Comparing beneficiaries of the Medicare savings programs with eligible nonparticipants

This note focuses on participation in two entitlement programs that help reduce out-of-pocket expenses for low-income Medicare beneficiaries: the Qualified Medicare Beneficiary (QMB) program and the Specified Low-Income Medicare Beneficiary (SLMB) program. As of 1999, about 2.75 million eligible, noninstitutionalized individuals were not enrolled in these Medicare savings programs. The eligible nonparticipants differed substantially from the QMB and SLMB participants in that they were less likely to be Supplemental Security Income beneficiaries and more likely to be elderly, nonblack, and in relatively good health. These findings, which could help target future outreach efforts, are based on Survey of Income and Program Participation data matched with administrative records from the Social Security Administration.     

Modeling SSI financial eligibility and simulating the effect of policy options

This article simulates eligibility for Supplemental Security Income (SSI) among the elderly, analyzes factors affecting participation, and looks at the potential effects of various options to modify financial eligibility standards for the federal SSI program. We find that in the estimated noninstitutional elderly population of 30.2 million in the United States in 1991, approximately 2 million individuals aged 65 or older were eligible for SSI (a 6.6 percent rate of eligibility). Our overall estimate of the rate of participation among eligible elderly is approximately 63 percent, suggesting that more than a third of those who are eligible do not participate in the program. The results of our analysis of factors affecting participation among the eligible elderly show that expected SSI benefits and a number of demographic and socioeconomic variables are associated with the probability of participation. We also simulate the effects of various policy options on the poverty rate, poverty gap, annual program cost, the number of participants, and the average estimated benefits among participants. The simulations consider the potential effects of five policy alternatives: Increase the general income exclusion (GIE) from $20 to $80. Increase the earned income exclusion (EIE) from $65 to $260. Increase the federal benefit rate (FBR) by $50 for individuals and $75 for couples and eliminate the GIE. Increase the asset threshold to $3,000 for individuals and $4,500 for couples. Increase the asset threshold to $6,000 for individuals and $9,000 for couples. Using 1991 microdata from the Survey of Income and Program Participation (SIPP) matched to Social Security Administration administrative records and making adjustments reflecting aggregate program statistics, we present the results of our simulations for December 1999. The results show substantial variation in the simulated effects of the five policy alternatives along the various outcome dimensions considered. The simulated effects on the poverty gap of the elderly population range from a 7.9 percent reduction ("Increase the GIE from $20 to $80") to a 0.1 percent reduction ("Increase the EIE from $65 to $260"). All simulated interventions are expected to increase the rate of SSI participation among the elderly from a high of 20.3 percent ("Increase the GIE from $20 to $80") to a low of 0.5 percent ("Increase the EIE from $65 to $260"). We also find that the interventions that have greater estimated effects in terms of increased participation and reduced poverty tend to cost more. At the high end, we estimate that increasing the GIE from $20 to $80 could raise annual federal SSI cash benefit outlays by about 46 percent, compared with only 0.9 percent for increasing the EIE from $65 to $260. Similar to the EIE intervention, raising the resource thresholds by 50 percent would reduce the overall poverty gap of the elderly by only 0.2 percent, would increase SSI participation only modestly (by 1.3 percent), but would entail slightly higher program costs (by 1.4 percent). Increasing the asset threshold by 200 percent would have higher estimated effects on all three outcomes, but it would still be associated with relatively low increases in both costs and benefits. Finally, the simulated effects on the three key outcomes of increasing the FBR by $50 for individuals and $75 for couples, combined with eliminating the GIE, are relatively large but are clearly less substantial than increasing the GIE from $20 to $80. This work relies on data from the SIPP matched to administrative data on federal SSI benefits that provide a more accurate picture of SSI participation than has been feasible for previous studies. We simulate eligibility for federal SSI benefits by applying the program rules to detailed information on the characteristics of individuals and couples based on the rich array of demographic and socioeconomic data in the SIPP, particularly the comprehensive information SIPP provides on assets and monthly income. A probit model is estimated to analyze factors affecting participation among the eligible elderly. Finally, we conduct the policy simulations using altered program rules represented by the policy alternatives and predicted participation probabilities to estimate outcomes under simulated program rules. We compare those simulated outcomes to observed outcomes under current program rules. The results of our simulations are conditional on the characteristics of participants and eligibles in 1991, but they also reflect aggregate adjustments capturing substantial changes in overall participation and program benefit levels between 1991 and 1999.     

Nanoscale analysis of the interaction between cyanoacrylate and vacuum metal deposition in the development of latent fingermarks on low-density polyethylene

Vacuum metal deposition (VMD) has been previously demonstrated as an effective development technique for latent fingermarks and in some cases has been shown to enhance prints developed with cyanoacrylate (CA) (superglue) fuming. This work utilizes scanning electron microscopy (SEM) to investigate the interactions of the two development techniques when applied to latent fingermarks on low-density polyethylene. CA is shown to act principally on the eccrine deposits around sweat pores, where polymerization results in long polymer fibrils a few 100 nm in width. Subsequent VMD processing results in additional areas of development, for example, between pores. However, the primary mode of deposition of zinc is by interaction with the polymerized CA, the fibrils of which become decorated with zinc nanoparticles. Areas with limited CA deposition and no significant polymerization are also enhanced with the VMD process, resulting in increased print development.     

A comparison of data protection legislation and policies across the EU

Although the protection of personal data is harmonized within the EU by Directive 95/46/EC and will be further harmonized by the General Data Protection Regulation (GDPR) in 2018, there are significant differences in the ways in which EU member states implemented the protection of privacy and personal data in national laws, policies, and practices. This paper presents the main findings of a research project that compares the protection of privacy and personal data in eight EU member states: France, Germany, the UK, Ireland, Romania, Italy, Sweden, and the Netherlands. The comparison focuses on five major themes: awareness and trust, government policies for personal data protection, the applicable laws and regulations, implementation of those laws and regulations, and supervision and enforcement.The comparison of privacy and data protection regimes across the EU shows some remarkable findings, revealing which countries are frontrunners and which countries are lagging behind on specific aspects. For instance, the roles of and interplay between governments, civil rights organizations, and data protections authorities vary from country to country. Furthermore, with regard to privacy and data protection there are differences in the intensity and scope of political debates, information campaigns, media attention, and public debate. New concepts like privacy impact assessments, privacy by design, data breach notifications and big data are on the agenda in some but not in all countries. Significant differences exist in (the levels of) enforcement by the different data protection authorities, due to different legal competencies, available budgets and personnel, policies, and cultural factors.     

Fingermark visualisation on metal surfaces: An initial investigation of the influence of surface condition on process effectiveness

Fingermark recovery from metal surfaces is an area of operational interest, both from the association of metals with weapons used in violent crime and from the increasing incidence in metal theft. This paper reports a feasibility study into the effectiveness of a range of fingermark visualisation processes in developing fingermarks on clean metals (brass, bronze and stainless steel), and on the same metals after prolonged exposure to an outdoor environment. Scanning electron microscopy (SEM) was used to investigate how the surface type and condition could influence the development of fingermarks for each of the processes used. It was found that the behaviour observed varied between each of the processes (cyanoacrylate fuming, Lumicyano?, gun blueing and carbon-based powder suspension). In some cases the chemical composition of the surface affected the development of the mark more than the surface condition, and in other cases the reverse was true. The best performing processes differed according to the surface type and condition, with cyanoacrylate fuming processes working best on brass and bronze, and powder suspensions being better on stainless steel. These preliminary results reinforce the need to take into account both surface type and condition before selection of the most effective fingermark visualisation process and demonstrate the value of techniques such as SEM in developing a fundamental understanding of the interactions between fingermarks and surfaces.     

Medicare premium buy-in programs: results of SSA demonstration projects.

Three programs known collectively as the Medicare buy-in programs are available to pay Medicare Part B premiums and, in some cases, other medical expenses for certain low-income individuals. The Health Care Financing Administration administers those programs, with most functions performed by the states. The Social Security Administration (SSA) plays an indirect role in the buy-in programs: with certain exceptions, people who qualify for Medicare and hence for buy-in are beneficiaries of Social Security retirement or disability programs. SSA is often cited as an agency that might be able to increase enrollment in the buy-in programs through outreach to its beneficiaries and by acting as an intermediary in the enrollment process. The three buy-in programs have different requirements for eligibility. The Qualified Medicare Beneficiary (QMB) program includes individuals who have Part A Medicare benefits and whose income does not exceed 100 percent of federal poverty guidelines. People in the Specified Low-Income Medicare Beneficiary (SLMB) program are individuals who would otherwise be QMBs but whose income is more than 100 percent but less than 120 percent of poverty guidelines. People in the Qualified Individual (QI) program are those who meet the other criteria but whose income is less than 175 percent of poverty guidelines. Various reports and studies by government agencies and advocacy organizations conclude that the buy-in programs are not reaching many of the people who are eligible. Low enrollment appears to be a particular issue for the SLMB and QI programs. States have tried various outreach efforts, but the effectiveness of those efforts has not been adequately assessed. In 1998, Congress mandated that SSA conduct a demonstration project to determine how to increase participation in the buy-in programs. The project tested six different administrative models in which outreach letters were sent to potential beneficiaries asking them to contact SSA and then be screened for eligibility and referred for enrollment. SSA was able to screen about 7.1 percent of letter recipients for buy-in eligibility: 4.2 percent were potentially eligible for the programs based on income and resources, and 3.7 percent enrolled in a buy-in program. An evaluation of the probability that letter recipients would contact SSA to be screened found that: Among the elderly, older individuals were less likely to be screened but more likely to enroll. Among the disabled, older individuals were more likely to be screened but less likely to enroll. The disabled were less likely to be screened but more likely to enroll. Individuals with higher Social Security benefits were more likely to be screened but less likely to enroll. Women were more likely to be screened and to enroll. Being married did not appear to affect screening but negatively affected enrollment. Individuals with a preference for materials in Spanish were much more likely to be screened and enrolled. In some of the demonstration sites, enrollment in a Medicare+Choice plan increased the probability of being both screened and enrolled. SSA conducted a survey of some people who did not respond to the outreach letter. Most of those from whom explanations of the nonresponse were obtained had not responded because they were not eligible on the basis of their income or resources. If SSA were to reproduce the demonstrations in a nationwide outreach effort, a national mailing would include nearly 20 million individuals. If response rates were similar to those seen in the 1999 demonstrations, outreach would produce over 740,000 new buy-in enrollees. That number might be increased modestly by conducting additional outreach efforts in conjunction with the mailing.     

Reagents for the chemical development of latent fingerprints: scope and limitations of benzo[f]ninhydrin in comparison to ninhydrin

Benzo[f]ninhydrin was compared to ninhydrin for fingerprint development on paper. Overall, the performance of ninhydrin on exhibits was slightly better than that of benzo[f]ninhydrin. The significant advantages of the benzo[f]ninhydrin over ninhydrin were the much stronger fluorescence it gave after treatment with zinc salts and a slightly quicker reaction under ambient conditions. This fluorescence is, however, similar to that obtained with other reagents, such as DFO or ninhydrin analogs. These advantages apparently are not sufficient to justify regular usage of benzo[f]ninhydrin, especially when one considers its low solubility and high cost.     

Reexamining the Effect of Racial Propositions on Latinos’ Partisanship in California

Many seasoned politicians and scholars have attributed the loss in support for the Republican Party in California to its push for three racially divisive propositions in the mid- 1990s, especially the anti-immigrant Proposition 187. Their costs are said to involve the partisan realignment of Latinos against the Republicans. Using three separate data sources, we find no evidence of a “tipping point” or abrupt realignment among Latino registered voters who made up the electorate. Latinos’ partisanship within California did not change significantly; it did not change much when compared to nearby states; nor did voter registration change materially. The loss of support for Republicans occurred primarily among unregistered Latino voters whom historically had never been strong supporters. Our findings question the conventional wisdom about the powerful political effects of the propositions, and reaffirm the long standing conclusion in the literature that realignment due to a “critical election” is rare.     

Eligibility for the Medicare buy-in programs, based on a survey of income and program participation simulation.

Medicare buy-in programs are designed to reduce out-of-pocket expenses of beneficiaries with modest income and assets. This article provides estimates of the size of the Medicare beneficiary population eligible for the Qualified Medicare Beneficiary (QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, and the Qualified Individual-1 (QI-1) program. The buy-in programs use the same resource limits (twice those used in the Supplemental Security Income (SSI) program) but different thresholds for determining income eligibility. The QMB program uses 100 percent of the poverty line as the cutoff, QI-1 covers persons above 120 percent but at or below 135 percent of the poverty line, and the SLMB program is in between. Making informed judgments about the rate of participation in the buy-in programs and the need for outreach requires an accurate estimate of the size of the eligible population. If that population is underestimated, policymakers might come to unduly optimistic conclusions about current buy-in participation. In contrast, an overestimate may make current participation seem too low. If policymakers react to an upwardly biased estimate of the eligible population by increasing outreach, they are bound to be disappointed by the results of that effort. Estimates of the eligible population from past studies of the QMB and SLMB programs range from 5.1 million to 9.1 million. In the absence of new information, it is difficult to judge the accuracy of those estimates because the methodologies had substantial shortcomings that might bias the results. The most common shortcomings include the lack of high-quality, monthly income data and the lack of information on assets from the same data file that was used to estimate participation and income eligibility for Medicare. The current study uses the most recently available (as of August 2000) Survey of Income and Program Participation (SIPP) file that is matched to the Social Security Administration's (SSA's) administrative records. The data file covers 1995 information. Estimates were also obtained using 1991 data to assess the sensitivity of eligibility estimates to the year chosen. The SIPP has several major advantages over other data sources because it contains relevant, high-quality information on both income and assets for establishing financial eligibility for the buy-in programs. First, the SIPP collects detailed and conceptually appropriate information on monthly, rather than annual, income and therefore has more complete information about income than do other surveys. As a result, SIPP-based estimates of poverty are substantially lower than estimates based on the Current Population Survey. Second, the SIPP also collects information on assets at the individual level. Thus, the survey provides enough detail to measure the major income and asset exclusions directly. Finally, the SIPP data are matched to SSA administrative records: Medicare eligibility can therefore be accurately measured, and self-reported data on Social Security and SSI benefits can be replaced with more accurate monthly information. Our 1995 simulation estimates that approximately 4.8 million persons in the U.S. noninstitutionalized population were eligible for the QMB program and an additional 1.6 million for the SLMB program. The total--roughly 6.5 million--is within the range of estimates from past studies but is closer to the lower end, suggesting that the eligible population is smaller than was previously believed. When the estimated QI-1 eligible population of 0.9 million is added, the total for the three buy-in programs is 7.4 million. Because the QI-1 program did not exist in 1995, only the estimated 6.5 million QMBs and SLMBs would actually have been eligible to receive benefits. The 7.4 million figure represents the 1995 Medicare beneficiaries who would be eligible for buy-in under program rules for 2000. Adjusting that number to account for increases in the Medicare population between 1995 and 1999 yields an estimated eligible population of 7.8 million in 1999. Compared with other elderly Medicare recipients, eligible elderly QMBs and SLMBs have poorer health, more functional limitations, and higher rates of health care use. Thus, not only are their income resources relatively limited, but their need for potentially expensive medical care is also greater. Similar differences were not found in health, functional limitations, and health care use among disabled participants in the QMB and SLMB programs. Our estimates imply that about 2.5 million noninstitutionalized individuals were eligible for but not enrolled in the QMB and SLMB programs in 1999. That finding suggests that fewer eligibles may be available for targeting by outreach efforts than was previously believed. Outreach may be more difficult than it would be with a larger eligible population. (ABSTRACT TRUNCATED)