Relative Affordability of Health Insurance Premiums under CHIP Expansion Programs and the ACA

Affordability is integral to the success of health care reforms aimed at ensuring universal access to health insurance coverage, and affordability determinations have major policy and practical consequences. This article describes factors that influenced the determination of affordability benchmarks and premium-contribution requirements for Children's Health Insurance Program (CHIP) expansions in three states that sought to universalize access to coverage for youth. It also compares subsidy levels developed in these states to the premium subsidy schedule under the Affordable Care Act (ACA) for health insurance plans purchased through an exchange. We find sizeable variability in premium-contribution requirements for children's coverage as a percentage of family income across the three states and in the progressivity and regressivity of the premium-contribution schedules developed. These findings underscore the ambiguity and subjectivity of affordability standards. Further, our analyses suggest that while the ACA increases the affordability of family coverage for families with incomes below 400 percent of the federal poverty level, the evolution of CHIP over the next five to ten years will continue to have significant implications for low-income families.     

Can a 12-step program work in methadone maintenance treatment?

Three consecutive, professionally led (as opposed to self-help) groups following the 12-step program (TSP) were integrated into a methadone maintenance treatment (MMT) program that included 32 heroin-addicted individuals in recovery. This report describes our experience in meeting the challenges that arose and our conclusions regarding the therapeutic potential of this integration. A professional therapeutic staff guided the groups. In-depth interviews of 10 participants and the reflections of the group leaders provided data for learning about the groups' experience. Initially the participants rejected the concepts of Step 1, powerlessness and unmanageability of life. The assimilation of Step 4 (defining character defect) also aroused some resistance. The participants eventually adopted the pragmatic aspects of TSP, including its terminology. The establishment of a common language of recovery helped to create group coherence and a sense of belonging, and helped to meet the needs of those who felt stigmatized by both the nonaddicted and addicted population undergoing nonmethadone recovery. TSP could be adapted to various aspects of daily life, produced a sense of self-efficacy, and stimulated motivation for change. Therapeutic implications are discussed.     

Justifying the Distinction Between Justifications and Power (Justifications vs. Power)

The paper suggests that there are two different ways in which a legal system restricts an individual’s rights. It can either grant a power that revokes the legal protection of the right or it can acknowledge the infringement of a legal right and yet justify such an infringement by means of a criminal law justification. The distinction proposed by the paper has both expressive and practical implications and is useful in solving dilemmas arising in emergencies when constitutional constraints make it impossible to grant the power to revoke legal protection of a basic right. In some of these situations a criminal law justification might support infringement of such a right. This claim is demonstrated by analyzing the ruling of the German Constitutional Court concerning the shooting down of a hijacked airplane in circumstances similar to those of September 11.     

Philanthropisches Handeln zu Lebzeiten und über den Tod hinaus

As the number of rich people in Germany increases, it becomes more and more relevant to ask how they spend their wealth, because among other aspects being rich can be legitimized by social commitment. For example, responsibility can be shown by financial commitment or volunteering. Academic results not only show a rising number of people that are philanthropically active but also an increase in philanthropic behavior in the last two decades. Unlike it is stated in the American literature, social commitment of wealthy people has not yet gained currency in the German literature. In addition, it is little known about inheritance to society beside family transfers after death. Based on the data of the study ??Verm?gen in Deutschland?? (ViD) (Wealth in Germany) the paper discusses these questions for the year 2008. The results reveal a considerably above-average commitment of wealthy households and people. Moreover, 41?% of all respondents plan to fund a part of their wealth for public purposes and charity.     

Perceived positive aspects of intimate relationships among abused women in methadone maintenance treatment programs (MMTP)

This study examines the positive aspects of intimate relationships perceived by drug-involved women victims of intimate partner violence (IPV). The article examines the association of psychological distress, childhood abuse, and severity of IPV with the different positive aspects the women indicated. Most analyses were conducted on a subsample of 149 women in methadone maintenance treatment who intended to continue their relationship with their abusive partner. The women most frequently valued fulfillment of the role of an intimate partner such as "he takes care of me, loves me, makes me laugh" (29.7%). Fewer than one tenth of the women valued their partners' role as economic provider; however, these women reported more physical IPV. Women intending to continue the relationship (more than two thirds of the participants) reported less physical or sexual IPV and experienced less psychological distress. Policy and practice implications are discussed.     

Deregulation, Competitive Pressures and the Emergence of Intermodalism

Deregulation has dramatically altered the face of Australian industry and associated services throughout the last decade or so. In the transport sector, in particular, changes have been significant and deregulation has led to pervasive changes in market structure, to the actual ownership of infrastructure and to a shift in strategic focus from a public utility to one of commercial viability and market orientation. Competitive pressures in the transport sector as a result of deregulation have meant that traditional public sector organisations such as railways and ports have been transformed. A major impact of these developments has been that transport operators, in an endeavour either to maintain or capture market share, have been forced to restructure and refocus and, in the face of growing competition, have been forced to reinvent themselves and move increasingly towards the provision of an integrated intermodal service. Rail operators are now no longer simple linehaul operators in container or bulk freight markets but have become market–focused third–party service providers of a range of integrated functions.