Healthcare.gov’s second act

Posted by & filed under CGR Staff, Rochester Business Journal.

Kent GardnerBy all accounts, the Affordable Care Act’s front door, healthcare.gov, performed admirably for consumers in its second year (although “back end” problems remain). Just to keep track, I registered on the site and have been getting a steady stream of emails and text messages ever since—29 text messages since October 24! They are filled with teasers like, “8 in 10 people who sign up can get financial help. You could too!” plus special messages for special days: “Cyber Monday: Shop for health plans today” and “Start the New Year with new health coverage.” And plenty of countdowns: “Only 9 days until the Dec 15 deadline” and, on Sunday, “Act now: Only hours left! This is your last chance to enroll . . .” Except that if you claim to have tried by Sunday, you’ll have until 2/22 to sign up for March 1 coverage. And the deadline to avoid an income tax penalty will likely be extended right up to Tax Day, avoiding shock and horror when the penalty becomes real.

Final enrollment figures will be forthcoming, but the Congressional Budget Office recently estimated that enrollment through the exchanges (both federal and state-run) will hit about 12 million this year (the White House reported 11.4 m by the deadline). CBO’s figures indicate that the Affordable Care Act has spurred an additional 11 million Medicaid enrollments, while reducing enrollment through other channels by about 5 million. The net increase in the number of individuals with health insurance as a consequence of the law totals about 19 million.Negative Trend

The political dynamic is fascinating (if you enjoy this sort of thing). Remember the old saw, that voters “hate Congress but love their Congressman?” ACA suffers from the schizophrenia. In November, Gallup reported that only 37% of the American public approve of ACA and 56%—a new high—disapprove. Support for specific provisions of the law—keeping dependents on family policies through age 26, eliminating the “pre-existing condition” exclusion for new policies, etc—is strong, however. Moreover, the CBO estimates that 9 million of those receiving coverage through the exchanges are getting subsidies—an average of $4,300 each. While these voters may express their disapproval of “Obamacare,” it’s a good bet that they’ll want their subsidies to continue.

As the Internet’s “Thanks, Obama” meme suggests, Obamacare is being blamed for all of the health system’s ills. A friend was told recently that her cataract surgery was being delayed because of ACA; a pharmacy employee reports that many customers complain that their drug costs have soared under the law. While the indirect effects of ACA are sweeping, neither is a direct outcome of the law.

Expansion of Medicaid coverage, one of ACA’s structural timbers, became voluntary after the Supreme Court’s NFIB v. Burwell ruling in 2012. Yet governors of refusenik states have been under pressure to expand Medicaid. Principled opposition is hard to maintain when massive federal subsidies are in the offing.

By not expanding Medicaid coverage, a “coverage gap” emerged that is manifestly unfair. A nondisabled, childless adult earning 100% of the federal poverty line ($11,770 in 2015) is eligible (obligated under the law, actually) to buy health insurance for an annual premium of 2% of income, $235, with the federal subsidy making up the difference. A loss of income—say, to $11,500—eliminates eligibility for Exchange subsidies. In the more than 20 states that didn’t expand Medicaid, nondisabled, childless adults at this income level would lose access to health insurance completely.

The Administration has been very willing to negotiate a compromise with nonexpansion states—the deal reached in a number of states, most recently Indiana, would seem to reinforce the states’ role as public policy laboratories. Indiana’s plan is worth studying, as it maintains most of the objectives of ACA but with cost-sharing and incentives that conservatives will like. For example, new enrollees in the expanded Healthy Indiana Plan (HIP) will be required to pay something toward their coverage to get full benefits—as little as $1 per month, but something. Moreover, coverage would not begin until the first premium payment is made, not on the date of application as in traditional Medicaid. Other financial incentives apply—co-payments up to $25 apply for nonemergency use of the hospital emergency room. And the benefits plan is somewhat trimmed, e.g. non-emergency medical transportation is disallowed for new enrollees.

All eyes will be back on the Supreme Court in just a couple of weeks, however. Oral argument in King v. Burwell is scheduled for March 4. Here’s the issue in the case: Whether by accident or intent, a plain language reading of the Affordable Care Act says that federal subsidies are only available to individuals who get coverage through a state-run exchange. StatemapIf the Court finds for the plaintiffs when it issues its ruling this summer, that could eliminate subsidies for a lot of people and put governors and legislatures in 37 states in a very awkward position. The Urban Institute estimates that 9.3 million individuals are likely to lose subsidies and that 8.2 million will lose coverage if the subsidies are ruled invalid.

If you consider what we’ve learned from the Gallup Poll, many of the 9.3 million would declare their support for repealing “Obamacare.” And nearly all will also want to keep their subsidy. Ain’t politics grand!

Red Light Cameras, Charlie Hebdo and Our Own Privacy

Posted by & filed under CGR Staff, Rochester Business Journal.

Kent GardnerRedlightcameraThe Chicago Tribune is at war with the City of Chicago over red light cameras. In a series of articles printed before Christmas (read at my mother’s kitchen table in suburban Chicago), the Trib reported on a study of the effects of the red light cameras on motor vehicle accidents: The number of accidents at intersections with cameras hadn’t changed. The Trib accused the City of Chicago of having installed the cameras only to raise money—slander, slander!

redlightcamera2If you’ve received one of those surprise citations for a “rolling right” turn, as my wife did, then you may share the Tribune’s indignation. My wife’s was compounded by the fact that she hadn’t been driving at the time (can’t imagine who was at the wheel). A colleague of mine was auto billed courtesy of a camera that captured her coming to a full stop at a red light, but beyond the crosswalk. See the November report on Rochester’s program.

A few quick observations about the cameras before I move to my main point (which is privacy): Read more »

Let’s Keep Gasoline Expensive

Posted by & filed under CGR Staff, Rochester Business Journal.

Kent GardnerBig is back. Light trucks (pickups, SUVs, etc) outsold cars by 100,000 in the month of November—sales were up 10% from the same period in 2013 while car sales were up just 1%. Oh, and gasoline prices have been sliding all year. Coincidence? Don’t think so.

And gas prices may have some distance to fall, even if crude oil prices stop their descent: Crude is down nearly 40% from its 2013 average while gasoline prices have dropped only about 25%.

gas pumpDon’t you love the low gas prices? Filled my little car’s tank for under $30 for the first time in, oh, forever. Actually, it only feels that way. Today’s prices are roughly where they were in 2010. Isn’t it interesting how quickly we adjust to new prices? Read more »

Improving Rochester Schools: A Steep Hill to Climb

Posted by & filed under CGR Staff, Rochester Business Journal.

Kent GardnerI attended a Great Schools for All event on November 10, a discussion of the school reform efforts of Raleigh, NC. Underlying the discussion was the proposition that when a substantial share of children in a classroom are in poverty, it is nearly impossible for students to achieve at a high level. Raleigh, part of the Wake County school district, responded to poverty concentration by establishing and preserving a balance of poor and non-poor children in every school in the district. Raleigh points to trends in graduation rates and other indicators that suggest that the policy has been effective. See Hope and Despair in the American City: why there are no bad schools in Raleigh, by Gerald Grant, Professor Emeritus, Syracuse University. A book review and summary can be found here. Read more »

Common Core Tests Fuel Criticism

Posted by & filed under CGR Staff, Rochester Business Journal.

Kent GardnerIn last month’s column, I joined the beleaguered defenders of the Common Core standards. The evidence shows that American children leave school having learned less than peers in other nations—27th of 34 nations tested in math, 17th in reading and 21st in science. Mobility recommends some level of standardization of “scope & sequence”—what children learn when—particularly in the elementary grades. The expressed goals of the architects of Common Core are hard to argue with—that reading instruction should challenge students to think about the content, not simply decode the superficial meaning of the words; that nonfiction should receive greater emphasis; that math should focus on analytical, not simply technical, skills; that instruction across the disciplines should reinforce independent thinking. Read more »

Stay the course on Common Core standards

Posted by & filed under CGR Staff, Rochester Business Journal.

Kent Gardner62,000 New York registered voters signed a petition supporting a “Stop Common Core” ballot line in November. I wonder how many signed with knowledge of the Common Core (CC) standards, not because of overheated rhetoric from opponents?

Yes, CC’s introduction in NYS schools has been a mess. CC is more rigorous than the prior standards—harder is the point, after all. If you’re a gym rat who can bench 200 pounds, you don’t just jump to 275, you work up to it. Nor can students jump right into a tougher curriculum. Teachers can’t be expected to learn a new approach overnight. State Ed gets a “D” in CC Implementation. Read more »

The Cold, Hard Financial Facts of Social Security

Posted by & filed under CGR Staff.

Geoffrey RosenbergerGuest Commentary from Geoff Rosenberger, CGR Trustee

The Social Security Trustees recently released their 2014 Annual Report. The Wall Street Journal carried a story about the report, but didn’t provide much detail (see The Hard Numbers on Social Security -also see How Should the Government Change Social Security? )

The long term projections are of course tenuous and highly susceptible to even subtle changes in assumptions around wage rates, demographics, immigration, GDP growth, inflation and a myriad of other factors. But there is still enough meat here to provoke a lot of thought. Note especially the charts and graphs at the end of this post!
Read more »

Where’s John Locke When you Need Him?

Posted by & filed under CGR Staff, Rochester Business Journal.

Kent GardnerI just watched a pair of fictional Supreme Court nominees debate the implications of repealing the Defense of Marriage Act (DOMA)—just the kind of “ripped from the headlines” thing that appeals to TV script writers. Only this was from a 2003 episode of The West Wing—my 27 year old daughter has discovered the show and is working her way through on Netflix. The case hit the court in 2013 and, as the The West Wing script suggested, was overturned. Now various state bans on same sex marriage appear headed to the high court, with the first—a ruling by the 10th circuit striking down Utah’s law—formally submitted at the beginning of August.

Nearly all Americans are disturbed by stories of atrocities by the Islamic State (ISIS/ISIL, etc). Whether the more appalling reports—the beheading of Christian children, female genital mutilation—are substantiated or not, radical Islam clearly sees fit to harness government to enforce religious conformity. Exile, imprisonment—even death—await those who break the rules or even disagree with accepted dogma. Christians have their own history to live down: The Catholic Church sent many “heretics” to a painful death during the Inquisition. The Protestant Reformation was equally intolerant in its early decades. Martin Luther and John Calvin were quite willing to use the power of government to impose their theology on all citizens. Read more »

Can the decision to refuse vaccination be truly ‘personal’?

Posted by & filed under CGR Staff, Rochester Business Journal.

Kent Gardner“So, so tired of seeing children dying of measles. Our measles ward has overflowed and using an additional 15 beds. One to 2 kids dying every day from measles. Another one just started seizing as measles attacks his brain. It’s a truly terrible disease. I had forgotten since it has been uncommon in the US since my childhood.”

This poignant Facebook post came from my wife’s cousin, a physician volunteering in Papua New Guinea, which is suffering from a measles epidemic. It reminds me of a recent conversation with a friend. She mentioned that she and her husband have chosen not to vaccinate their daughter, and that “this was a very personal decision for us.”

This goes to the heart of how we think about evidence and about risk in an uncertain world. And is it possible for such a decision to be truly personal? Read more »

Proof that isn’t

Posted by & filed under CGR Staff, Rochester Business Journal.

Kent GardnerWe are routinely bombarded by claims that have been “proven” with statistics. Today’s column offers tips in judging these claims.

  • Surprising results get headlines. “Did you hear that hurricanes with female names are more deadly? Who knew?!!” An Internet search of this report from last week yields thousands of citations.
  • That’s why autism is on the rise!! It’s the vaccines!” The 1998 study making this claim got a lot more ink than The Lancet’s retraction, after the study’s publisher learned that the results were fraudulent.

Pure fabrication may be rare, but many studies are published with claims that should be served with many grains of salt. The first question to ask: “Is there enough data?” Read more »