Delays and denials of health coverage are troubling in a country that underperforms across many health outcomes, but how do coverage denials impose a broader set of administrative burdens? Though KFF analyses highlight the number of denied ACA marketplace claims that are appealed, this chapter offers the first survey evidence of appeals and reversals at the patient level. Such an analysis helps to unpack not only the number of appeals, but also who appeals, and to what extent the admininistrative burdens of appealing are inequitable. Drawing on survey evidence, interviews with patients, and administrative data, this chapter shows how few patients understand they can appeal, and often they underestimate the odds of prevailing against health insurance giants. What’s more, not only are less affluent patients less likely to challenge denials, but also Black and Hispanic Medicaid patients and sicker patients are less likely to appeal successfully. That appealing – and doing so successfully – is so inequitably distributed offers new insights into the scope of this health policy problem and how it can deepen racial and socioeconomic divides in access to health benefits.

Every day, millions of Americans face barriers accessing prescription drugs because of delays and denials driven by prior authorization. Though this practice seeks to guard against runaway health care costs and unnecessary treatments, it can keep out of reach quite necessary drugs for common conditions such as diabetes and depression. Prescription drugs are a particularly important setting in which to examine this insurance practice not only because approximately two-thirds of American adults take prescription drugs, but also because this setting is astonishingly complex, placing heavy informational burdens on patients as well as on their physicians. This complexity is driven in part by each health insurer managing its own formulary, such that there is uncertainty about coverage whenever one changes insurers, with physicians often feeling as though they are prescribing in a black box. Drawing on interviews with patients and physicians, this chapter shows that discretion-laden medical necessity guidelines, coupled with formulary variation across insurers, can lead to treatment interruptions that exact a health and economic price for patients, especially those with fewer resources.

Mid-century corporate executives received most of their compensation from salaries and cash bonuses, making them highly vulnerable to the top marginal income tax rates. Because executives were also able to negotiate custom pay packages, they adopted policies to dodge those rates. Most importantly, executives were influential in spreading and legitimizing tax dodging not only within their own companies, where they could affect the nature and structure of their own pay packages and those of their employees, but they could influence compensation, benefit and perquisite, and reimbursement policies at thousands more companies in part by lobbying for legislative and regulatory action that officially sanctioned these new policies. Although executive tax dodging was not the only reason corporations partnered with the government in creating the plans that form the backbone of our employer-sponsored retirement and health insurance systems, as well as the stock-based compensation that helped to drive the wealth and pay gap between executives and workers, it was a powerful force in a system that has endured for decades.

Many jurisdictions around the world, which came to be known as “tax havens,” offered refuge against the high mid-century tax rates. Some individual taxpayers physically moved to these havens, which were primarily located in small, resource poor, countries whose primary source of commerce was from tourism because of their exotic locales. Corporations used techniques to shift profits to these tax haven jurisdictions while remaining based in the U.S. In either case, not only would the profits and income earned be free from tax in these jurisdictions, but because they were sourced there it would shield them from tax in the U.S. until the money was repatriated. These tax havens were portrayed in marketing materials and in the media in a way that deliberately associated the tax savings with the pristine beaches or snow-capped mountain ski resorts of the countries that hosted them, making the whole enterprise of tax dodging seem glamorous and exciting to the average taxpayer reading about them. Even though they were but a mirage for these average taxpayers, they inspired envy rather than resentment, which helped to normalize and spur interest in tax dodging among the middle class.

Contrary to what modern observers might have you believe, tax dodging during the 1950s and 1960s was more about tax cuts than tax increases. Faced with a high tax rate it did not support, but, for political reasons, it could not lower, Congress did the next best thing. It riddled the tax laws with “leaks, loopholes, exemptions, and preferences,” while looking the other way at much of the widespread “income-tax chiseling” in American society and only occasionally passing watered down legislation targeting the more high-profile tax dodging schemes.1 In effect, it cut the tax rates implicitly, rather than explicitly, which amounted to a tax cut of the worst kind. It was not transparent, it was not evenly distributed among the taxpayers or even targeted to achieve any policy objective in some cases, and, because it was too unpredictable for taxpayers to rely upon for planning purposes, it was inefficient.

This chapter traces the way that employers used the expense account and the deduction for entertainment, meal, and travel expenses to facilitate a rapid expansion of tax dodging. Employers were able to divert taxable compensation that would have been subject to the steep post-war marginal rates to business expenses that the employer could deduct and the employee could exclude from his individual income tax return. People of modest means were able to live lavishly, encouraging the development of country clubs, dinner clubs, expensive restaurants, and post-dinner entertainment options such as theaters and operas, to service this new demand. Resorts also began to host business conferences to attempt to make vacations tax deductible. Moreover, the rise in conspicuous consumption appeared to induce others to seek out similar opportunities to finance personal consumption with tax-deductible dollars.

This chapter describes the law governing transgender girls’ participation in girls’ sports. It compares the interpretations of Title IX’s prohibition on sex discrimination by the Obama and Biden administrations on the one hand and the Trump administration on the other. It explores the state laws regarding transgender girls’ inclusion or exclusion that have arisen against the backdrop of Title IX ambiguity. Finally, the chapter examines what courts have said about what Title IX and the Equal Protection Clause require with regard to transgender girls’ inclusion in or exclusion from girls’ sports.

This chapter explores the scientific connection between sex and sport. It begins by examining the meaning of sex and the criteria used to assign individuals to the male or female category. It ends by exploring the link between sex and sport and identifying the sex-related traits that have the greatest impact on athletic performance.

The rise in rates and drop in the exemption, not increased interest in tax advice among the wealthy, but among the new generation of middle class taxpayers. Tax advisors spring up to fill this new demand, not only in the form of tax lawyers and accountants for the well-off, which existed, albeit in smaller numbers, before World War II, but in the emergence of retail tax help, such as H&R Block, self-help advice books, tax advice columns in newspapers and magazines, and fly-by-night advice for people with far less ability to pay. Some of these were focused on tax return preparation, but because of the pressures to attract customers in the low margin retail tax industry, there were substantial incentives to promise high refunds. The growth of the tax advice industry sensitized the average person to common tax dodging techniques and to the practice of planning, rather than merely reacting, to taxes. The growth of tax advice also created a space for tax dodging school and tax protester movements, who spread information on tax dodging methods and justifications for non-filing in this pre-internet era by distributing pamphlets, organizing small group meetings and giving lectures.

Tax advisors may have helped a meaningful percentage of taxpayers to dodge their taxes, but advertising was a far more powerful medium in mid-century America for signaling the rising respectability of tax dodging. Publicity and advertising provided exposure and exposure helped to demystify, destigmatize, and normalize tax dodging. Although stories about the high-profile tax dodging described in the previous section provided exposure too, advertising suggested that it was not something only available to the rich and famous. Advertising alone may not have changed attitudes toward tax dodging, but it mirrored and reinforced changes in social attitudes toward the practice.

The question of whether transgender girls should be permitted to participate in girls’ sports has been one of the most politically contested and socially controversial of the last decade. Neither law nor medicine provides definitive answers. This book takes on the absolutist positions staked out by both the left and the right and argues in favor of a more nuanced framework that seeks to ensure all girls and boys –both transgender and cisgender – have access to the benefits of organized sports.

This chapter examines the arguments for transgender girls’ exclusion from girls’ sports that have dominated right-leaning public and political discourse. The chapter articulates the argument for exclusion based on fairness and contends that it cannot justify total exclusion of transgender girls from girls’ sports at every age and level. The chapter next uncovers the claims about human flourishing and personal dignity that also motivate arguments for exclusion and argues that such claims are too empirically dubious and normatively controversial to drive policy decisions.