The Effects of Mandated Health Insurance Benefits for Autism on Out‐of‐Pocket Costs and Access to Treatment

As of 2014, 37 states have passed mandates requiring many private health insurance policies to cover diagnostic and treatment services for autism spectrum disorders (ASDs). We explore whether ASD mandates are associated with out‐of‐pocket costs, financial burden, and cost or insurance‐related problems with access to treatment among privately insured children with special health care needs (CSHCNs). We use difference‐in‐difference and difference‐in‐difference‐in‐difference approaches, comparing pre–post mandate changes in outcomes among CSHCN who have ASD versus CSHCN other than ASD. Data come from the 2005 to 2006 and the 2009 to 2010 waves of the National Survey of CSHCN. Based on the model used, our findings show no statistically significant association between state ASD mandates and caregivers’ reports about financial burden, access to care, and unmet need for services. However, we do find some evidence that ASD mandates may have beneficial effects in states in which greater percentages of privately insured individuals are subject to the mandates. We caution that we do not study the characteristics of ASD mandates in detail, and most ASD mandates have gone into effect very recently during our study period.     

The Institutional Interplay Regarding the New Architecture for the EC's External Assistance

Abstract:  The article concerns the inter-institutional relations and describes the dynamics between the main EC institutions in the decision-making process regarding the adoption of the new external action instruments. In 2004, the Commission had proposed a set of new external action instruments as base for the delivery of the Community's external assistance. By that time, the existing instruments amounted to more than 30 different legal instruments, which implicated a loss of efficiency in the management of the EC's external assistance. After 2 years of inter-institutional negotiations between the European Parliament, Council and the Commission, the new set of instruments was finally adopted. Compared to the initial Commission proposals, the design of the new instruments got significantly reshaped in the course of the inter-institutional decision-making procedure. In particular, the European Parliament had gained an unprecedented degree of power over the legislative framework for external spending.
Compared to the former range of geographic and thematic regulations, the new external action instruments fundamentally reform the delivery of external financial assistance with their streamlined and simplified structure. They consist of three horizontal instruments to respond to particular needs or crisis situation: an Instrument for Stability, an Instrument for Nuclear Safety Co-operation) and a European Instrument for Democracy and Human Rights. With regard to geographic coverage, four instruments will implement particular policies: the Instrument for Pre-accession Assistance, the European Neighbourhood and Partnership Instrument and the Instrument for Development Co-operation and an Instrument for Co-operation with Industrialised Countries.     

STATE IMPLEMENTATION OF THE SURFACE MINING CONTROL AND RECLAMATION ACT OF 1977

The implementation of the Surface Mining Control and Reclamation Act (SMCRA) of 1977 in coal producing states is guided by a partial preemption policy approach t h a t establishes a balance between federal and state decision-making authority. The usefulness of this approach is assessed by analyzing state enforcement actions in relation the institutional capacity of states to shoulder regulatory responsibilities and the propensity of the federal Office of Surface Mining (OSM) t o oversee state enforcement actions and, if necessary, to undertake corrective action. Our results indicated that state administration of SMCRA was canstrained by the lack of effective federal oversight but was largely unaffected by interstate differences in political, economic, or administrative characteristics.