The two analyses I’ve reviewed this week demonstrate the nuances in the study of “access.” When you audit offices, Medicaid appears to offer potentially problematic access. But when you examine the experience of enrollees themselves—particularly ones with continuous coverage, as is more likely to be the case as the uninsurance rate drops—few access issues are apparent. This difference in “access” across methodology has been observed before in other studies. But it’s not one many commentators and pundits seem to be aware of.But see Ezra Klein on data changing minds:
You can make Medicaid look dreadful by cherry picking how you define “access.” Or you can take a broader, more nuanced view of “access,” considering also patients’ experience. When you do, you find that Medicaid works pretty well.
[Yale law professor Dan] Kahan is quick to note that, most of the time, people are perfectly capable of being convinced by the best evidence. There’s a lot of disagreement about climate change and gun control, for instance, but almost none over whether antibiotics work, or whether the H1N1 flu is a problem, or whether heavy drinking impairs people’s ability to drive. Rather, our reasoning becomes rationalizing when we’re dealing with questions where the answers could threaten our tribe — or at least our social standing in our tribe. And in those cases, Kahan says, we’re being perfectly sensible when we fool ourselves.More politics and policy below the fold.
While the political world has spent the past several months watching enrollment numbers in Obamacare health insurance marketplaces, maybe we should have been focusing on employer-sponsored insurance.Jonathan Bernstein:
A new survey from Rand Corp. estimates 9.3 million people were newly insured between September 2013 and March 2014, a trend that was mostly driven by an enrollment increase in employer-sponsored plans.
The growing market for employer-sponsored insurance is still the nation's most common source of coverage. The survey, which comes with some caveats, finds that of the previously uninsured who gained new coverage, 7.2 million were covered by employer plans, 3.6 million were covered by Medicaid and 1.4 million signed up through the Obamacare exchanges. In all, employer coverage increased by 8.2 million since September, Rand said.
Can we please retire the “will he or won’t he?” (or, more often this time around, “will she or won’t she?”) question about presidential candidates?Greg Sargent:
To cite Josh Putnam again, the media needs to understand the difference between running for 2016 and running in 2016.
What the press should be doing is reporting on whether candidates are currently running for 2016, and how those campaigns are going.
The reason is that candidates don’t actually know whether they will be running in 2016. I’m sure that in April 2010 Tim Pawlenty thought he would be running in 2012. It didn’t work out that way. Or, consider the less-obvious case of Haley Barbour, who did campaign-like things for a while and then dropped out in April 2011. Perhaps, unlike Pawlenty, Barbour never fully committed to a 2012 run. It seems more likely, however, that he was interested at some level and that, based on the response to his early campaign, he decided the chances of winning weren’t high enough.
“Will she or won’t she” is inadequate because it doesn’t capture what actually happens in the invisible primary. Here’s the long version of the argument.
You’ll be startled to hear, via Bloomberg News, that House Republicans have once again put on hold their plans to release their alternative to Obamacare. Bloomberg quotes Republicans claiming they are in the midst of making process-y decisions about how to offer their alternative in legislative terms.Seth Mnookin on NPR talking about vaccination:
But it may also be that Republicans are running into the same old problem: There just isn’t any real policy space for an alternative that would meaningfully accomplish what the law accomplishes. Indeed, along these lines, one GOP aide was remarkably candid in an interview with Sahil Kapur:One congressional GOP health aide, who was granted anonymity to speak candidly, said his party is as determined as ever to fight Obamacare, and will remain so as long as it exhibits failure. He said devising an alternative is fraught with the difficulty of crafting a new benefits structure that doesn’t look like the Affordable Care Act.You don’t say!
“If you want to say the further and further this gets down the road, the harder and harder it gets to repeal, that’s absolutely true,” the aide said. “As far as repeal and replace goes, the problem with replace is that if you really want people to have these new benefits, it looks a hell of a lot like the Affordable Care Act…To make something like that work, you have to move in the direction of the ACA. You have to have a participating mechanism, you have to have a mechanism to fund it, you have to have a mechanism to fix parts of the market.”
MARTIN: And Seth, you spoke to a lot of parents who are not vaccinating children for your book. So talk about this - you actually tried to trace this down and figure out why it is that these stories, rumors, opinions about vaccinations have kind of spread. Tell us what you found out, as briefly as you can.And some good old Jeb Bush reality talk:
MNOOKIN: Well, I think there are a couple of reasons - one is there have been these fraudulent reports that have been published. But I think the larger reason is that we're very uncomfortable just as people with introducing something into our body to protect us against a disease that we haven't had yet.
And so you combine that with the fact that because of the way our health care system is set up, there's not a lot of time for parents to discuss these issues with their doctors. And so they do end up either learning about it on social media and getting misinformation or, you know, talking about it at the playground or with other parents.
And I think one thing we really need to do is think about how we can bring this conversation, initiate this conversation, in a medical setting so the first exposure parents have to it is one where they're getting accurate information.
The notion that Jeb Bush is going to be the Republican presidential nominee is a fantasy nourished by the people who used to run the Republican Party. Bush has been out of a game that changed radically during the 12 years(!) since he last ran for office. He missed the transformation of his brother from Republican savior to squish; the rise of the tea party; the molding of his peer Mitt Romney into a movement conservative; and the ascendancy of a new generation of politicians — Marco Rubio, Paul Ryan, Scott Walker, Ted Cruz, among them — who have been fully shaped by and trained in that new dynamic. Those men occasionally, carefully, respectfully break with the movement. Scorning today’s Republican Party is, by contrast, the core of Jeb’s political identity.Wendell Potter:
Executives at health insurance giant WellPoint are predicting they will have to implement “double-digit plus” rate increases next year, demonstrating once again just how politically tone deaf and profit-obsessed they apparently are.
When I read WellPoint CEO Joe Swedish comments in Modern Healthcare that, there will “undoubtedly be remarkable price increases” for health insurance sold through the Obamacare-created exchanges, I remembered the outrage his firm provoked four years ago when it told its Anthem Blue Cross of California policyholders that it planned to hike their premiums by as much as 39 percent. When many of those policyholders complained to the media and members of Congress, it all but assured the passage a few weeks later of the Affordable Care Act, which contained numerous consumer protections and regulations the insurance industry hated...
Earlier that day, by the way, WellPoint raised its 2014 profit forecast after saying it expected to add more than a million new customers — with half of them coming from the Obamacare exchanges — by the end of this year.
Once again, HHS Secretary Sebelius was ready with a response. Discounting WellPoint’s prediction, she said that overall, premium increases next year would be “far less significant than they were before the passage of the Affordable Care Act.”
As Bloomberg News pointed out in a story about WellPoint’s investor day comments, people who bought their own insurance in 2009 for coverage in 2010 paid 13 percent more than the year before.