A Flea in the Fur of the Beast

“Death, fire, and burglary make all men equals.” —Dickens

Category: Health Care

Huelskamps Gonna Huelskamp

by evanmcmurry

Tim Huelskamp (R-KA), basically the individual every invocation of “obstinate tea party wingnut congressman” refers to, thinks the ACA raised the uninsured rate in Kansas:

“It’s hard to get accurate numbers on anything,” the tea party congressman said. “But the numbers we see today is that — as I understand them — we believe there are more people uninsured today in Kansas than there were before the president’s health care plan went into effect. And I thought the goal was to bring more people into insurance.”

Of course, the national uninsured rate is falling, and fast, since the implementation of the ACA. But Huelskamp is being far more cynical than simple dissembling. Kansas rejected every provision of the ACA it could possibly reject: it didn’t set up a state exchange, and it didn’t take the federal government’s offer to expand Medicaid. Which is to say that Kansas went out of its way not to insure more of its residents, even on the federal government’s dime.

Sure enough, Gallup found last week that the uninsured rate is dropping three times as fast in states that embraced Obamacare than in states that did not*:

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To refuse any and all participation in the ACA and then complain that it didn’t lower your uninsured rate is pretty nasty—except that this complaint was the entire goal behind refusing the expansion. Tens of thousands of people, many of them low-income, were denied insurance, but Tim Huelskamp got a talking point out of it. As we know, Huelskamps are gonna Huelskamp.

* Note that the uninsured rate is still falling, even in states that stuck their heads in the repealing sand.

Employment Report, Good and Bad

by evanmcmurry

By most indicators, today’s jobs report was cause for relief. That the unemployment rate dropped three-tenths to 7.0 without a decline in the labor participation force is especially notable; in a good number of recent reports the decline of the unemployment rate has been at least partially attributable to people dropping out of the job search altogether.

None of that, however, changes the fact that November’s labor participation was the second-lowest in the past decade, save for October:

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That goes a long way toward explaining why Obama’s approval numbers on the economy are so low despite a few months in a row of modest hiring. Until that labor participation number goes up, the economy isn’t “improving” in a way that’s immediately palpable, whatever the larger indicators say.

Now, good news for everybody but Ted Cruz: “The number of persons employed part time for economic reasons (sometimes referred to as involuntary part-time workers) fell by 331,000 to 7.7 million in November.”

The deplorable rollout of Healthcare.gov and the seizure over  “if you like your crap plans you can keep them” has distracted Obamacare’s critics in the past two months from their main narrative that the ACA is a job killer. One of their specific predictions is that the ACA’s mandate that employers provide insurance for everyone over 30 hours or pay a fine will create a part time economy. Granted, the employer mandate doesn’t kick in until next summer, but if this warning were in any way true, that part time number would be going up, not down by 330K.

“I am alive so must live”

by evanmcmurry

The juxtaposition of these two tweets—the lower one written a day before Deeds’ son was released from a mental health facility due to lack of beds and went home, stabbed his father, and killed himself; the other posted after Deeds was released from the hospital this morning—is heartbreaking:

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He clearly wasn’t sharing that NYT article just cuz.

Well, That Didn’t Work

by evanmcmurry

According to a new NBC/WSJ poll*, the GOP House’s approval rating (24%) is the lowest in the poll’s recorded history, just one day after it hit rock bottom in a Gallup poll. Meanwhile Obama’s approval rating climbed two points from last month. That’s a statistically-insignificant improvement and within the margin of error, but it also definitively douses any hopes of the backlash anticipated by Republicans who have been hammering him for not “negotiating“—and makes Obama far and away the most popular player in the shutdown showdown. (Trademark.)

Now for the real news:

The health-care law has become more popular since the shutdown began. Thirty-eight percent see the Affordable Care Act (or “Obamacare”) as a good idea, versus 43 percent who see it as a bad idea – up from 31 percent good idea, 44 percent bad idea last month.

That’s right, Obamacare, after a week of what even its supporters have to admit has been a desultory rollout, had an eight-point swing in favorability ratings. Imagine—imagine!—that number had there not been an asinine government shutdown distracting from the website problems.

Ted Cruz’s inexplicable credentials as a legislative strategist were just revoked. I’d say I hope he’s proud of himself, but he probably actually is.

UPDATE: WaPo notices this:

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Under the Ted Cruz all-the-right-people-hate-me logic, doubling your unfavorables is good, no?

* Eternal poll caveats: polls are statistically-isolated snapshots of wavering opinion, heavily influenced by leading questions and of little long-term consequence. And to quote Homer Simpson, you can use facts to prove anything that’s even remotely true.

Call Me When We Get To Some Real Fascism

by evanmcmurry

Guess what! The judge who thought Obamacare was the creep of fascism is the same judge who approved the expansive NSA data-mining program.

Next time a progressive wants to pass anything, they should just make some shit up about how it fights terrorism. That’s all it ever comes down to.

Obamacare Could Help Turn Texas Blue

by evanmcmurry

Ezra Klein has a good summary of a Rand report on what’s going to happen to states that refuse Obamacare the Affordable Care Act’s expansion of Medicare:

The study, by the Rand corporation, looks at the 14 states that have said they will opt out of the new Medicaid funds. It finds that the result will be they get $8.4 billion less in federal funding, have to spend an extra $1 billion in uncompensated care, and end up with about 3.6 million fewer insured residents.

So then, the math works out like this: States rejecting the expansion will spend much more, get much, much less, and leave millions of their residents uninsured. That’s a lot of self-inflicted pain to make a political point.

Note that refusing isn’t just bad for the people who don’t get insured. When those people get sick, they will become a drain on publicly-funded services. Which means these states, rather than spend money up front and have healthier people, will spend money later on sicker people. This is the position Rick Perry, et al, are selling as morally and financially responsible.

Klein points to one unintended consequence: poking poor people with a stick might not be such a good idea electorally, especially if the people you’re callously leaving uninsured are part of a demographic that’s already set to imperil your party’s vice-like grip on state government.

In Texas, for instance, 38 percent of the Hispanic population is uninsured. Will having that security so near, and then learning that it’s been blocked by their government, activate that voting bloc in the way Prop 187 did in California? It’s a possibility National Journal columnist Ron Brownstein raised in a recent article. “In 1994, California Republican Gov. Pete Wilson mobilized his base by promoting Proposition 187, a ballot initiative to deny services to illegal immigrants. He won reelection that year—and then lost the war as Hispanics stampeded from the GOP and helped turn the state lastingly Democratic. Texas Republicans wouldn’t be threatened as quickly, but they may someday judge their impending decision on expanding Medicaid as a similar turning point.”

For some time now, Texas GOP town criers have been running around ringing a warning bell  about the growing Hispanic population, and what it will do the GOP’s monopoly if the party doesn’t act. Perry’s war on Medicare expansion will only exacerbate this exodus. I believe that’s what those in the biz call an “unforced error.”

Obamacare Opponents Now Basing Arguments Off Pop-up Ads They Found On The Internet

by evanmcmurry

News about Obamacare the Affordable Care Act had been getting good and better until this Forbes article that claimed the ACA would raise rates in California from 64-146%. This was in stark contrast to all the data emerging from the state’s new insurance exchange, which looked to be lowering rates. What gives?

Well…

What policies, I wondered, had Avik used as his point of comparison in reaching his startling conclusion?

I soon had my answer as Roy revealed where he had acquired his data, writing, “But in 2013, on eHealthInsurance.com (NASDAQ:EHTH), the median cost of the five cheapest plans was only $92.”

I must admit that it took a moment to sink in as my first reaction was to laugh. eHealthInsurance.com? Seriously?

Was Avik really using teaser rates published on the Internet by eHealthInsurance.com as his point of comparison? I mean, you don’t have to be a healthcare policy expert to know that websites like eHealthInsurance.com always flash low rates in front of you—prices that maybe one person in a thousand might actually hope to achieve—to tickle the interest of a potential customer.

This is like comparing the bus ticket you just bought to MegaBus’ “$1 FARES!” ad.

Obamacare Is A Train Wreck, If By Train Wreck You Mean Working Better Than Expected, Pt. 3

by evanmcmurry

Obamacare The Affordable Care Act has already begun making health care more affordable in states that have chosen to set up their own exchanges. Now it’s reducing costs via a tax on so-called Cadillac plans:

Proponents of the law say the Cadillac tax is helping bring down costs by making employers pay attention to what their health care costs are likely to be in the long run. “It’s really one of the most significant provisions” in the Affordable Care Act, said Jonathan Gruber, the M.I.T. economist who played an influential role in shaping the law. “It’s focusing employers on cost control, not slashing,” he said.

[snip] The percentage of employers revising their plans as a result of the tax has increased to 17 percent this year from 11 percent in 2011, according to a survey of United States companies released this month by the International Foundation of Employee Benefit Plans.

Although the tax does not start until 2018, employers say they have to start now to meet the deadline and they are doing whatever they can to bring down the cost of their plans.

One of the explicit goals of the ACA was to rein in health care costs. While taxing Cadillac plans will result in higher deductibles for fewer benefits, the overall cost of health care will be reduced at the same time: if fancier plans don’t cover every test and procedure under the sun, all arms of the health care industry will focus care. You’ll pay more out of pocket, but health care in general will become less of a catastrophic proposition, both on the individual and societal level.

This is also causing companies to look at ways to keep employees healthier:

Larger companies are also trying a variety of initiatives to improve the health of their workers — experimenting with an array of disease management and wellness programs, for instance, or even setting up their own work-site clinics as a way to sidestep the tax.

So: lower costs and healthier people, in exchange for paying more out of pocket.

More in the series:

Obamacare Is A Train Wreck, If By Train Wreck You Mean Working Better Than Expected, Pt. 2

Obamacare Is A Train Wreck, If By Train Wreck You Mean Working Better Than Expected, Pt. 1

Obamacare Is A Train Wreck, If By Train Wreck You Mean Working Better Than Expected, Pt. 2

by evanmcmurry

Followers of this blog/author will recall that it/he has been saying for some time that those states that got on board early with Obamacare the Affordable Care Act Medicaid expansion would soon be leaving their fellow states in the Tenth Amendment, crowded-ER dust.

Ahem:

California is a particularly important test for Obamacare. It’s not just the largest state in the nation. It’s also one of the states most committed to implementing Obamacare effectively. Under Gov. Arnold Schwarzenegger — remember how that really happened? — California was the first state to begin building its insurance exchanges. The state’s outreach efforts are unparalleled. Its insurance regulators are working hard to bring in good plans and make sure they’re playing fair. If California can’t make the law work, perhaps no one can. But if California can make the law work, it shows that others can, too.

[snip] The way this competition can drive down rates is already evident in Oregon. There, one insurer came in with monthly premium costs in the $169 range, while other insurers asked to charge more than $400. But then, seeing  what their competitors were charging, two insurers came back to the state’s regulators and asked if they could refile at lower rates. Otherwise, they wouldn’t be competitive in the exchange. The Obama administration was ecstatic to see this: It’s exactly what they’re hoping will happen across the country.

Klein goes on to say that this will be embarrassing for Texas come 2016, when California’s health care system is blossoming and Texas’ is a mess. This assumes anybody in the Capitol Building or Governor’s Mansion in Austin cares, which they don’t.

Obamacare Is a Trainwreck, If By Trainwreck You Mean Working Better Than Expected

by evanmcmurry

Via Jonathan Cohn:

On Thursday, officials in that state offered the first detailed glimpse of what consumers buying health benefits on their own can expect to pay next year. And from the looks of things, these consumers will be getting a pretty good deal.

Based on the premiums that insurers have submitted for final regulatory approval, the majority of Californians buying coverage on the state’s new insurance exchange will be paying less—in many cases, far less—than they would pay for equivalent coverage today. And while a minority will still end up writing bigger premium checks than they do now, even they won’t be paying outrageous amounts. Meanwhile, all of these consumers will have access to the kind of comprehensive benefits that are frequently unavaiable today, at any price, because of the way insurers try to avoid the old and the sick. 

[snip] On Thursday, officials and consumer advocates were talking about a very different kind of sticker shock: Premium bids that were lower than expected. “For plan after plan, we’re getting the best-case scenarios,” said Peter Lee, executive director of Covered California.

The reasons? Cohn points to a combo: insurers competitively pricing premiums to get new market shares; agencies in California having wide authority to keep offers competitive; and insurers actually playing ball for the purposes of making policy functional. I know, that last one’s crazy—we’re so used to wingnuts intentionally sabotaging policy for political gain we forgot that occasionally organizations make choices based on more than ideological self-immolation. Who knew?

Aaaaaaaaaand the kicker:

Unfortunately, millions of uninsured and under-insured Americans live in places like Florida and Texas, where there is far less sympathy—and a great deal more hostility—to the idea of Obamacare. It’s entirely possible that the insurance bids in those states will be a lot higher, precisely because state officials there are doing nothing to help and quite a bit to hurt implementation. But if that happens, blame won’t belong with the heath care law or the federal officials in charge of its management. It will belong with the state officials who can’t, or won’t, deliver to their constituents the benefits that California’s officials appear to be providing theirs.

On the bright side, if you apply for unemployment in Texas or Florida, you’ll get drug tested, so you got that going for you.