Introduction

Chapter 1 explains that this book examines two economic “principles,” or beliefs, that have shaped the perception of the economic system in the United States today: (1) the belief that the U.S. economy is competitive, making government market regulation unnecessary, and (2) the belief that corporations exist for the benefit of their shareholders, but not for other stakeholders. Contrary to what many economists and policymakers believe, the chapter shows that numerous markets in the United States are not competitive and that the belief in shareholder primacy is not an economic principle but a normative notion. In addition, the belief in the existence of competitive markets is used to argue that market regulation is unnecessary because competition provides all the needed constraints. If there are no constraints from competition and no regulation, serious harm can result, as shown by the Great Recession of 2008. The chapter also points out that there never was a purely laissez-faire market economy. The real question is how much market regulation is desirable. It is often difficult to debate this issue because many people label any expansion of government regulation as socialism. In addition, some people just do not like being told what to do by the government. That was a principle reason for the objection to the individual mandate in the Affordable Care Act. The chapter then introduces the relationship between the two economic narratives and the millions of job losses this century, using lessons from the new institutional economics to analyze the issues.

Does the Individual Mandate Affect Insurance Coverage? Evidence from Tax Returns

We estimate the effect of the ACA’s individual mandate on insurance coverage using regression discontinuity and regression kink designs with tax return data. We have four key results. First, the actual penalty paid per uninsured month is less than half the statutory amount. Second, nonetheless, we find visually clear and statistically signifi-cant responses to both extensive margin exposure to the mandate and to marginal increases in the mandate penalty. Third, we find substantial heterogeneity in who responds; men are especially responsive. Fourth, our estimates imply fairly small quantitative responses to the individual mandate, especially in the Health Insurance Exchanges. (JEL G22, H24, H51, I13, I18)

The Affordable Care Act’s Coverage Impacts in the Trump Era

The 2016 US presidential election created uncertainty about the future of the Affordable Care Act (ACA) and led to postponed implementation of certain provisions, reduced funding for outreach, and the removal of the individual mandate tax penalty. In this article, we estimate how the causal impact of the ACA on insurance coverage changed during 2017 through 2019, the first 3 years of the Trump administration, compared to 2016. Data come from the 2011–2019 waves of the American Community Survey (ACS), with the sample restricted to non-elderly adults. Our model leverages variation in treatment intensity from state Medicaid expansion decisions and pre-ACA uninsured rates. We find that the coverage gains from the components of the law that took effect nationally—such as the individual mandate and regulations and subsidies in the private non-group market—fell from 5 percentage points in 2016 to 3.6 percentage points in 2019. In contrast, the coverage gains from the Medicaid expansion increased in 2017 (7.0 percentage points) before returning to the 2016 level of coverage gains in 2019 (5.9 percentage points). The net effect of the ACA in expansion states is a combination of these trends, with coverage gains falling from 10.8 percentage points in 2016 to 9.6 percentage points in 2019.

Suspect Spheres, Not Enumerated Powers: A Guide for Leaving the Lamppost

Despite longstanding orthodoxy, the Constitution’s enumeration of congressional powers does virtually nothing to limit federal lawmaking. That’s not because of some bizarrely persistent judicial failure to read the Constitution correctly. It’s because the enumeration of congressional powers is not a well-designed technology for limiting federal legislation. Rather than trying to make the enumeration do work that it will not do, decisionmakers should find better ways of thinking about what lawmaking should be done locally rather than nationally. This Article suggests such a rubric, one that asks not whether Congress has permission to do a certain thing but whether a certain kind of lawmaking is more prone to pathology at the national or the state level. That inquiry could identify “suspect spheres”: areas of policymaking where federal law calls for more justification than elsewhere. Federal legislation within suspect spheres would not necessarily be subject to judicial invalidation, but the judgment that legislation falls within a suspect sphere could underwrite softer forms of judicial resistance to nationalization. We illustrate the suspect-spheres model with a principle of federalism we call the corporate nondelegation doctrine, by which federal delegations of power to private corporations are to be treated skeptically. Early on, that principle animated Madison’s opposition to the Bank of the United States and much of the Jacksonian approach to federalism. It later underwrote the Supreme Court’s decision in Schechter Poultry. In the current century, the idea that the corporate nondelegation doctrine defines a suspect sphere helps explain otherwise puzzling judicial behaviors in federalism cases, including the presumption against preemption and the resistance to the individual mandate of the Affordable Care Act. By illustrating the possibility of a suspect-sphere approach, we suggest a tool that might be useful at a time of destructively polarized national politics, when rubrics for allocating some polarizing issue spaces to state-level decisionmakers might help lower the national temperature.

The Individual Health Insurance Mandate and Veterans Health Coverage

In December 2017, Congress repealed the individual insurance mandate penalty. Given the poor health status of veterans, their higher demands for health insurance, and the substantial number of uninsured veterans, the repeal of the individual mandate should have a significant impact on the veterans. This article investigates how the repeal of the individual mandate effective in January 2019 is likely to affect the number of uninsured veterans and their enrollments in Veterans Affairs (VA) insurance. By analyzing 52,692 nonelderly veterans in Florida and California from 2008 to 2017, the findings suggest that the repeal will lead to a considerable increase in the number of uninsured veterans. Veterans who are unemployed, poor, and suffering disabilities are more likely to sign up for the VA insurance than better-off veterans. Thus, one of the important functions of veteran health care is to serve as a social safety net for vulnerable veterans. Thus, the Veterans Health Administration should establish a policy to minimize the expected negative repercussions of the repeal.

Uncompensated Care: How Much is Too Much?

Texas is home to the largest uninsured population in the U.S. Such problems emerge, in large measure, from thestate’s rejection of Medicaid expansion. That decision has prevented Texas from receiving $100 billion in federalcash over a decade. Consequently, the number of uninsured residents either going without local medical care oroverloading adjacent communities is likely to increase. Therefore, this study seeks to explain the implicationsof Medicaid expansion in Denton county. This paper explores the effects of expanding Medicaid and how thatwould affect race, income, and Medicaid eligibility for indigent patients. The results of a Python–based simulationshow that, adjusting for Denton’s population growth at projected levels of uninsured, by 2020 the uncompensatedcare will cost Denton County $42,716,796. This number will continue to rise to a total of $61,462,134 as a resultof ceasing Medicaid expansion and getting rid of the individual mandate. These numbers are important as theyshow the rising costs of uncompensated care that are associated with an increase in population growth.

Nonprofit Practitioners Chat Back: An Exploratory Content Analysis of Participant Responses to the National Council of Nonprofit’s Webinar on the 2017 Tax Cuts and Jobs Act

As the first major overhaul of the United States’ tax code in a generation, the passage of the Tax Cuts and Jobs Act of 2017 has particular significance for the operation of US nonprofit organizations. Provisions of the Tax Act, including raising the ceiling on individual standard deductions, imposing excise taxes on highly compensated nonprofit employees, repealing the individual mandate of the Affordable Care Act, etc., are causing great uncertainty and consternation within organizations of, and bridging, the nonprofit sector. In response to some of the initial confusion, the National Council of Nonprofits offered a webinar, entitled, “Now What: How the New Federal Tax Law Impacts Charitable Nonprofits” on January 11, 2018. A one-hour slide-show with voice-overs was complemented by a running “chat” of nonprofit listeners/participants. This exploratory study undertakes a content analysis of the one-hour nonprofit participant chat that accompanied the webinar in order to take a pulse of the concerns of the practitioners as the potential impact of the law was explicated.