ECONOMIC REPORT OF THE PRESIDENT

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Figure 4-3 Health Insurance Coverage Status by Household Income, 2008 Panel A: Children Under Age 19 Percent of Population 100 Uninsured 80 60 Individual Market 40 Public 20 Employment-Based 0 0 100 200 300 400 500 600 Household Income as a Percent of Federal Poverty Level Panel B: Adults Ages 19 to 64 Percent of Population 100 80 60 Uninsured Individual Market 40 20 Public Employment-Based 0 0 100 200 300 400 500 600 Household Income as a Percent of Federal Poverty Level Panel C: Adults Ages 65 and Up Percent of Population 100 Uninsured 80 60 Public 40 20 Individual Market 0 Employment-Based 0 100 200 300 400 500 600 Household Income as a Percent of Federal Poverty Level Note: Employment-based coverage is defined as coverage from a current or former employer, including military and VA coverage. Public coverage is defined as Medicare, Medicaid, and other government coverage for people with low-incomes or a disability. Individuals reporting multiple sources of coverage were assigned to a single insurance type using the following hierarchy: Medicare; military health coverage; VA health coverage; Medicaid and other government coverage for people with low-incomes or disabilities; coverage through a current or former employer; and coverage purchased directly from an insurance company. This hierarchy was applied prior to categorizing individuals into the coverage groups described above. Source: American Community Survey; CEA calculations. Reforming the Health Care System | 203
But these efforts left significant gaps even for children. They left even larger gaps for adults. Prior to the ACA, most state Medicaid programs did not cover adults without children, no matter how low their incomes, and the median state only covered working parents with incomes below 61 percent of the Federal Poverty Level (Heberlein, Brooks, and Alker 2013). As a result, low- and moderate-income non-elderly adults were by far the age and income group most likely to lack health insurance, as illustrated in Panel B of Figure 4-3. Failures of the Individual Health Insurance Market In addition to the affordability challenges described above, many uninsured Americans faced an additional barrier: the dysfunction of the individual health insurance market. While most non-elderly individuals had access to coverage through an employer, it was far from universal, even at relatively high income levels, as depicted in Figure 4-4. Retirees, many students, the self-employed, people working part-time due to family or other obligations, and the unemployed were all particularly likely to lack access to coverage through the workplace, as were individuals who happened to work at smaller firms or in industries where insurance coverage was not commonly offered. These individuals, if they did not qualify for public programs, had no choice but to turn to the individual market. The fundamental flaw of the pre-ACA individual health insurance market was that, unlike the employer market, the individual market lacked a mechanism for forming broad pools that included both relatively healthy and relatively sick individuals. The employer market forms broad pools by taking advantage of the fact that people are matched to employers based on a wide variety of factors, many of which are only loosely related to health status. In addition, employers typically cover around three-quarters of the premium, ensuring participation by a broad cross-section of their workforces, including both healthier and sicker workers (KFF/HRET 2016). Insurers offering coverage through employers can therefore be confident that their products will attract a balanced pool of healthier and sicker enrollees. As a result, their economic incentives generally drive them to design products that maximize the well-being of the pool as a whole. By contrast, insurers in the individual market had to contend with the possibility of “adverse selection,” the tendency of people with greater health care needs—and thus higher costs to insurers—to prefer more generous insurance coverage. Insurers’ concerns that they would attract an adversely selected pool drove them to engage in a wide range of practices aimed at discouraging enrollment by sicker individuals. These practices kept the individual market from performing the core functions of a health insurance 204 | Chapter 4
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ECONOMIC REPORT OF THE PRESIDENT To
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C O N T E N T S ECONOMIC REPORT OF
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economic report of the president To
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eforms in history. Banks have sharp
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the annual report of the council of
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C O N T E N T S CHAPTER 1: EIGHT YE
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. THE ECONOMIC RATIONALE FOR FEDERA
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2.4. Government Purchases as Share
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4.iii. Premium for the Benchmark Pl
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6.18. Systemic Risk (SRISK) 2005-20
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C H A P T E R 1 EIGHT YEARS OF RECO
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Figure 1-1 Actual and Consensus For
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Figure 1-3 Real Hourly Wage Growth
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Figure 1-4 Real GDP per Capita: Eur
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Figure 1-6 Household Net Worth in t
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Figure 1-8 Global Trade Flows in th
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Subsequent revisions to fourth-quar
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Percent 6 Figure 1-9 Fiscal Expansi
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substantial costs to the Federal Go
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worked to promote innovation and in
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expansion, a period of low producti
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The 2017 Economic Report of the Pre
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Chapter 4: Reforming the Health Car
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to the ACA and other factors. The A
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than 98 percent of Americans should
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Figure 1-13 Borrowers in Income Dri
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success of the financial rescue and
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einforced U.S. leadership in the ru
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Partnership (OGP), a global partner
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Figure 1-16 Labor Productivity Grow
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Labor Force Participation Household
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number of steps to ensure that econ
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C H A P T E R 2 THE YEAR IN REVIEW
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Percent 11 Figure 2-1 Unemployment
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allowing for additional investments
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Percentage Point 0.6 0.4 Figure 2-3
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public, largely highway constructio
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The size of the Federal Reserve’s
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Figure 2-5 Private-Sector Payroll E
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fell 80 percent from September 2014
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Figure 2-8 Rates of Part-Time Work,
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Figure 2-v Prime-Age Male Labor For
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Output Real GDP grew 1.6 percent ov
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Figure 2-11 Compensation and Consum
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Table 2-i Optimal Weighting for Hou
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esults suggest that, to a first app
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Figure 2-viii Real GDP, Average and
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Figure 2-13 Consumer Sentiment and
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Figure 2-xi Household Debt Service,
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Ratio to Annual DPI 1.10 1.05 Figur
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Figure 2-17 National House Price In
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Index 220 Figure 2-19 Housing Affor
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Figure 2-21 Composition of Growth i
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Figure 2-23 Capital Services per Un
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Box 2-7: Explanations for the Recen
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Figure 2-xv Business Fixed Investme
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Figure 2-26 Foreign Real GDP and U.
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somewhat generalizable (Box 2-8), b
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prices weakened and the global econ
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inadequate demand has contributed t
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Figure 2-31 Nominal Wage Inflation
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Figure 2-33 Real Hourly Wage Growth
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Index 6 Figure 2-36 Financial Condi
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Percent 4.0 Figure 2-38 Nominal Lon
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Dollars per Barrel 80 Figure 2-40 B
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Figure 2-41 IMF World Real GDP Grow
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against the Mexican peso, the Chine
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United Kingdom It has been a turbul
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for example, Japan has grown almost
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Figure 2-45 Credit to Nonfinancial
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Meanwhile, core inflation (excludin
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kept rates low across a wide range
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Investments in surface transportati
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Table 2-2 Supply-Side Components of
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Conclusion The economy continued to
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Page 159 and 160: developments; individual behavior;
Page 161 and 162: action affecting income inequality
Page 163 and 164: have occurred. In doing so, these p
Page 165 and 166: Percent 24 21 18 15 12 9 6 African
Page 167 and 168: without the policy response.5 These
Page 169 and 170: Box 3-2: Income Inequality and the
Page 171 and 172: unable to obtain insurance at any p
Page 173 and 174: Figure 3-7B Percent 50 Uninsured Ra
Page 175 and 176: and have not expanded Medicaid foun
Page 177 and 178: Box 3-3: Safety Net Policies as Ins
Page 179 and 180: Millions of People 18 Figure 3-8 Im
Page 181 and 182: Figure 3-9 Effective Tax Rates for
Page 183 and 184: Box 3-4: Additional Actions to Make
Page 185 and 186: $294 million in newly appropriated
Page 187 and 188: 15 10 5 0 -5 -10 -15 Figure 3-12 Pe
Page 189 and 190: Administration with those of previo
Page 191 and 192: as a share of potential GDP by Pres
Page 193 and 194: Figure 3-17 Changes in the Distribu
Page 195 and 196: 30 25 20 15 10 5 0 Single Source: C
Page 197 and 198: ate on capital gains and dividends
Page 200 and 201: C H A P T E R 4 REFORMING THE HEALT
Page 202 and 203: eneficiaries have received cumulati
Page 204 and 205: form of lower premium costs and ind
Page 206 and 207: Percent 25 20 Creation of Medicare
Page 210 and 211: 90 80 70 60 50 40 30 20 10 0 25 55
Page 212 and 213: Percent Uninsured 25 CHIP Created 2
Page 214 and 215: Legislative actions subsequent to C
Page 216 and 217: Percent Uninsured 40 35 Figure 4-7
Page 218 and 219: ecause of the ACA’s provision all
Page 220 and 221: Box 4-2: Dynamics in the Individual
Page 222 and 223: projected during the debate over th
Page 224 and 225: whelming majority of Marketplace en
Page 226 and 227: Figure 4-v Change in Benchmark Prem
Page 228 and 229: 20 Figure 4-10 Share of Workers in
Page 230 and 231: percent during the decade preceding
Page 232 and 233: Panel A: Share with a Personal Doct
Page 234 and 235: Box 4-3: Interpreting Results from
Page 236 and 237: Fortunately, the OHIE is not the on
Page 238 and 239: Figure 4-14 Uncompensated Care as a
Page 240 and 241: Figure 4-15 Uninsured Rate by Popul
Page 242 and 243: Figure 4-17 Monthly Gain in Private
Page 244 and 245: Change in Working-Age Employment to
Page 246 and 247: this cross-sectional relationship b
Page 248 and 249: ecent discussions of macroeconomic
Page 250 and 251: Figure 4-23 Life Expectancy at Birt
Page 252 and 253: Figure 4-24 Mortality Rate vs. Medi
Page 254 and 255: more to cover Medicare patients tha
Page 256 and 257: example, through CMMI, the Administ
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orient payment around the entirety
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Percent of Payments 60 Figure 4-26
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covered under ACO contracts at the
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Additional Steps to Reform the Heal
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legislation that overrides the reco
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Figure 4-28 Health Care Price Infla
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Figure 4-30 Trends in Real Prices f
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average growth rate of real per enr
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Figure 4-34 Growth in Real Costs fo
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made a large, readily quantifiable
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in states experiencing weaker and s
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distribution, holding fixed both sp
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individuals among individuals 65 an
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Figure 4-40 Average Real Deductible
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Figure 4-41 Real Per-Enrollee Presc
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educe the growth rate of Medicare s
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improvements will strengthen ACOs
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-5 0 -2 Figure 4-42 Cumulative Perc
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Woolhandler 2015). These analysts a
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productivity on the job. These bene
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Figure 4-46 Premiums and Cost Shari
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(KFF 2016). Another fifth of tradit
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2030 2028 2026 2024 2022 2020 2018
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C H A P T E R 5 INVESTING IN HIGHER
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Gainful Employment regulations. To
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Thousands of 2015 Dollars 900 800 7
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externalities, credit constraints,
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Figure 5-4 Earnings by Age and Educ
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Figure 5-5 Variation in Earnings by
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Box 5-1: Anti-Poverty Efforts and E
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careers. Some of the effects of the
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eligibility cutoff likewise finds s
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Box 5-2: Federal Investments in K-1
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Evaluations of early local Promise
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America’s College Promise Playboo
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Dollars 45,000 40,000 35,000 30,000
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pre-payment penalty. Second, by tyi
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equirements, pushed efforts associa
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Figure 5-16 Size of Outstanding Loa
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Figure 5-17 Average Monthly Payment
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Figure 5-18 Distribution of Key Out
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Figure 5-20 Earnings by Family Inco
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to student needs and improve test s
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Box 5-5: Making Sure Students Enter
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prior, the early FAFSA reform helps
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Figure 5-ii Number of Institutions
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Figure 5-23 Gainful Employment Earn
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Additionally, Pell Grants can be be
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C H A P T E R 6 STRENGTHENING THE F
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with no easy way to get the funds f
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public has limited information, run
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value added of the sector has gradu
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managers. Thus, after fees, savers
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Too Many Resources in Finance? Beyo
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of the firm after the purchase affe
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Percent 100 Figure 6-2 Mortgage Ori
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Figure 6-4 Case-Shiller Home Price
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Figure 6-7 Global OTC Derivative Ma
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consumer and investor protections.
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Figure 6-iv Top 5 Banks as Share of
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cult to replace with services from
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Are U.S. Banks Too Big? The questio
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The three federal banking agencies
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Risk Taking The Dodd-Frank Act took
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Box 6-3: The Performance of Communi
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Figure 6-ix Return on Assets of Ban
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egulators can take a more holistic
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Figure 6-13 Repo and Reverse Repo,
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Figure 6-15 Private Funds Reporting
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Days 60 Figure 6-16 Weighted-Averag
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Figure 6-18 Systemic Risk (SRISK),
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In the absence of another financial
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lower funding costs in 2007-09, “
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through the Dodd-Frank Act and othe
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Prior to the financial crisis, one
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asis.24 One of the advantages of ce
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findings from the NRSRO examination
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Prior to the crisis, enforcement of
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Box 6-5: Addressing the Problem of
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Table 6-i Sources of Investment Adv
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financial system and the systems of
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Box 6-6: The JOBS Act While it was
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Figure 6-23 S&P 500, 2003-2016 Inde
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Figure 6-27 Mortgage Delinquency an
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It created the FSOC to consider ris
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energy efficient and lower greenhou
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of domestic actions to reduce green
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people and vegetation (U.S. Global
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investment are much higher than the
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Delaying Action on Climate Change I
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uses and land management activities
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Carbon Pollution Standards for Powe
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a projected range of $16 billion to
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these resulted in insignificant cha
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Figure 7-4 Corporate Average Fuel E
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diesel fuel and jet fuel. The Vehic
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Box 7-3: Building Resilience to Cur
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sources in the oil and gas sector,
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emissions and total greenhouse gas
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Figure 7-7 Energy Intensity of Real
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Figure 7-10 U.S. Petroleum Consumpt
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Figure 7-12 Energy Intensity Transp
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Figure 7-14c Energy Intensity Comme
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Figure 7-16 U.S. Energy Consumption
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2008 to 7 percent in 2015. Figure 7
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Index, 2008 =0 0.1 0.0 -0.1 Figure
Page 471 and 472:
Figure 7-23 Decomposition of Emissi
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three determinants of emissions? If
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Percent 100 80 Figure 7-26 Sectoral
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characteristics, and management tre
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oil and gas sector) were subsequent
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while creating new jobs and raising
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such as using similar methodologies
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Box 7-4: Supporting Increased Penet
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sector, the fee would incentivize p
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to be used to decompose emissions i
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Reinvestment Act.” NBER Working P
Page 493 and 494:
D’Amico, Stefania, et al. 2012.
Page 495 and 496:
______. 2016. “Chapter 3: Develop
Page 497 and 498:
Chetty, Raj, et al. 2014. “Where
Page 499 and 500:
NBER Working Paper 22170. Cambridge
Page 501 and 502:
American Hospital Association and H
Page 503 and 504:
Cantor, Joel C., et al. 2012. “Ea
Page 505 and 506:
______. 2012a. “Direct Spending a
Page 507 and 508:
Dranove, David, Craig Garthwaite, a
Page 509 and 510:
Wars: Global Solutions for Developi
Page 511 and 512:
Huang, Jidong, and Frank J. Chaloup
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McWilliams, J. Michael. 2016. “Ch
Page 515 and 516:
Pinkovskiy, Maxim. 2014. “The Imp
Page 517 and 518:
______. 2016. “Certification of M
Page 519 and 520:
Arcidiacono, Peter, V. Joseph Hotz,
Page 521 and 522:
Bulman, George, and Caroline Hoxby.
Page 523 and 524:
______. 2015a. “Economic Costs of
Page 525 and 526:
Dobbie, Will, and Roland G. Fryer J
Page 527 and 528:
Committee on Health, Education, Lab
Page 529 and 530:
Jepsen, Christopher, Kenneth Troske
Page 531 and 532:
Marcotte, Dave E., et al. 2005. “
Page 533 and 534:
Reynolds, Arthur J., et al. 2011.
Page 535 and 536:
Chapter 6 Acharya, Viral. V., Deniz
Page 537 and 538:
Fama, Eugene F., and Kenneth R. Fre
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Wheelock, David C., and Paul W. Wil
Page 541 and 542:
______. 2016a. “The Economics of
Page 543 and 544:
______. 2016c. Short Term Energy Ou
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Interagency Working Group on the So
Page 547 and 548:
Office of Management and Budget (OM
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A P P E N D I X A REPORT TO THE PRE
Page 553 and 554:
Council Members and Their Dates of
Page 556 and 557:
Report to the President on the Acti
Page 558 and 559:
consulting with a wide variety of o
Page 560 and 561:
In October, the Council released a
Page 562 and 563:
Research Economists David Boddy . .
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A P P E N D I X B STATISTICAL TABLE
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GOVERNMENT FINANCE, INTEREST RATES,
Page 569 and 570:
Year or quarter Table B-1. Percent
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Table B-2. Gross domestic product,
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Table B-3. Quantity and price index
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Table B-5. Real exports and imports
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Year Total Table B-7. Real farm inc
Page 579 and 580:
Table B-9. Median money income (in
Page 581 and 582:
Labor Market Indicators Table B-11.
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Year or month Table B-12. Civilian
Page 585 and 586:
Table B-14. Employees on nonagricul
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Year or month Table B-15. Hours and
Page 589 and 590:
Government Finance, Interest Rates,
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Table B-19. Federal receipts and ou
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Table B-21. Federal and State and l
Page 595 and 596:
Table B-23. U.S. Treasury securitie
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Year and month Bills (at auction) 1
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Year and month Table B-26. Money st
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ECONOMIC REPORT OF THE PRESIDENT

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