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Medicaid was Responsible for Most of Newly Insured in California

By: Wednesday July 30, 2014 9:57 am

Sources Of Coverage Among California’s Previously UninsuredRoughly 3.4 million previously uninsured adult Californians say they have obtained health insurance since the beginning of the year, according to the Kaiser Family Foundation. This means that 58 percent of the once uninsured population in the state now have an insurance policies of some type.

The bulk of of this increase was thanks to the expansion of the California’s Medicaid program Medi-Cal. It was responsible for almost half of the increase in coverage while people buying plans on the new exchange accounted for only about one sixth. People signing up for employer coverage played a significant role.

Not only was Medi-Cal responsible for the biggest reduction in the uninsured but people like it better and find it easier to use than the exchange. The survey found 74 percent of people who signed up for Medi-Cal said the process was at least somewhat easy. By comparison just 60 percent who get coverage on the exchange felt that way. People who got coverage on the exchange also had a tougher time finding out if they qualified for financial assistance and confirming their coverage.

Similarly, while most found using their new plan a positive experience, on average Medi-Cal performed noticeably better than the exchange.

So Far Most Newly Insured Report Positive Experiences With Their Plan

The survey also looked at why many still remain uninsured. An incredible 71 percent of this group said insurance is something they needed. The problem remains cost and access. Half cited not being able to afford coverage or not being able to get enough financial assistance.

Roughly a third of the remaining uninsured actually tried to get coverage but most of this group found the process difficult. They found it difficult to compare plans, compares costs, and find a policy which fit their needs.

Once again the data should put the value of the private insurance exchanges in serious question even in states that do a good job building their systems. They are more difficult to use, they are more expensive, and more people are unhappy with the coverage they provide. Just expanding public insurance is much more effective.

Automatic Plan Renewal on the Exchanges Could Cause Some New Problems

By: Monday July 28, 2014 8:43 am

Shopping for health insurance: not all it’s cracked up to be

The Affordable Care Act exchanges will allow people to automatically renew the policy they selected last year but the complexity of how affordability tax credits are calculated means that could cause new problems for people. From the AP:

Insurance exchange customers who opt for convenience by automatically renewing their coverage for 2015 are likely to receive dated and inaccurate financial aid amounts from the government, say industry officials, advocates and other experts.

If those amounts are too low, consumers could get sticker shock over their new premiums. Too high, and they’ll owe the tax man later.

At issue is the inability of the government to update everyone’s information so people who automatically renew policies will assume to qualify for the same tax credits they got last year. For a lot of people though that won’t be right.

Any change in income or family structure completely changes what they qualify for. In addition because tax credits are based on the price of the second cheapest silver plan, any change in what is offered in the market could noticeably change everyone’s subsidies. The cheap plan you had could quickly become a relatively expensive one.

Effectively, if people want to be sure they won’t be hit with an unexpected bill they should go through the entire open enrollment process again each year. This is more of an inconvenience than a fatal problem, but it is another example of how the complicated design of the system makes it a bigger hassle than it needs to be.

My hope is at least this whole experience convinces regular people there is nothing desirable about shopping for health insurance so maintaining an expensive third party system purely to give people this “privilege” is idiotic.

Photo by Polycart under Creative Commons license

Jonathan Gruber Has an Honesty Problem

By: Friday July 25, 2014 12:41 pm

Either Gruber was misleading these people earlier, perhaps in an attempt to promote his consulting work or trick more states into adopting exchanges to make the law seem more popular, or he is misleading people now.

It appears more people are realizing Jonathan Gruber, the economist who was a top consultant for the White House on the Affordable Care Act, has an honesty problem when it comes to talking about the law.

The latest example is a 2012 video of him basically making the same arguments made by conservatives against the federally run exchanges being able to provide tax credits. Gruber claims he >misspoke. One mistake over the course of hundreds of appearances about the law would be completely understandable, but it turns out it wasn’t an isolated incident.

Gruber apparently made basically the exact same argument that only state exchanges can access tax credits on at least one other occasion. This time it wasn’t in response to a question but seems to be part of his planned remarks. Gruber is now claiming this was also a mistake but that stretches credibility. This argument he once made directly contradicts other statements he has made in defense of the law about the exchange subsides applying in all states.

Either Gruber was misleading these people earlier, perhaps in an attempt to promote his consulting work or trick more states into adopting exchanges to make the law seem more popular, or he is misleading people now.

The fact that Gruber might be less than honest when it comes to the Affordable Care Act shouldn’t come as a surprise. He actively allowed himself to be quoted as an outside expert during the debate when he was actually a paid consultant on the law, and during those interviews he would make hyperbolic statements in defense of the law that were provably false.

This whole incident shouldn’t make much of a difference to the legal argument since he is not a member of Congress. But it is possible it could give the conservatives on the Supreme Court the intellectual cover they need to rule against a law they dislike.

It would be more than be extremely ironic if Gruber’s misleading statements helped get the law approved in first place and his other statements helped legally undermine it.

Under Obamacare, the Hen House Guards Morph Into Foxes

By: Friday July 25, 2014 10:23 am

It looks like the new state-based exchanges created by the Affordable Care Act are powering the next spin of the Revolving Door. We are not even a full year into implementation and already the head of Colorado’s insurance exchange is moving on to more lucrative pastures on the other side. From The Denver Post:

The state health insurance exchange’s chief executive, Patty Fontneau, announced Thursday she will leave Connect for Health Colorado to take a job as president of Private Exchange Business for Cigna.

She will leave her post in mid-August. The exchange’s board of directors said they plan to name an interim CEO within a week.

In theory it might be possible to build effective states insurance exchanges using only private insurers which would aggressively control costs and strongly protect consumers; but in practice, I’ve long had serious doubts. The potential for them to be subverted and corrupted is just too high, especially in our country with for-profit insurance companies that can offer obscene salaries and have a history of bad behavior.

The people tasked with watching the hen houses under Obamacare are at the same time becoming the foxes. Amazingly, Democrats still seemed shocked that the law hasn’t become more popular.

The West’s Water Problems Could Get a Lot Worse

By: Friday July 25, 2014 8:19 am
Colorado River Basin mapThis is the concerning news of the day. A new NASA study indicates the Western states are using up ground water at an alarming rate during what has been an over-decade long dry period.  From NASA:

A new study by NASA and University of California, Irvine, scientists finds more than 75 percent of the water loss in the drought-stricken Colorado River Basin since late 2004 came from underground resources. The extent of groundwater loss may pose a greater threat to the water supply of the western United States than previously thought.

This study is the first to quantify the amount that groundwater contributes to the water needs of western states. According to the U.S. Bureau of Reclamation, the federal water management agency, the basin has been suffering from prolonged, severe drought since 2000 and has experienced the driest 14-year period in the last hundred years.


“We don’t know exactly how much groundwater we have left, so we don’t know when we’re going to run out,” said Stephanie Castle, a water resources specialist at the University of California, Irvine, and the study’s lead author. “This is a lot of water to lose. We thought that the picture could be pretty bad, but this was shocking.”

This region affected, spread across several states, is home to millions of Americans.

Paul Ryan Calls for Sentencing Reform to Reduce Poverty

By: Thursday July 24, 2014 9:34 am

Paul Ryan directly attacked our current drug laws as unfair, ill-designed, and damaging.

Former Republican vice presidential candidate Paul Ryan (R-WI) is calling for significant sentencing reform to reduce the prison population. His proposed changes to our prison system were only part of a larger package of ideas to address poverty and improve economic mobility in the country.

At least in the criminal justice reform section of his plan Ryan can easily find common ground with Democrats, fiscal conservatives, libertarians, and progressives.

Ryan directly attacked our current drug laws as unfair, ill-designed, and often very damaging. He writes, “under current law, a single gram of crack cocaine could be all that separates a convict from a less-than-five-year sentence and a 40-year sentence. Rigid and excessive mandatory sentences for low-level drug offenders, like these, may add to an already over-crowded prison system without appreciably enhancing public safety.”

To make the system fairer Ryan strongly advocates the adoption of the bipartisan Smarter Sentencing Act currently making its way through the Senate. The measure would reduce mandatory minimums sentencing for non-violent drug offenders and gives judges more freedom to impose lower sentences if they are appropriate.

Ryan also wants the federal government to put more focus on programs to reduce recidivism, help individuals re-enter society and find employment. This would include changes at the federal level and partnerships with the states.

Because sentencing reform would also reduce the deficit, it is one of the few areas of bipartisan agreement which actually stands a decent chance of moving through a mostly gridlocked Congress. With Ryan’s support it might actually get a vote in the House.

How Public Feels About Obamacare Next Year Will Be More Important Than Halbig Decision

By: Wednesday July 23, 2014 11:26 am
justice statue scales

Justice may be blind but she’s also slow

I’m fairly confident this partial decision by the D.C. Circuit on Halbig v. Burwell will not stand. It is obviously absurd from a legal perspective, which is why other courts have ruled against the idea. But if by some miracle the opponents of the Affordable Care Act do ultimately prevail there is a real question of how much damage it could really do.

What is important to remember is that the case won’t even change anything for at least a year. The case will likely first get an en banc review by the full D.C. Court. That will take several months. Then the case will likely be appealed to the Supreme Court. If the Supreme Court even decides to take the case, it will be months before they hear oral arguments on it and several more months before they actually reach a verdict. Under the worst case scenario the Supreme Court won’t issue a ruling taking tax credits away from people in states with federally run exchanges well into 2015.

By that time the exchange tax credits will have been going to millions of people across the country for almost two years. People will have come to depend on them and eliminating these tax credits would be hugely disruptive. It would cost millions of people their coverage, savings, and/or jobs. It will not just be an immediate huge hit to people in the individual market, but also to hospitals, doctors, pharmacies and other businesses in the health care industry.

At the same time, fixing the issue would be extremely easy. Congress could pass a small correction or all the state governments could just just say they officially created a “state exchange” but contracting to do everything. These millions of people who would be directly and significantly hurt by the ruling should be able to create enough political pressure to force through one of these fixes.

If, after two years in operation most of the people who are supposed to benefit from the exchanges aren’t willing to fight over them, then the law fundamentally has a problem that goes way beyond this lawsuit. In the long run the program’s existence depends on the users wanting it to stay and being willing to change their votes based on the outcome.

If the law isn’t at least winning over its base of users by 2015, eventually it will be crippled either in one big move or in a thousand cuts. No government program that cost tens of billions a year, like the exchange tax credits, will survive long without a real base of support.

17 Percent Now Oppose Obamacare for Not Being Liberal Enough

By: Wednesday July 23, 2014 7:10 am

health care ACA single payer obamacareWith over half a year since the exchanges opened the American people have gotten plenty of time to judge the new health care law based on real world experiences and they continue to dislike it.

Only 40 percent favor the Affordable Care Act according to a new CNN/ORC poll, while 59 percent oppose it. This level of opposition has been basically unchanged for the past year and there is no reason to expect support to improve by November.

Some Democrats take solace in the fact that only 38 percent oppose the law for being too liberal while 17 percent oppose the law for not being liberal enough, so at least there isn’t popular support for the Republicans’ position either. Of course this still means one of the few big Democratic achievements in recent years is a huge disappoint to many of their potential voters. That is also a real problem in midterm elections where victory often depends on who turns out.

At 17 percent, opposition to the law for not being liberal enough is now the highest it has ever been in a CNN poll. This might just be basic fluctuation within the margin of error or an early sign that more left leaning people are starting to see some real practical flaws in the program.

The Undying Filibuster Myth

By: Tuesday July 22, 2014 10:23 am

walking deadI thought when Senate Democrats so easily eliminated the filibuster for executive appointees that was going to be the final nail in the coffin of the filibuster myth, but I was mistaken. The myth that the filibuster is some insurmountable hurdle, instead of something which can easily be dealt with, lives on in Kevin Drum’s defense of President Obama’s first year. From Drum:

As for Obama, could he have done more? I suppose he probably could have, but it’s a close call. Even with his earnest efforts at bipartisanship at the beginning of his presidency, he only barely passed any stimulus at all. If instead he’d issued thundering populist manifestos, even Susan Collins would have turned against him and the stimulus bill would have been not too small, but completely dead. Ditto for virtually everything else Obama managed to pass by one or two votes during his first 18 months. If that had happened, the economy would have done even worse, and if you somehow think this means the public would have become more sympathetic to the party in the White House, then your knowledge of American politics is at about the kindergarten level. Democrats would have lost even more seats in 2010 than they did.

Imagine it is 2009. Obama’s popularity is still sky high and a huge number of Democrats in Congress owe their seats to his big coattails. Picture him going to Congressional Democrats saying he needs them to pass something, say a $1 trillion stimulus or a health care law. He says the economy and his entire presidency depends on it, but the Senate Republicans are actively trying to sabotage him so he needs Congressional Democrats to do it without them.

Do we really think Senate Democrats would have responded, “tough luck Obama we think letting Republicans filibuster things is the most important thing ever?” Or do we think they would have found a way to do it by changing the filibuster or using reconciliation, just like Republicans did a few years early to pass Bush’s tax cuts?

I can’t guarantee Senate Democrats would have responded correctly, but this is a legitimate strategy that could have produced a dramatically different result. As we recently saw when pushed Democrats are willing and able to change the Senate rules.

Contrary to Drum’s claim there was nothing approved by only one or two votes in 2009, because Democrats simply preferred having over 60 votes for everything. Obama chose to live under this artificial constraint but he could have tried to fight to get rid of it to greatly expand his options.

Drum’s argument only works if you take the filibuster myth as fact. I can almost guarantee in the future once the filibuster is fully eliminated people will look back in disbelief at how pathetic it was that Obama let his first term to be crippled by something so stupid and easily dealt with.

D.C. Circuit Reaches Absurd Conclusion Against Obamacare Subsidies

By: Tuesday July 22, 2014 8:22 am

health careThe U.S. Court of Appeals for the D.C. Circuit in a 2-1 partial decision have reached jaw dropping, absurd conclusion that would potentially take away the Affordable Care Act’s insurance subsidies from people in over half the country.

The case is Halbig v. Burwell and it is based on a very contrived reading the law that completely ignores context and the entire Congressional record. Basically a group of employers are suing claiming the insurance tax credits can’t be provided to people in states where the exchanges are run by the federal government because that provision says tax credits are only for people enrolled in plans, “through an Exchange established by the State.”

This decision is incredible because never during the the months of debate was there any indication that a member of Congress thought the law should be read the way the court did. While on the other hand there is overwhelmingly evidence in the Congressional record and official CBO analysis that everyone assumed the law would allow subsidies on federally run exchanges. In addition many other provisions of the law, like those allowing for the creation of a federally run exchange where states fail to set up their own, would make zero logical sense if you follow the court’s tortured interpretation.

If the ruling stands it would mean several million Americans in states with federally run exchanges would lose their subsidies and likely lose their insurance as a result. It would also likely cause premiums to dramatically increase even for people who didn’t qualify for subsidies as healthy people leave the exchange.

It is unlikely the ruling will stand though. The Obama administration will likely ask the entire D.C. Circuit to review the decision “en banc.” The 11 members of the full court are more Democratic leaning than this three judge panel.

Image by Neff Connor under Creative Commons license