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102-525: In the 42 years of NASCAR sanctioning weekly racing for a national championship, the tracks have been split, initially by geographical proximity of the tracks for purposes of developing regional champions, then randomly among four divisions and currently by states that have tracks participating. The series began as the NASCAR Winston Racing Series in 1982 as weekly, local track racing sanctioned by NASCAR. Due to restrictions imposed by

204-666: A 2016 survey found that: For the "non-group" market, of which two-thirds are covered by the ACA exchanges, a survey of 2015 data found that: According to the OECD, U.S. prescription drug spending in 2015 was $ 1,162 per person on average, versus $ 807 for Canada, $ 766 for Germany, $ 668 for France, and is capped in the UK at £105.90($ 132) The reasons for higher U.S. healthcare costs relative to other countries and over time are debated by experts. U.S. healthcare costs in 2015 were 16.9% GDP according to

306-517: A Model Statute attached to the MSA and enacted by all of the settling states. Most of the settling states have also voluntarily adopted "complementary" legislation to provide additional enforcement tools to compel compliance with the Model Statute. The original escrow statutes provided that NPM payments would remain in escrow for 25 years, but authorized an early release of any escrow amount which

408-588: A Nonparticipating Manufacturer (NPM). As an incentive to join the Master Settlement Agreement, the agreement provides that, if an SPM joined within ninety days following the Master Settlement Agreement's "Execution Date," that SPM is exempt ("exempt SPM") from making annual payments to the settling states unless the SPM increases its share of the national cigarette market beyond its 1998 market share, or beyond 125% of that SPM's 1997 market share. If

510-452: A few states. Because the originally enacted escrow statute refunded escrow funds to the extent those funds exceeded each state's "allocable share" of the national MSA payment, NPMs were able to obtain refunds of most of the monies they had paid into a state's escrow fund. To illustrate, if an NPM only sold cigarettes in Kansas in 2006, the Kansas escrow statute would require that NPM to pay into

612-452: A more simplified point system. The system awarded two points per position in the feature event, with a maximum of 25 cars starting and 50 points going to the winner. If more than 25 cars started, two points were awarded from 26th place on back. Bonus points were also awarded to each driver starting a feature — 20 points for at least 21 cars starting, 10 points for 15 to 20 cars starting, and none for less than 15 cars starting. The same system

714-464: A participating manufacturer, the excess shall be released from escrow and revert to such tobacco product manufacturer. Thus, an NPM still has to pay annually into a state's escrow fund an amount calculated by multiplying the number of cigarettes the NPM sells in that state during the year in question by the same per-cigarette amount for that year as set forth in the state's escrow statute. The NPM can obtain

816-481: A payment equal to its "Allocable Share," a percentage of the funds held in escrow that has been agreed upon by the settling states and memorialized in the MSA. This "Allocable Share" (as measured by a percentage of the total funds in escrow) does not vary according to how many cigarettes are sold in a particular state in a given year. During the drafting of the MSA, the OPMs and the settling states contemplated that many of

918-510: A public archive of documents resulting from the cases. The settlement also dissolved the tobacco industry groups Tobacco Institute , the Center for Indoor Air Research , and the Council for Tobacco Research. In the MSA, the original participating manufacturers (OPM) agreed to pay a minimum of $ 206 billion over the first 25 years of the agreement. In September 1950, an article was published in

1020-411: A refund to the extent those escrowed funds are greater than the amount that the NPM would have had to pay under the MSA for that same year, based upon that same number of cigarettes sold. By the middle of 2000, domestic NPMs and importers had begun to obtain greater market share. The NAAG noted that reductions in settlement payments which result from an overall reduction in cigarette consumption benefit

1122-485: A release from its Kansas escrow fund of more than 49 per cent of its full escrow payment. In other words, the original allocable share release provision created an unintended loophole: it only operated as intended if the NPMs distributed their products nationally. In that circumstance, the NPMs' total escrow obligations to all states with similar tobacco statutes approximately totaled the payments those NPMs would have made under

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1224-406: A settling state's allocated payment—that is, the portion of the annual MSA payment that a particular state receives in a given year—could be reduced by applying a non-participating manufacturers ("NPM") adjustment. That adjustment lowers a state's allocated share of the annual MSA payment if the OPMs lose market share to NPMs and if "a nationally recognized firm of economic consultants" determines that

1326-463: Is thus in the interest of the State to require that such manufacturers establish a reserve fund to guarantee a source of compensation and to prevent such manufacturers from deriving large, short-term profits and then becoming judgment-proof before liability may arise. In light of that, the model escrow statute requires an NPM selling cigarettes in [*1122] a given state to do one of two things: 1) join

1428-650: The British Medical Journal linking smoking to lung cancer and heart disease. In 1954 the British Doctors Study confirmed the suggestion, based on which the government issued advice that smoking and lung cancer rates were related. In 1964 the United States Surgeon General 's Report on Smoking and Health likewise began suggesting the relationship between smoking and cancer. By the mid-1950s, individuals in

1530-591: The Affordable Care Act . Unadjusted for timing shifts, in 2017 Medicare spending was $ 595 billion and Medicaid spending was $ 375 billion. Medicare covered 57 million people as of September 2016. While on the other hand, Medicaid covered 68.4 million people as of July 2017, 74.3 million including the Children's Health Insurance Program (CHIP). Medicare and Medicaid are managed at the Federal level by

1632-732: The American Medical Association (AMA) and AARP support a "fair and accurate valuation for all physician services". Very few resources exist, however, that allow consumers to compare physician prices. The AMA sponsors the Specialty Society Relative Value Scale Update Committee , a private group of physicians which largely determine how to value physician labor in Medicare prices. Among politicians, former House Speaker Newt Gingrich has called for transparency in

1734-599: The California Healthcare Foundation found that only 25% of visitors asking for pricing information were able to obtain it in a single visit to a hospital. This has led to a phenomenon known as "surprise medical bills", where patients receive large bills for service long after the service was rendered. Since the majority (85%) of Americans have health insurance , they do not directly pay for medical services. Insurance companies, as payors, negotiate health care pricing with providers on behalf of

1836-531: The Centers for Medicare and Medicaid Services (CMS). CMS sets fee schedules for medical services through Prospective Payment Systems (PPS) for inpatient care, outpatient care, and other services. As the largest single purchaser of medical services in the U.S., Medicare's fixed pricing schedules have a significant impact on the market. These prices are set based on CMS' analysis of labor and resource input costs for different medical services based on recommendations by

1938-495: The Kaiser Foundation reported that for the second-lowest cost "Silver plan" (a plan often selected and used as the benchmark for determining financial assistance), a 40-year old non-smoker making $ 30,000 per year would pay effectively the same amount in 2017 as they did in 2016 (about $ 208/month) after the subsidy/tax credit, despite large increases in the pre-subsidy price. This was consistent nationally. In other words,

2040-716: The Tobacco Master Settlement Agreement , Winston's sponsorship was replaced by Dodge in 2001 (coinciding with their re-entry to the Cup Series that year), lasting until 2006. Whelen Engineering picked up the sponsorship in 2007, renaming it the NASCAR Whelen All-American Series. For the 2010 season, NASCAR lowered the age minimum for its weekly racing series from 16 to 14. In 2005 the Weekly Series became

2142-610: The Wayback Machine , which offer hospital price comparison and appointment booking services. According to the estimation of the US government, hundreds of thousands of Americans (Californians ) traveled to Mexico annually to get healthcare services. In the United States and most other industrialized nations, emergency medical providers are required to treat any patient that has a life-threatening condition, irrespective of

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2244-494: The " Tour Type " and the SK formula), dirt Modifieds and Late Models, and street stocks, super stocks are considered eligible categories. Participating tracks are all short tracks, ranging from 1/4 mile to 5/8 mile; most are paved, but a significant number of dirt tracks also participate. Tobacco Master Settlement Agreement The Tobacco Master Settlement Agreement ( MSA ) was entered on November 23, 1998, originally between

2346-429: The 14 states that grow flue-cured and burley tobacco used to manufacture cigarettes are eligible to receive payments from the trust fund. The states are Alabama, Florida, Georgia, Indiana, Kentucky, Maryland, Missouri, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and West Virginia. At the time the Master Settlement Agreement became effective, the OPMs collectively controlled approximately 97% of

2448-534: The 1980s, tobacco companies claimed contributory negligence as they asserted adverse health effects were previously unknown or lacked substantial credibility. In the mid-1990s, more than 40 states commenced litigation against the tobacco industry, seeking monetary, equitable, and injunctive relief under various consumer-protection and antitrust laws. The first case was declared in May 1994 by Mississippi Attorney General Mike Moore . The general theory of these lawsuits

2550-627: The 46 settling states (including Kansas) have enacted these statutes. See K.S.A. § 50-6a04. The Kansas Attorney General is charged with enforcing the Escrow and Contraband Statutes. Health care prices Health care prices in the United States of America describe market and non-market factors that determine pricing, along with possible causes as to why prices are higher than in other countries. Compared to other OECD countries, U.S. healthcare costs are one-third higher or more relative to

2652-417: The ACA marketplaces, which covered an estimated 12 million persons in 2017 who individually obtain insurance (e.g., not as part of a business). The law is designed to pay subsidies in the form of premium tax credits to the individuals or families purchasing the insurance, based on income levels. Higher income consumers receive lower subsidies. While pre-subsidy prices rose considerably from 2016 to 2017, so did

2754-659: The Allocable Share Release Repealer ("ASR Repealer"), a model statute which eliminated the ASR. In a memo dated September 12, 2003, Attorney General William H. Sorrell of Vermont, Chairman of the NAAG Tobacco Project, underscored the urgency of "all States taking steps to deal with the proliferation of NPM sales, including enactment of complementary legislation and allocable share legislation and consideration of other measures designed to serve

2856-746: The American Medical Association. As part of Medicare's pricing system, relative value units (RVUs) are assigned to every medical procedure. One RVU translates into a dollar value that varies by region and by year; in 2005 the base (not location adjusted) RVU equaled roughly $ 37.90. Major insurers use Medicare's RVU calculations when negotiating payment schedules with providers, and many insurers simply adopt Medicare's payment schedule. The AMA-sponsored committee in charge of determining RVUs of medical procedures that inform Medicare's payment to physicians has been shown to grossly inflate their figures. An estimated 155 million persons under

2958-722: The Attorneys General of the remaining 46 states, as well as of the District of Columbia, Puerto Rico, and the Virgin Islands, entered into the Master Settlement Agreement with the four largest manufacturers of cigarettes in the United States. ( Florida , Minnesota , Texas and Mississippi had already reached individual agreements with the tobacco industry.) The four manufacturers— Philip Morris USA , R. J. Reynolds Tobacco Company , Brown & Williamson Tobacco Corp. , and Lorillard Tobacco Company —are referred to in

3060-670: The Federal Tobacco Legislation Offset, the Litigating Releasing Parties Offset, and the offsets for claims over described in subsections XII(a)(4)(B) and XII(a)(8). The attorneys general did not have the authority to grant all this by themselves: the Global Settlement Agreement would require an act of Congress. Senator John McCain of Arizona carried the bill, which was much more aggressive than even

3162-448: The Kansas escrow fund $ .0167539 for each cigarette the NPM sold in that state. Pursuant to the refund provision in the originally enacted Kansas escrow statute, however, the NPM could obtain a refund of all but .8336712% of those payments. One commentator further explains that the calculations under the [originally enacted escrow] statutes were based on an assumption that a nonparticipating manufacturer sold cigarettes nationally. When this

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3264-601: The MSA as the Original Participating Manufacturers (OPMs). This settlement process yielded two other national agreements: In the Smokeless Tobacco Master Settlement Agreement, which was executed at the same time as the Master Settlement Agreement, the leading manufacturer in the smokeless tobacco market (United States Tobacco Company, now known as U.S. Smokeless Tobacco Company ) settled with

3366-532: The MSA provide these other tobacco companies with incentives to join the agreement. One such incentive, called the NPM Adjustment, provides that the payments by the PMs to the settling states may be adjusted according to the "NPM Adjustment Percentage." According to this provision, if a nationally recognized firm of economic consultants determines that the PMs have lost market share as a result of compliance with

3468-462: The MSA requires from OPMs and SPMs for sales which are not exempt. To the extent it differs, the OPMs pay slightly more than the SPMs, which pay slightly more than the NPMs. The escrow statute specifically requires that the NPM place into a qualified escrow fund by April 15 of the year following the year in question the following amounts (as such amounts are adjusted for inflation)— Each state receives

3570-482: The MSA was "a significant factor contributing to the Market Share Loss for the year in question." The NPM adjustment does not apply to any state that has enacted and has in "full force and effect" a "qualifying" or model escrow statute. All settling states have enacted qualifying statutes. The escrow statute is premised on the legislative finding that, in light of the MSA settling the states' claims against

3672-432: The MSA within 90 days of its execution, the annual payments are determined by the number of cigarettes an SPM sells beyond the "grandfathered" volume—calculated as the higher of either the individual SPM's market share in 1998 (the year the MSA was executed) or 125% of the SPM's market share in 1997. If an SPM's sales volume or market share declines below the grandfathered amount, then it is not required to make any payments to

3774-401: The MSA, agreeing to "become a participating manufacturer (as that term is defined in section II(jj) of the [MSA]) and generally perform its financial obligations under the [MSA]," or 2) make similar annual payments into a state "liability reserve" escrow account, the funds of which can only be used to pay a judgment or settlement on a claim against the NPM. (After 25 years, any amount remaining in

3876-414: The MSA, the PMs' required payments to the settling states will be reduced to account for the loss. The NPM Adjustment therefore gives the settling states an incentive to protect the market dominance of the PMs, because [*551] otherwise the settling states themselves will receive less funds. The MSA also provides a safe harbor from the NPM Adjustment if a settling state "diligently enforces" the provision of

3978-492: The MSA. In addition, the congressional proposal would have mandated Food and Drug Administration oversight and imposed federal advertising restrictions. It also would have granted immunity from state prosecutions; eliminated punitive damages in individual tort suits; and prohibited the use of class actions, or other joinder or aggregation devices without the defendant's consent, assuring that only individual actions could be brought. The congressional proposal called for payments to

4080-448: The MSA. If an NPM concentrated its sales in a few state with low allocable share percentages, however, the NPM could obtain a refund of much of its escrow payments. Because the Kansas percentage was so low—roughly 0.8 per cent—NPMs concentrated their sales within Kansas and a few other states to receive immediate escrow refunds from those states. Rather than selling cigarettes nationally, several NPMs instead concentrated their sales in just

4182-616: The National Association of Attorneys General and the Majors jointly petitioned Congress for a global resolution. On June 20, 1997, Mississippi Attorney General Michael Moore and a group of other attorneys general announced the details of the settlement. The settlement included a payment by the companies of $ 365.5 billion, agreement to possible Food and Drug Administration regulation under certain circumstances, and stronger warning labels and restrictions on advertising. In exchange

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4284-469: The OECD, over 5% GDP higher than the next most expensive OECD country. With U.S. GDP of $ 19 trillion, healthcare costs were about $ 3.2 trillion, or about $ 10,000 per person in a country of 320 million people. A gap of 5% GDP represents $ 1 trillion, about $ 3,000 per person relative to the next most expensive country. In other words, the U.S. would have to cut healthcare costs by roughly one-third ($ 1 trillion or $ 3,000 per person on average) to be competitive with

4386-419: The OPMs have agreed to pay the settling states each year. Those annual amounts are subject to a number of adjustments. The OPMs each pay a portion of the total annual payment according to each OPM's "Relative Market Share" for the preceding year. For the SPMs (Subsequent Participating Manufacturers), the payments are determined by their relative market share as compared to other SPMs. For the SPMs that joined

4488-404: The PMs are required to annually contribute to the states varies according to several factors. All payments are based primarily on the number of cigarettes sold. For the OPMs (Original Participating Manufacturers), the payments are determined in accordance with their relative market share as of 1997. The payment amount of a particular OPM is also dictated by the "Volume Adjustment," which compares

4590-423: The SPM's national cigarette sales for a given year. In addition to its annual payment obligations, in order [**9] to join the Master Settlement Agreement now, a non-exempt SPM must, "within a reasonable time after signing the" Master Settlement Agreement, pay the amount it would have been obligated to pay under the Master Settlement Agreement during the time between the Master Settlement Agreement's effective date and

4692-577: The Subsequent Participating Manufacturers (SPMs), are bound by the Master Settlement Agreement's restrictions and must make payments to the settling states as set forth in the Master Settlement Agreement. Collectively, the OPMs and the SPMs are referred to as the Participating Manufacturers (PMs). Any tobacco company choosing not to participate in the Master Settlement Agreement is referred to as

4794-616: The United States began to sue the companies responsible for manufacturing and marketing cigarettes for damages related to the effects of smoking. In the forty years through 1994, over 800 private claims were brought against tobacco companies in state courts across the country. The individuals asserted claims for negligent manufacture, negligent advertising, fraud, and violation of various state consumer protection statutes. The tobacco companies were successful against these lawsuits. Only two plaintiffs ever prevailed, and both of those decisions were reversed on appeal. As scientific evidence mounted in

4896-427: The age 65 were covered under health insurance plans provided by their employers in 2016. The Congressional Budget Office (CBO) estimated that the health insurance premium for single coverage would be $ 6,400 and family coverage would be $ 15,500 in 2016. The annual rate of increase in premiums has generally slowed after 2000, as part of the trend of lower annual healthcare cost increases. The Federal Government subsidizes

4998-447: The age of 65 were uninsured. Unlike most markets for consumer services in the United States , the healthcare market generally lacks transparent market-based pricing . Patients are typically not able to comparison shop for medical services based on price, as medical service providers do not typically disclose prices prior to service. Government mandated critical care and government insurance programs like Medicare also impact

5100-473: The annual MSA payment among themselves according to each state's preset allocable share, rather than according to the volume of sales made in a particular state in a given year. An NPM's payments into a state's escrow fund, on the other hand, were dependent on the number of cigarettes that the NPM sold in that state in a given year. Nevertheless, the originally enacted escrow statute based any refund of those escrowed funds payments on that state's allocable share of

5202-477: The annual inflation rate in healthcare costs has declined in recent decades, it still remains above the rate of economic growth, resulting in a steady increase in healthcare expenditures relative to GDP from 6% in 1970 to nearly 18% in 2015. Health insurance coverage is provided by several public and private sources in the United States. During 2016, the U.S. population overall was approximately 325 million, with 53 million persons 65 years of age and older covered by

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5304-476: The companies agreed to curtail or cease certain tobacco marketing practices , as well as to pay, in perpetuity, various annual payments to the states to compensate them for some of the medical costs of caring for persons with smoking-related illnesses. The money also funds a new anti-smoking advocacy group , called the Truth Initiative , that is responsible for such campaigns as Truth and maintains

5406-489: The companies would be freed from class-action suits and litigation costs would be capped. This proposed congressional remedy (1997 National Settlement Proposal (NSP), a.k.a. the "June 20, 1997 Proposal") for the cigarette tobacco problem resembled the eventual Multistate Settlement Agreement (MSA), but with important differences. For example, although the congressional proposal would have earmarked one-third of all funds to combat teenage smoking, no such restrictions appear in

5508-456: The country, with many individuals having deductibles of $ 2500 or more, their ability to pay for costly procedures diminishes, and hospitals end up covering the cost of patients care. Many health systems are putting in place price transparency initiatives and payments plans for their patients so that the patients better understand what the estimated cost of their care is, and how they can afford to pay for their care over time. Organizations such as

5610-527: The date on which the SPM joined the agreement. The addition of the Subsequent Participating Manufacturers meant that nearly all of the cigarette producers in the domestic market had signed the Multistate Settlement Agreement. Their addition was significant. The Majors allegedly feared that any cigarette manufacturer left out of a settlement (Non-Participating Manufacturers or NPMs) would be free to expand market share or could enter

5712-455: The denominator in the calculation is the total OPM market share, not the total OPM and SPM market share." Furthermore, the parties agree that the amount the SPMs pay per cigarette is roughly the same as the per-cigarette amount that the OPMs pay under the MSA. To the extent the amount differs, the OPMs pay slightly more than the SPMs on a per cigarette basis. The payments from all the PMs are deposited into an escrow account until disbursement to

5814-571: The disabled. Medicaid was established at the same time to provide medical insurance primarily to children, pregnant women, and certain other medically needy groups. The Congressional Budget Office (CBO) reported in October 2017 that adjusted for timing differences, Medicare spending rose by $ 22 billion (4%) in fiscal year 2017, reflecting growth in both the number of beneficiaries and in the average benefit payment. Medicaid spending rose by $ 7 billion (2%) in part because of more persons enrolled due to

5916-439: The domestic market for cigarettes. In addition to these "originally settling parties" (OSPs), the Master Settlement Agreement permits other tobacco companies to join the settlement; a list of these "subsequently settling parties" (SSPs) is maintained by the National Association of Attorneys General. Since 1998, approximately 41 additional tobacco companies have joined the Master Settlement Agreement. These companies, referred to as

6018-436: The employer market, some of this is because of insurance policies that have a higher deductible , co-payments and out-of-pocket maximums that shift costs from insurers to patients. In addition, many employees are choosing to combine a health savings account with higher deductible plans, making the impact of the ACA difficult to determine precisely. For those who obtain their insurance through their employer ("group market"),

6120-422: The employer-based market by an estimated $ 250 billion per year (about $ 1,612 per person covered in the employer market), by excluding health insurance premiums from employee income. This subsidy encourages people to buy more extensive coverage (which places upward pressure on average premiums), while also encouraging more young, healthy people to enroll (which places downward pressure on premium prices). CBO estimates

6222-422: The escrow account is returned to the NPM.) An NPM's annual escrow payments in a particular state are calculated by multiplying a per-cigarette amount, established by the state's legislature and set forth in the statute, by the number of cigarettes the NPM sold in that state in the year for which payment is being made. The parties agree that this per-cigarette amount is roughly equivalent to the per-cigarette amount

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6324-438: The exempt SPM's market share in a given year increases beyond those relevant historic limits, the MSA requires that the exempt SPM make annual payments to the settling states, similar to those made by the OPMs, but based only upon the SPM's sales representing the exempt SPM's market share increase. SPMs joining the Master Settlement Agreement after this ninety-day exempt period must, instead, make annual payments based upon all of

6426-492: The federal Medicare program. The 272 million non-institutional persons under age 65 either obtained their coverage from employer-based (155 million) or non-employer based (90 million) sources or were uninsured (27 million). Approximately 15 million military personnel received coverage through the Veteran's Administration. During the year 2016, 91.2% of Americans had health insurance coverage. An estimated 27 million people under

6528-472: The first NASCAR-sanctioned series to have a permanent presence outside of the United States, as tracks in Saint-Eustache, Quebec , Delaware, Ontario , and Wetaskiwin, Alberta , elected to be represented in the series. Advance Auto Parts assumed naming rights for the series on June 10, 2020. Under the original regional format (1982–2004), a competition performance index (CPI) was used to determine

6630-400: The four largest United States tobacco companies ( Philip Morris Inc. , R. J. Reynolds , Brown & Williamson and Lorillard – the "original participating manufacturers", referred to as the "Majors") and the attorneys general of 46 states. The states settled their Medicaid lawsuits against the tobacco industry for recovery of their tobacco-related health-care costs. In exchange,

6732-543: The four states recovering a total of over $ 35 billion. Four states (Mississippi, Florida, Texas and Minnesota) settled with the OPMs before the MSA. The OPMs pay those four states (the "previously settled states") 17 per cent of the MSA per-cigarette payment amount for each cigarette sold in any state. Thus, the OPMs pay the settling and previously settled states 104.55 per cent of the per-cigarette amount for each cigarette sold. In 2005, OPM payments totaled about 2.2 cents per cigarette or 44 cents per box. On November 23, 1998,

6834-471: The global settlement. However, in the spring of 1998, Congress rejected both the proposed settlement and an alternative proposal submitted by McCain. While the proposed legislation was being discussed in Congress, some individual states began settling their litigation against the tobacco industry. On July 2, 1997, Mississippi became the first. Over the next year, Florida, Texas, and Minnesota followed, with

6936-512: The insured. Hospitals, doctors, and other medical providers have traditionally disclosed their fee schedules only to insurance companies and other institutional payors, and not to individual patients. Uninsured individuals are expected to pay directly for services, but since they lack access to pricing information, price-based competition may be reduced. The introduction of high-deductible insurance has increased demand for pricing information among consumers. As high-deductible health plans rise across

7038-484: The interests of the States in avoiding reductions in tobacco settlement payments." He stressed that "NPM sales anywhere in the country hurt all States," that NPM sales in any state reduce payments to every other State," and that "[a]ll States have an interest in reducing NPM sales in every State." The "Allocable Share Release Repeal" ("ASR Repeal") revised the originally enacted escrow statute's refund calculation to remove

7140-529: The jurisdictions who signed the MSA, plus Minnesota and Mississippi. The next year, the major cigarette manufacturers settled with the tobacco-growing states to compensate tobacco growers for losses they were expected to suffer due to the higher cigarette prices resulting from the earlier settlements. Called the "Phase II" settlement, this agreement created the National Tobacco Growers' Settlement Trust Fund. Tobacco growers and quota holders in

7242-409: The major cigarette manufacturers, [i]t would be contrary to the policy of the State if tobacco product manufacturers who determine not to enter into such a settlement could use a resulting cost advantage to derive large, short-term profits in the years before liability may arise without ensuring that the State will have an eventual source of recovery from them if they are proven to have acted culpably. It

7344-448: The market pricing of U.S. health care. According to The New York Times in 2011, "the United States is far and away the world leader in medical spending, even though numerous studies have concluded that Americans do not get better care " and prices are the highest in the world. In the U.S. medical industry , patients generally do not have access to pricing information until after medical services have been rendered. A study conducted by

7446-464: The market with lower prices, drastically altering the Majors' future profits and their ability to increase prices to pay for the settlement. The Original Participating Manufacturers (OPMs) agreed to several broad categories of conditions: A section on enforcement gave jurisdiction to individual state courts to implement and enforce the term, and established a state enforcement fund ($ 50 million one-time payment). The participating manufacturers also paid

7548-464: The medical system by increasing prices for other patients and through collection of government subsidies. Harvard economist N. Gregory Mankiw explained in July 2017 that "the magic of the free market sometimes fails us when it comes to healthcare." This is due to: Medicare was established in 1965 under President Lyndon Johnson , as a form of medical insurance for the elderly (age 65 and above) and

7650-426: The national MSA payment. This refund provision, then, assumed an NPM would sell its cigarettes nationally. If an NPM made the bulk of its sales in a few states, however, it could obtain a refund of those escrow payments in excess of what it would have paid each of those States had it been an SPM. For example, an NPM which made 50 per cent of its sales in Kansas (which has a relatively low allocable share) would obtain

7752-412: The net effect is to increase premiums 10-15% over an un-subsidized level. The Kaiser Family Foundation estimated that family insurance premiums averaged $ 18,142 in 2016, up 3% from 2015, with workers paying $ 5,277 towards that cost and employers covering the remainder. Single coverage premiums were essentially unchanged from 2015 to 2016 at $ 6,435, with workers contributing $ 1,129 and employers covering

7854-409: The next most expensive country. Healthcare spending in the U.S. was distributed as follows in 2014: Hospital care 32%; physician and clinical services 20%; prescription drugs 10%; and all other, including many categories individually making up less than 5% of spending. These first three categories accounted for 62% of spending. Important differences include: The Congressional Budget Office analyzed

7956-513: The number of cigarettes sold in each payment year to the number of cigarettes sold in 1997. If the number of cigarettes sold by an OPM in a given year is less than the number it sold in 1997, the Volume Adjustment allows that OPM to reduce its payment to the settling states. In other words, a reduction in the amount of cigarettes sold by the OPMs results in the settling states receiving less money. The MSA sets forth specific amounts that

8058-546: The patient's financial resources. In the U.S., the Emergency Medical Treatment and Active Labor Act requires that hospitals treat all patients in need of emergency medical care without considering patients' ability to pay for service. This government mandated care places a cost burden on medical providers, as critically ill patients lacking financial resources must be treated. Medical providers compensate for this cost by passing costs on to other parts of

8160-651: The prices of medical devices, noting it is one of the few aspects or U.S. health care where consumers and federal health officials are "barred from comparing the quality, medical outcomes or price". Recently, some insurance companies have announced their intention to begin disclosing provider pricing as a way to encourage cost reduction. Other services exist to assist physicians and their patients, such as Healthcare Out Of Pocket , Accuro Healthcare Solutions , with its CarePricer software. Similarly, medical tourists take advantage of price transparency on websites such as MEDIGO and Purchasing Health Archived 2017-10-20 at

8262-407: The reasons for healthcare cost inflation over time, reporting in 2008 that: "Although many factors contributed to the growth, most analysts have concluded that the bulk of the long-term rise resulted from the health care system's use of new medical services that were made possible by technological advances..." In summarizing several studies, CBO reported the following drove the indicated share (shown as

8364-593: The reference to the enacting state's "allocable share" of the annual MSA payments. HN2The amended statute, therefore, now provides that an NPM will be entitled to a refund[t]o the extent that a tobacco product manufacturer establishes that the amount it was required to place into escrow, based on units sold in the state ... in a particular year, was greater than the [MSA] payments, as determined pursuant to section IX(i) of that agreement including, after final determination of all adjustments, that such manufacturer would have been required to make based on such units sold had it been

8466-428: The regional and national championships. The complicated CPI used four factors — winning percentage (feature wins / feature starts), top fives (top five finishes / feature starts available at tracks), car counts (track's average car count / highest average car count of track in a region) and starts (features driver started / feature starts available at the track). With the change to the divisional format in 2005 along came

8568-418: The remainder. The President's Council of Economic Advisors (CEA) described how annual cost increases have fallen in the employer market since 2000. Premiums for family coverage grew 5.6% from 2000-2010, but 3.1% from 2010-2016. The total premium plus estimated out-of-pocket costs (i.e., deductibles and co-payments) increased 5.1% from 2000-2010 but 2.4% from 2010-2016. Separate from the employer market are

8670-427: The settling states' motivation was different from that of the OPMs, these states also were concerned about the effect of the tobacco companies that refused to join the MSA. The settling states worried that the NPMs would be able to regulate their sales so as to stay afloat financially while at the same time being effectively judgment-proof. As a result of these twin concerns, the OPMs and the settling states sought to have

8772-430: The settling states. The MSA includes a model escrow (or qualifying) act and provides strong incentives for settling states to adopt it. "[A] Qualifying Statute ... is one that effectively and fully neutralizes the cost disadvantages that the Participating Manufacturers experience vis-a-vis Nonparticipating Manufacturers within the state." The MSA encouraged settling states to adopt the model escrow act by providing that

8874-464: The settling states. SPMs that failed to join the MSA within 90 days of its execution do not receive the benefit of any grandfathered amount. Both exempt and non-exempt SPMs' annual payment obligations under the MSA are "calculated on the basis of the percentage of the four original participating manufacturers' total domestic market share represented by the SPM[s'] domestic market share. ... In other words,

8976-569: The size of the economy (GDP). According to the CDC , during 2015, health expenditures per-person were nearly $ 10,000 on average, with total expenditures of $ 3.2 trillion or 17.8% of GDP . Proximate reasons for the differences with other countries include higher prices for the same services (i.e., a higher price per unit) and greater use of healthcare (i.e., more units consumed). Higher administrative costs, higher per-capita income, and less government intervention to drive down prices are deeper causes. While

9078-462: The smaller tobacco companies would choose not to join the MSA. This failure to join posed a potential problem for both the OPMs and the settling states. The OPMs worried that the NPMs, both because they would not be bound by the advertising and other restrictions in the MSA and because they would not be required to make payments to the settling states, would be able to charge lower prices for their cigarettes and thus increase their market share. Although

9180-481: The state unless the manufacturer becomes a PM under the MSA or is an NPM which makes all escrow payments required by the Escrow Statute. The model Contraband Statute imposes a criminal penalty on wholesalers who sell cigarettes made by NPMs who are not duly registered in the state and making full escrow payments. By the middle of 2002, only seven settling states had enacted Contraband Statutes. As of 2007, 44 of

9282-563: The states because health care costs imposed by each cigarette exceed the settlement payments. On the other hand, when reductions in settlement payments occur because NPM sales displace PM sales, the states receive no benefits if the NPMs do not make escrow payments. Therefore, in late 2000, the NAAG drafted a model Contraband Statute to ensure that NPMs made escrow payments on cigarettes. See PX 116. The model Contraband Statute provides that excise tax stamping agents may not stamp cigarettes for sale in

9384-703: The states of $ 368.5 billion over 25 years. By contrast, assuming that the Majors would maintain their market share, the MSA provides baseline payments of about $ 200 billion over 25 years. This baseline payment is subject to the Inflation Adjustment, the Volume Adjustment, the Previously Settled States Reduction, the Non-Settling States Reduction, the NPM Adjustment, the offset for miscalculated or disputed payments described in subsection XI(i),

9486-663: The states' Attorney Fees. Generally, the participating manufacturers agreed not to "take any action, directly or indirectly, to target Youth within any Settling State in the advertising, promotion or marketing of Tobacco Products, or take any action the primary purpose of which is to initiate, maintain or increase the incidence of Youth smoking within any Settling State." (§III(a)) The restrictions specified included bans on outdoor billboards , advertising on transit vehicles, as well as restrictions on sports marketing, event sponsorships and promotional products. States were to receive over $ 206 billion over 25 years: The amount of money that

9588-460: The subsidies increased along with the pre-subsidy price, fully offsetting the price increases. This premium tax credit subsidy is separate from the cost sharing reductions subsidy discontinued in 2017 by President Donald Trump, an action which raised premiums in the ACA marketplaces by an estimated 20 percentage points above what otherwise would have occurred, for the 2018 plan year. While health insurance premium cost increases have moderated in

9690-555: The subsidies, to reduce the after-subsidy cost to the consumer. For example, a study published in 2016 found that the average requested 2017 premium increase among 40-year-old non-smokers was about 9 percent, according to an analysis of 17 cities, although Blue Cross Blue Shield proposed increases of 40 percent in Alabama and 60 percent in Texas. However, some or all of these costs are offset by subsidies, paid as tax credits. For example,

9792-417: The total payments that such manufacturer would have been required to make in that year under the [MSA] ... had it been a participating manufacturer. This "Allocable Share Release Provision" was intended to create substantial equivalence between the escrow obligation of NPMs under the escrow statutes and the amounts the NPMs would have paid if they had they joined the MSA. The settling states agreed to divide

9894-426: The treatment of smoking-induced illnesses. Importantly, the defenses of personal responsibility that were so effective for the tobacco industry in suits by private individuals were inapplicable to the causes of action alleged by the states. Faced with the prospect of defending multiple actions nationwide, the Majors sought a congressional remedy, primarily in the form of a national legislative settlement. In June 1997,

9996-481: The winner started in a single-digit position (i.e., fifth) or five points if the winner had a double-digit starting position (i.e., 12th). What cars are used to score points in the weekly series is up to the discretion of the individual participating tracks, within Weekly Series guidelines. As of 2005, sportsman, two classes of pavement Late Model chassis (Super Late Models, which have offset chassis, and Late Models, which have perimeter chassis), pavement Modifieds (both

10098-409: Was greater than the allocable share which that state would have received if the NPM had been an SPM. The originally enacted escrow statutes permitted an NPM to obtain a refund of the amount the NPM paid into the escrow fund to the extent that a tobacco product manufacturer establishes that the amount it was required to place into escrow in a particular year was greater than the State's allocable share of

10200-551: Was that the cigarettes produced by the tobacco industry contributed to health problems among the population, which in turn resulted in significant costs to the states' public health systems. As Moore declared, "'[The] lawsuit is premised on a simple notion: you caused the health crisis; you pay for it.'" The states alleged a wide range of deceptive and fraudulent practices by the tobacco companies over decades of sales. Other states soon followed. The state lawsuits sought recovery for Medicaid and other public health expenses incurred in

10302-418: Was the case, the statutes functioned as intended, permitting the NPM to obtain a refund of excess amounts placed in escrow in each state. However, when an NPM followed a regional sales strategy, as several did, the original escrow statutes allowed the NPM to obtain a refund that was much larger than intended. To close this loophole, in late 2002, the National Association of Attorneys General ("NAAG") introduced

10404-407: Was used when the change to the state format took place in 2007, but the bonus points were reduced to just five points for the feature winner. In 2010 the maximum was dropped to 20 cars starting and 40 points going to the winner. For the 2014 season the maximum cars starting was dropped to 18 resulting in 36 points for the winner. Bonus points for the feature winner was also changed to three points if

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