ABSTRACT
Unlike many large employers, the U.S. military does not offer flexible spending account (FSA) options to members of the armed services and their families. Contributions to either a health care FSA (HCFSA) and/or dependent care FSA (DCFSA) reduce the amount of income subject to income and payroll taxes, thereby reducing the individual's tax liability. FSAs interact with other tax incentives in the U.S. tax code, potentially reducing or even eliminating the potential tax savings to individuals participating in an FSA. For service members to take advantage of an FSA, they must have eligible dependent care and medical expenses for themselves or their family members. For example, in the case of health care, most members would have few or no eligible out-of-pocket medical care costs associated with TRICARE. This study presents an analysis-requested by the Office of the Secretary of Defense as input for Congress-on the implications of FSA options for active-duty service members and their families that would allow pre-tax payment of dependent care expenses, insurance premiums, and out-of-pocket medical expenses. The authors evaluate the benefits and costs of FSA options to active members and the U.S. Department of Defense (DoD), and present an implementation plan should FSA options be implemented by DoD. They also identified legislative or administrative barriers to these options.
ABSTRACT
Active duty service members and their families have unique behavioral health care service needs. The purpose of this study is to determine geographical access to specialized behavioral health programs tailored to active duty U.S. service members and military families from military installations. This study generated network distance measures between active duty military installations and licensed substance use disorder (SUD) treatment facilities and mental health treatment facilities for 2015-2018 using data from national surveys administered by the Substance Abuse and Mental Health Services Administration and coordinates for active duty military installations from the Defense Installation Spatial Data Infrastructure Program. Using regression analysis, we calculated the share of installations that are at-risk of being remote from behavioral healthcare services. Separately, we calculated the share of treatment facilities accepting military insurance that offer specialized programs for active duty service members and/or military families within a 30-minute drive to an installation. Three out of 10 installations were at-risk of being remote from a behavioral health treatment facility. About 25 percent of behavioral health treatment facilities accepting military insurance within a 30-minute drive to an installation offered a specialized treatment program for active duty military or military families. Lack of a specialized treatment programs could suggest facilities may not be equipped to manage stressors unique to being in the military, and as a consequence, could adversely impact the health and well-being of this population. Further research is necessary to understand what specialized treatment programs for military populations entail.
ABSTRACT
This article investigates how a change in minimum nurse staffing regulation for California skilled nursing facilities (SNFs) affects nurse employment and how induced changes in nurse staffing affect patient mortality. In 2000, legislation increased the minimum nurse staffing standard and altered the calculation of nurse staffing, which created incentives to shift employment to lower skilled nurse labor. SNFs constrained by the new regulation increase absolute and relative hours worked by the lowest skilled type of nurse. Using this regulation change to instrument for measured nurse staffing levels, it is determined that increases in nurse staffing reduce on-site SNF patient mortality.
