Expanding dependent coverage for young adults: lessons from state initiatives

The Patient Protection and Affordable Care Act (ACA) requires that adults up to age twenty-six be permitted to enroll as dependents on their parents' health plans. This article examines the experiences of states that enacted dependent expansion laws. Drawing on public information from thirty-one enacting states and case studies of four diverse reform states, it derives lessons that are pertinent to the implementation of this ACA provision. Dependent coverage laws vary across the states, but most impose residency, marital status, and other restrictions. The federal Employee Retirement Income Security Act further limits the reach of state laws. Eligibility for expanded coverage under the ACA is much broader. Rules in some states requiring or allowing separate premiums for adult dependents may also discourage enrollment compared with rules in other states (and the ACA), where these costs must be factored into family premiums. Business opposition in some states led to more restrictive regulations, especially for how premiums are charged, which in turn raised greater implementation challenges. Case study states did not report substantial young adult dependent coverage take-up, but early enrollment experience under ACA appears to be more positive. Long-term questions remain about the implications of this policy for risk pooling and the distribution of premium costs.     

Perceptions of the health system and public trust in government in low- and middle-income countries: evidence from the World Health Surveys

In low- and middle-income countries, health care systems are an important means by which individuals interact with their government. As such, aspects of health systems in these countries may be associated with public trust in government. Greater trust in government may in turn improve governance and government effectiveness. We identify health system and non-health system factors hypothesized to be associated with trust in government and fit several multilevel regression models to cross-national data from 51,300 respondents in thirty-eight low- and middle-income countries participating in the World Health Surveys. We find that health system performance factors are associated with trust in government while controlling for a range of non-health system covariates. Taken together, higher technical quality of health services, more responsive service delivery, fair treatment, better health outcomes, and financial risk protection accounted for a 13 percentage point increase in the probability of having trust in government. Health system performance and good governance may be more inter-related than previously thought. This finding is particularly important for low-income and fragile states, where health systems and governments tend to be weakest. Future research efforts should focus on determining the causal mechanisms that underlie the observed associations between health system performance and trust in government.     

Understanding Presidential Failure in South America

This article examines the issue of presidential failure in South America by evaluating the multiple factors that create risk of resignation, removal, or impeachment of presidents. The study draws on various economic variables that have not been thoroughly investigated in the past and uses survival analysis to identify what factors are influential. In performing this testing, the importance of variables such as civil protest, executive wrongdoing, and specific measures of economic hardship—inflation and prolonged recession—becomes clear. Majority legislative support also remains significant, supporting early arguments about the influence of presidential institutions. This investigation provides a unique perspective on presidential survival while evaluating the importance of previously excluded variables in a comprehensive manner.     

Occupancy rights: life planners and the Navajos

ABSTRACT

This Comment focuses on the limitations of Stilz’s individualist conception of occupancy rights. Her account of occupancy is critical to her attempt to answer the question of where one holds territorial rights as well as related place-related rights like the right of return. Her account appeals to the geographical location of individual life plans. This Comment argues that this fails to distinguish between Indigenous People who are connected historically and in many other ways to a place and individual Life-Planners: it treats the two as equivalent, which I argue is counter-intuitive. I also argue that Stilz’s occupancy account fails to explain the scope of occupancy rights in a number of cases that she appeals to in her examples, such as the Navajos’ expulsion from the area in which they lived. What she needs, I argue, is a group based conception of occupancy rights, in addition to the idea of individual rights of residency.