy experts believe the tax is one of the most important pieces of the Affordable Care Act - not so much for the revenue it raises but because of the market behaviors it encourages, and discourages.

They argue that the tax will lead to reductions in health care costs in two ways. First, by encouraging employers to exchange higher-cost health benefits for higher wages. Second, by reducing overall demand for health care services - especially services that cost a lot of money but don’t do much to actually improve health care outcomes.

And then there’s the revenue the tax generates. The latest estimate by the Joint Committee on Taxation is that the tax will raise $91 billion over the next 10 years. That’s hardly chump change.

But that amount pales in comparison to the savings in health care costs the tax could generate by reducing the number of high-priced, comprehensive health plans and the high-cost, low-value use of the health care system they encourage.

A recent report by the Congressional Research Service says those savings could reach $40 billion to $60 billion a year by 2024. The tax could significantly decrease the rate of health care inflation - indeed, some economists argue that it already has.

So why so much opposition from such a diverse group if this policy would do so much good? Because while the good it does is spread across the nation and the economy, the costs are concentrated among a powerful few: unions, corporations, health insurance providers and the rich. In other words, the sorts of people who make big campaign contributions that capture the attention of candidates.

The tax would be a hefty 40 percent on the value of employer-sponsored plans that exceed current thresholds: currently $10,200 for individual coverage and $27,500 for family coverage. Only the portion above those thresholds would be taxed, so for instance, only $200 of a $10,400 individual plan would be subject to the tax.

Very few households would currently be hit by the tax - about 6 percent, according to a study by the Tax Policy Center. Whether the thresholds increase or decrease depends on health care inflation. If the tax contains inflation as expected, the number of plans affected would decrease.

Though Democrats have gone to great lengths to defend the Affordable Care Act against Republican attacks, the Cadillac tax is a tough political sell in light of union opposition. Democrats are not immune from feathering their own nests. Mr. Sanders and seven other Democratic senators have introduced legislation to repeal it.

Before Democrats make common cause with the Chamber of Commerce and health insurers, though, they need to make sure they understand what experts say the tax will accomplish, and what getting rid of it may do to health care costs in the United States.


The Joplin Globe, Oct. 12

Tobacco money up in smoke:

The warnings were as pronounced as the ones on the side of a cigarette package, yet Missouri’s state officials took no heed.

Instead, our state leaders have used tobacco settlement money to plug gaps in the state’s budget rather than spend it the way the 1998 tobacco settlement intended. Missourians continue to pay the price because our state has used so little of the money for anti-smoking campaigns and programs.

This past week, Missouri’s acting budget director announced Missouri has lost $50 million of its money as a result of a federal appeals court decision involving tobacco settlement payments.

Under the national settlement with several states including Missouri, the major-brand tobacco companies paid the states for the costs the states claim they bore for financing health treatment for lower-income smokers.

As part of the agreement, states are required to impose a tax on other tobacco companies that were not part of the settlement. In that way, nonparticipating companies couldn’t sell cheap cigarettes.

But Missouri never bothered to meet the requirements. Add this to the list of all the other ways its not living up to its part of the deal when it comes to the tobacco settlement.

By the way, Missouri ranks last in all 50 states in funding anti-smoking programs for its youths. Even though it collected about $231.2 million in tobacco settlement and taxes this past year, it spent almost nothing on prevention.

Missouri’s budget director, Dan Haug, this past week told The Associated Press that the state is now reviewing how it will deal with the loss.

Too little, too late and too contemptuous to heed the warnings, Missouri state officials deserve the wake-up call.


The Kansas City Star, Oct. 10

Kansas City must keep battling to reduce high murder rates:

When the FBI recently released a voluminous report on crime figures from 2014, it highlighted this fact: The number of murders across the United States decreased by 0.5 percent.

Kansas City easily outdistanced that mark. Homicides here plummeted 21 percent.

According to numbers reported to the FBI, Kansas City’s murders fell from 99 in 2013 to 78 in 2014.

Here’s the disappointing twist:

Kansas City still had the eighth worst murder rate among the 50 largest U.S. cities last year, according to information compiled by The Star using the FBI report and U.S. Census Bureau population estimates.

Moreover, this was only a modest improvement for Kansas City. It had the fourth worst murder rate among the country’s 50 biggest cities in 2013 and the fifth worst in 2012.

Overall, Kansas City’s homicide rate has fallen from 22.6 per 100,000 people in 2012 to 16.6 in 2014. The national rate was 4.5 last year.

Kansas City hasn’t dropped further in the rankings because violent crime has declined in recent years in many other large cities. Also, Kansas City started at a high mark.

Kansas City’s still-notable progress in 2014 occurred, in part, because of concentrated efforts by police, social service officials and citizens to stanch the bleeding on the city’s streets.

The Kansas City No Violence Alliance program deservedly has gained the most attention. In a collaborative effort with prosecutors, federal law enforcement agencies, University of Missouri-Kansas City criminologists and social workers, police identify the persons most likely to commit violent crimes as well as others in their “circles.” NoVa targets them for intervention through aggressive law enforcement or social services that help them get a job or a better education.

Yet all that work wasn’t enough to make Kansas City as safe as many of its peers in 2014. Murder rates per 100,000 people for other cities included 3.5 for Austin, 4.7 for Denver, 6.4 for Fort Worth, 7.2 for Omaha, 7.3 for Oklahoma City and 9.1 for Dallas.

Several large cities that have suffered from negative crime news in the past also are doing better than Kansas City. They include New York City (3.9 homicides per 100,000 people), Boston (8.1) and Houston (10.8).

If there’s a silver lining for Kansas City, the big drop in its 2014 murder rate brought it closer to a few other cities, such as Milwaukee, Chicago, Indianapolis and Cleveland.

Finally, Kansas City’s streets weren’t as deadly as those in Detroit, which led the nation with 43.8 homicides per 100,000 people in 2014. Other cities that have had high murder rates the last few years were Baltimore, New Orleans, Oakland and Atlanta.

St. Louis had a sky-high murder rate of 50.1 in 2014, but it’s no longer among the 50 largest U.S. cities.

By now, most Kansas Citians know the number of local homicides has jumped so far in 2015, especially after a spate of deaths in September.

Through Thursday, the Police Department had reported 77 murders, just one less than was initially recorded in all of 2014. In addition, a spike in murders is occurring in other cities, including Milwaukee, St. Louis, Baltimore and Washington, D.C.

As we have noted, that doesn’t mean prevention strategies such as NoVa are failing. While police have succeeding in slowing gang violence, it appears homicides have increased in domestic violence cases this year. The easy access to guns is making it far too common for arguments to escalate into senseless killings.

The Star has called for the General Assembly to reverse course and tighten Missouri’s overly lenient gun laws. In the 2016 legislative session, Kansas City officials should again promote common sense changes that include a special court docket to expedite and properly handle gun cases.

Despite occasional steps forward, the recent increase in Kansas City’s murders shows just how difficult it’s going to be to consistently improve the city’s dismal national homicide ranking.


St. Joseph News-Press, Oct. 11

Another drug threat:

Abuse of drugs has many collateral victims.

Not only the abuser, but also family members and employers suffer. And then there is the very real threat that the public will be endangered by addicts and the criminal activities spawned by drug dealers.

This is the backdrop for understanding that abusers and dealers come in many forms, and their drugs of choice can be obtained either in the black market or by legal means.

The Missouri Hospital Association reports a study finds hospital treatments for abuse of commonly prescribed painkiller drugs have more than doubled in the state in the last 10 years. This class of legal drugs is known as opioids and includes morphine, methadone, hydrocodone and oxycodone. Heroin is also an opiod and is illegal.

“We found . the rate of prescription drug abuse had skyrocketed in Missouri,” Association Spokesperson David Dillon said. “. The medical problems related to prescription drug abuse are staggeringly high and continue, basically, to grow in Missouri at a rate that is much higher than the Midwest.”

To this point, the growth rate of painkiller hospitalizations in Missouri is the highest in the country, Mr. Dillon said.

And in case you are wondering, it is not an aging population that is driving this increase. The hospital association’s study says the highest growth rates are among white males under age 30.

This trend is disturbing news that leaves the average citizen looking to health and legal authorities for an appropriate response. We agree with the first step planned by the association - to partner with prescription providers to find a solution.

The hospital association says it intends “to work through solutions that can be done on our end, meaning in the people who provide health care services.”

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