University of Wisconsin Madison

Rising health care prices in the U.S. are leading employers outside the health care sector to reduce their payroll and decrease their number of employees, according to a new study. The study found that when health care prices increased, non-health care employers responded by reducing their payroll and cutting the jobs of middle-class workers. For the average county, a 1% increase in health care prices would reduce aggregate income in the area by approximately $8 million annually. Rising health care prices in the U.S. are leading employers outside the health care sector to reduce their payroll and decrease their number of employees, according to a new study co-authored by Yale economist Zack Cooper. The study, published June 24 as a working paper by the National Bureau of Economic Research (NBER), found that when health care prices increased, non-health care employers responded by reducing their payroll and cutting the jobs of middle-class workers. For the average county, a 1% increase in health care prices would reduce aggregate income in the area by approximately $8 million annually. The study was conducted by a team of leading economists from Yale, the University of Chicago, the University of Wisconsin-Madison, Harvard University, the U.S. Internal Revenue Service (IRS), and the U.S. Department of the Treasury. "When health care prices go up, jobs outside the health care sector go down," said Cooper, an associate professor of health policy at the Yale School of Public Health and of economics in the Faculty of Arts and Sciences. "It's broadly understood that employer-sponsored health insurance creates a link between health care markets and labor markets. Our research shows that middle- and lower-income workers are shouldering rising health care prices, and in many cases, it's costing them their jobs. Bottom line: Rising health care costs are increasing economic inequality." To better understand how rising health care prices affect labor market outcomes, the researchers brought together insurance claims data on approximately a third of adults with employer-sponsored insurance, health insurance premium data from the U.S. Department of Labor, and IRS data from every income tax return filed in the United States between 2008 and 2017. They then used these data to trace out how an increase in health care prices -- such as a $2,000 increase on a $20,000 hospital bill -- flows through to health spending, insurance premiums, employer payrolls, income and unemployment in counties, and the tax revenue collected by the federal government. "Many think that it's insurers or employers who bear the burden of rising health care prices. We show that it's really the workers themselves who are impacted," said Zarek Brot-Goldberg, an assistant professor at the Harris School of Public Policy at the University of Chicago. "It's vital to understand that rising health care prices aren't just impacting patients. Rising prices are hurting the employment outcomes for workers who never went to the hospital." For the new study, the authors used hospital mergers as a vehicle to assess the effect of price increases. From 2000 to 2020, there were over 1,000 hospital mergers among the approximately 5,000 U.S. hospitals. In past work, the authors found that approximately 20% of hospital mergers should have been expected to raise prices by lessening competition, according to merger guidelines from the Department of Justice and the Federal Trade Commission. These mergers, on average, raised prices by 5%. "We can use our analysis to estimate the effect of hospital mergers," said Stuart Craig, an assistant professor at the University of Wisconsin-Madison Business School. "Our results show that a hospital merger that raised prices by 5% would result in $32 million in lost wages, 203 lost jobs, a $6.8 million reduction in federal tax revenue, and a death from suicide or overdose of a worker outside the health sector." The study also showed that because rising health care prices leads firms to let go of workers, a knock-on effect of hospital mergers is that they lead to increases in government spending on unemployment insurance and reductions in the tax revenue collected by the federal government. "It's vital to point out that hospital mergers raise spending by the federal government and lower tax revenue at the same time," said Cooper. "When prices in the U.S health sector rise, it's actually a net negative for the economy. It's leading to fewer jobs and precipitating all the consequences we associate with workers becoming unemployed." Other authors of the study were Lev Klarnet from Harvard University, Ithai Lurie from U.S. Department of Treasury, and Corbin Miller from the U.S. Internal Revenue Service.

New research shows that degraded savanna ecosystems can reap lasting benefits from a single seeding of native understory plants. Once a diverse understory of savanna plants became established, its long-term persistence was relatively unaffected by environmental factors -- with one exception. Higher temperatures during the height of the growing season were associated with poorer long-term survival among some species, indicating one threat posed by a warming climate. In the race to restore some of North America's most biodiverse and threatened ecosystems, a straightforward first step is likely among the most important. New research shows that degraded savanna ecosystems can reap lasting benefits from a single seeding of native understory plants. Published this week in the journal PNAS, the study underscores the long-term value of even a brief burst of targeted land management in efforts to restore fallow agricultural fields and other landscapes scarred by decades or centuries of human activity. The eight-year experiment led by a team of scientists at the University of Wisconsin-Madison and Michigan State University centered on three large tracts of federal land within the historical range of the longleaf pine savanna ecosystem. Longleaf pine savanna dominated portions of the southeastern United States prior to the arrival of Europeans. This biodiversity hotspot once spanned some 90 million acres but has largely vanished. Less than 5 percent of the continent's longleaf pine savanna remains, and much of what does persist is a shadow of the unspoiled ecosystem of the past. "In a high-quality longleaf stand, you can find over 30 species in a square meter. It's incredible," says John Orrock, a professor of ecology at UW-Madison. Orrock and UW-Madison professor Ellen Damschen, an ecologist and conservation biologist, led the study with Lars Brudvig at Michigan State. The longleaf stands where the researchers set up their experiment started out with decidedly fewer plant species than an unspoiled tract would contain. But, after assessing more than 230 sites, the team selected 48 that met specific parameters. These criteria allowed them to gauge whether factors like the depth of fallen pine needles or the spacing between trees would measurably affect whether native understory plants could establish or persist after seeding. Once the researchers identified their desired mix of sites, they applied herbicide to portions of some before planting them all with seeds from about two dozen species of native non-woody plants that they collected locally, including tall ironweed and sweet goldenrod. Over the course of eight years, the team returned periodically to document how successful each species was in becoming established and, crucially, how well they persisted year after year. They found that factors like needle depth, tree spacing and seasonal temperature and precipitation did have some influence on the initial success of seeding, including germination and establishment of healthy seedlings. Specifically, cooler and wetter conditions promoted better establishment, as did shallower needle depth and greater spacing between trees. These latter conditions reflect the ecosystem's natural state of periodic low-intensity wildfires that burn up leaf litter and saplings. The team found that preemptive herbicide applications did not measurably affect establishment. Once a diverse understory of savanna plants became established, its long-term persistence was relatively unaffected by environmental factors -- with one exception. Higher temperatures during the height of the growing season were associated with poorer long-term survival among some species, indicating one threat posed by a warming climate. In addition to highlighting risks of a warming climate, the results of the long-term study demonstrate that a single addition of native seeds can have clear benefits that last for years and years. The researchers are optimistic their results can help land managers direct limited resources toward restoration strategies with the greatest chance of success, especially because their study helps identify the best place and time to add seeds. "We can custom tailor the information from these experiments to conservation or restoration practitioners," says Orrock. "Depending on what your site is like, we can actually give you better information to increase the likelihood that you're going to succeed in your endeavor of restoring these plant species." While the results are most applicable in the context of the longleaf pine savanna ecosystem, they could prove useful for management of similar ecosystems, such as the oak savanna that once dominated large swaths of Wisconsin and the Midwest. "I see a lot of parallels in the work that we do both here in Wisconsin in tallgrass prairie and oak savanna and longleaf pine savanna in the southeast," says Damschen. "In fact, many of the species are identical, and the major plant families are extremely similar." Looking forward, Orrock and Damschen say they would like to better understand the traits of species and even individual plants that might help them germinate and establish healthy seedlings. This type of knowledge could prove especially useful for land managers dealing with new and rapidly unfolding environmental conditions associated with a changing climate.

Researchers describe a new family of nano-scale capsules made of silica that can carry genome-editing tools into many organs around the body and then harmlessly dissolve. Gene therapies have the potential to treat neurological disorders like Alzheimer's and Parkinson's diseases, but they face a common barrier -- the blood-brain barrier. Now, researchers at the University of Wisconsin-Madison have developed a way to move therapies across the brain's protective membrane to deliver brain-wide therapy with a range of biological medications and treatments. "There is no cure yet for many devastating brain disorders," says Shaoqin "Sarah" Gong, UW-Madison professor of ophthalmology and visual sciences and biomedical engineering and researcher at the Wisconsin Institute for Discovery. "Innovative brain-targeted delivery strategies may change that by enabling noninvasive, safe and efficient delivery of CRISPR genome editors that could, in turn, lead to genome-editing therapies for these diseases." CRISPR is a molecular toolkit for editing genes (for example, to correct mutations that may cause disease), but the toolkit is only useful if it can get through security to the job site. The blood-brain barrier is a membrane that selectively controls access to the brain, screening out toxins and pathogens that may be present in the bloodstream. Unfortunately, the barrier bars some beneficial treatments, like certain vaccines and gene therapy packages, from reaching their targets because in lumps them in with hostile invaders. Injecting treatments directly into the brain is one way to get around the blood-brain barrier, but it's an invasive procedure that provides access only to nearby brain tissue. "The promise of brain gene therapy and genome-editing therapy relies on the safe and efficient delivery of nucleic acids and genome editors to the whole brain," Gong says. In a study recently published in the journal Advanced Materials, Gong and her lab members, including postdoctoral researcher and first author of the study Yuyuan Wang, describe a new family of nano-scale capsules made of silica that can carry genome-editing tools into many organs around the body and then harmlessly dissolve. By modifying the surfaces of the silica nanocapsules with glucose and an amino acid fragment derived from the rabies virus, the researchers found the nanocapsules could efficiently pass through the blood-brain barrier to achieve brain-wide gene editing in mice. In their study, the researchers demonstrated the capability of the silica nanocapsule's CRISPR cargo to successfully edit genes in the brains of mice, such as one related to Alzheimer's disease called amyloid precursor protein gene. Because the nanocapsules can be administered repeatedly and intravenously, they can achieve higher therapeutic efficacy without risking more localized and invasive methods. The researchers plan to further optimize the silica nanocapsules' brain-targeting capabilities and evaluate their usefulness for the treatment of various brain disorders. This unique technology is also being investigated for the delivery of biologics to the eyes, liver and lungs, which can lead to new gene therapies for other types of disorders.