Teens these days

Via the Incidental Economist a fascinating study from the Journal of Adolescent Health that attempts to decompose the reasons behind the continual slow down in the teen birth rate. Teenagers are having just as much sex at the end of the study period as at the beginning. They are just having much smarter and safer sex.

They found that that sexual activity didn’t decline. What changed was contraceptive use. Use of the pill went up from 26% to 35%, as did IUDs (1.3% to 2.7%), condoms (49% to 56%), and even withdrawal (15% to 20%). The use of multiple methods increased from 23% to 34%. The percentage of kids reporting no contraceptive use dropped from 20% to 13%.

This led to the PRI dropping 5% every year from 2007 to 2012. Further, about 94% of the decline in the pregnancy risk index was attributable to contraceptive use.

I would love to see a follow-up once the 2014/2015 policy years are included as that is when IUD adaption has significantly increased. Given people tools to minimize risk, teaching them how to use those tools to minimize risk leads to lower risk.

And now I’m double dipping on The Incidental Economist and teen pregnancy prevention programs as they also flag a recent study on the baby simulator doll program:

A number of people, and programs, have decided that one way to combat teen pregnancy is to teach teens how hard it is to raise a baby. They sometimes force kids to “couple up” in school and pretend they have a child. Sometimes, they even give them a doll – one that cries, wakes up at night, etc. – to bring home the point…
And… more girls in the intervention group got pregnant. In the intervention group, 8% of the girls had at least one birth, compared to 4% of those in the control group. Even after adjusting for potential confounders, the intervention group had a more-than one-third higher relative risk of pregnancy in the teenage years.

So not only are those baby-doll-simulators likely a waste of time and money, they may be leading to an increase in teenage pregnancy.

Scaring them straight seldom works.

Kids these days… how will us old(er) people complain about the next generation when they are way less stupid than my cohort?

Well at least we had snow to walk through uphill both ways…..

Wednesday Morning Open Thread: Some Local Primary Results

Which may or may not say anything useful about the big one in November…

Vox reports “Debbie Wasserman Schultz fends off primary challenge from insurgent backed by Bernie Sanders”:

Wasserman Schultz faced a primary race from Tim Canova, a law professor who was endorsed by Bernie Sanders. But Wasserman Schultz looks to have won easily, with the Associated Press projecting at around 10pm that she’d defeat Canova in her bid for a seventh term…

… [I]t was never really clear how Canova’s bid threatened the long-time Democratic Congresswoman. Sanders’s endorsement of Canova helped him raise money, but probably didn’t make him that much popular — after all, Clinton easily defeated Sanders in Wasserman Schultz’s district.

Good night for Repub incumbents, too. The Washington Post:

Sen. John McCain beat back a primary challenge Tuesday from a Republican tea party activist to win the right to seek a sixth term in November in a race that has been inundated with questions about GOP presidential candidate Donald Trump.

The 2008 GOP presidential nominee easily defeated former state Sen. Kelli Ward and two other Republicans.

He faces a tough Democratic challenge in the November general election from U.S. Rep. Ann Kirkpatrick. She advanced Tuesday after facing only a write-in opponent in the primary…

AZ ‘Juicers: Should ‘we’ set up an ActBlue widget for Kirkpatrick?

Speaking of thirsty, the WaPo also mentions 2020 presidential hopeful looking to keep his interim seat:

Rubio easily won the Republican nomination to retain his seat and will be challenged by Democratic U.S. Rep. Patrick Murphy, who defeated Congressman Alan Grayson in Tuesday’s Senate primary. It’s a race Democrats are targeting in an effort to regain a majority in the Senate, and their hope is that Rubio’s presidential ambitions have dulled the shine he had with Florida voters..

And a genuinely positive win, via commentor Hovercraft, from the Florida Times-Union:

Melissa Nelson, an unknown corporate lawyer and former prosecutor three months ago, cleared her path to become one of the most powerful and influential figures in Northeast Florida on Tuesday night when she easily defeated incumbent 4th Judicial State Attorney Angela Corey.

The election caps a dizzying rise for Nelson and an equally shocking fall for Corey, one of the most polarizing political figures in Jacksonville history who generated national attention and enormous criticism for her prosecutions of George Zimmerman, Marissa Alexander, 12-year-old Cristian Fernandez and many others. Corey will depart office in the first week of January as the first incumbent state attorney in modern history to lose a contested election…

Controversy had followed Corey even before she was elected as Duval, Clay and Nassau’s top prosecutor. She had engaged in a long-running feud with Shorstein, her predecessor and former boss that rose up again this year when Corey unsuccessfully tried to tie Nelson to Shorstein, blaming both for dropping the death penalty against convicted murderer William Wells, who would later kill again in prison.

Once in office Corey engaged in multiple feuds, refusing to speak to this newspaper for a year, and often lashed out at criticism of her.

And that criticism became more vocal when she chose to prosecute Zimmerman for the second-degree murder of Trayvon Martin, sought a 60-year prison sentence for Alexander after she fired a shot in the direction of her abusive husband and decided to try Fernandez as an adult…

What else is on the agenda for the day?

Early Morning WTF Open Thread: With Donald Trump, It Can Always Get Weirder

Epic fiction may be the only way to get a proper handle on the dumpster fire behind the fertilizer plant that is Donald Trump’s presidential campaign. Gonna be a long day for political reporters, this Wednesday.

As of right now (pre-dawn), my best guess is that Trump’s handlers are using this last-minute visit as an excuse for Trump to put off/cancel his big Phoenix Immigration Pivot(tm) Speech, because he can’t do morning fundraisers in Los Angeles, jet down to Mexico City, meet with Presidente Nieto, and get to Phoenix in time for prime-time news coverage.

Josh Marshall has what seems like the most sensible take — “Can Trump Be This Stupid? Not A Trick Question”:

It’s a general rule of politics not to enter into unpredictable situations or cede control of an event or happening to someone who wants to hurt you. President Nieto definitely does not want Donald Trump to become President. He probably assumes he won’t become president, simply by reading the polls. President Nieto is himself quite unpopular at the moment. But no one is more unpopular than Donald Trump. Trump is reviled. Toadying to Trump would be extremely bad politics; standing up to him, good politics…

Remember that the central force of Trump’s political brand is dominance politics. Trump commands, people obey. Trump strikes, victims suffer. It will be extremely difficult for him to manage anything like this in the Mexican capital. He comes with a weak hand, no leverage and the look of a loser. All Peña Nieto needs to say is no.

Again, when you’re in a campaign under constant scrutiny you do your best to control every situation, reduce the risk of unpredictable, embarrassing or damaging events. You try not to cede control to others. You especially try not to cede near total control to someone who has every interest in the world in harming you. The maximal version of that ‘big thing you’re not supposed to do’ is precisely what it looks like Trump is doing.
Read more

Social Cues Fail Open Thread: Trump (Ain’t) Going to Mexico

Mexican President Enrique Peña Nieto: “We must do lunch, one of these days.”
Deadbeat Donald Trump: “See ya on Wednesday — you’re buying!”

Donald Trump is considering jetting to Mexico City on Wednesday for a meeting with Mexican President Enrique Peña Nieto, just hours before he delivers a high-stakes speech in Arizona to clarify his views on immigration policy, according to people in the United States and Mexico familiar with the discussions.

The possibility, which was hatched in recent days by Trump and his campaign advisers, comes after Trump has wavered for weeks over whether he would continue to hold his hard-line positions on the central and incendiary issue of his campaign, in particular his call to deport an estimated 11 million immigrants who are living in the United States illegally…
Read more

Breaking News: Abu Muhammed al Adnani is Dead


(Abu Muhammed al Adnani*)

Abu Muhammed al Adnani (real name: Taha Subhi Falaha), the number 2 man within the Islamic State and its commander for special operations (terrorist operations outside of the declared caliphate, recruitment, social media, and communications), is dead. It is being reported that al Adnani was killed in Aleppo earlier today and had been targeted by the US military led coalition forces in a precision strike near the town of al Bab. Here is CENTCOM’s release of the coalition strikes in Syria for today, as well as the past several days. Al Bab is not mentioned, but that may just mean it will be in tomorrow’s press release on coalition strikes. Expect the information on this to solidify over the next 24 to 48 hours. We’ll also see what this does to the Islamic State’s operational capabilities, especially those outside of the self declared caliphate in Iraq and Syria.

* Image found here.

Open Thread: Taking the High Road

But seriously: Good for President Obama…

President Obama on Tuesday commuted the sentences for 111 inmates, the latest in his push to ease harsh penalties given to nonviolent drug offenders.

Obama has been critical of what he has called the “devastating” effects of severe sentences handed down during the country’s war on drugs. He became the first sitting president to visit a federal prison, and spoke there about the importance of “second chances.”

Obama said that he hoped the bipartisan push for criminal justice reform could wind up weighing how to fight crime alongside “the need for proportionality in sentencing and the need to rehabilitate those who commit crimes”…

Tuesday Evening Open Thread: The NYTimes “Sh… ugar” Test

In honor of the proverbial gently-reared lady who “wouldn’t say ‘shit’ if she had a mouthful of it.” Because the real social solecism is calling an old white man the R-word!

From Maine’s Portland Press-Herald, “In the morning Gov. LePage says he might resign; by afternoon he discounts the idea”:

In a morning radio interview, LePage said he was totally at fault for leaving a threatening voice mail last week for a Democratic lawmaker whom he believed had called him a racist. He later invited Rep. Drew Gattine to the State House to have a face-to-face meeting on Wednesday, and Gattine accepted.

LePage also raised the possibility more than once on the radio that he may not finish his second term because of the controversy, which has stretched on for a week.

“I’m looking at all options,” the Republican governor said while appearing on WVOM, a Bangor talk radio station, Tuesday morning. “I think some things I’ve been asked to do are beyond my ability. I’m not going to say that I’m not going to finish it. I’m not saying that I am going to finish it.”

He said later in the interview: “If I’ve lost my ability to help Maine people, maybe it’s time to move on.”

Some six hours later, in a tweet posted from his Twitter account, LePage backed away from any suggestion that he was considering resignation…

The uncertainty comes after several days of sustained controversy that began last week when the governor told an audience in North Berwick that he’s been keeping a three-ring binder of drug dealers and that 90 percent of those dealers are black or Hispanic. Statistics show that the overwhelming majority of drug dealers arrested in Maine are white, and critics have said that even if the governor’s numbers were accurate, he is wrong to focus on race….

During his radio interview, LePage did apologize to the people of Maine and to Gattine’s family for leaving a threatening voice mail last week, but didn’t apologize to Gattine directly.

“When I was called a racist I just lost it, and there’s no excuse,” the governor said. “It’s unacceptable. It’s totally my fault.” LePage said being called a racist for him was, “like calling a black man the ‘N’ word or a woman the ‘C’ word. It just absolutely knocked me off my feet.”

Incidentally… and no surprise, given LePage is a Republican…

While LePage has repeatedly emphasized his concern about the impact of drug addiction in Maine, state spending on addiction treatment during his administration has actually declined

He’s unfit for his current position, but maybe the RNC can offer him a replacement job as their national mascot / cheerleader? Because I sense he’d do much better as an opener for Trump ralies than that Reince Priebus guy…

Apart from deploring the Disloyal Opposition, what’s on the agenda for the evening?

More “Both Sides” Juice

Via CNN:

The FBI expects to publicly release as soon as Wednesday the report the bureau sent to the Justice Department in July recommending no charges in the Hillary Clinton email server investigation, according to multiple law enforcement officials.

Perhaps then Director Comey (R-FBI) can go on a book tour to promote the novella-sized email report — he did a smashing job of turning a statement about the decision not to recommend charges into a closing argument for the prosecution last month.

Venues like network TV morning shows and old timey radio screech-a-thons might be a good way to generate buzz for the book tour. To keep the momentum going and appeal to the youngs, maybe the FBI could release a graphic novel edition in mid-September.

With any luck, the movie rights will get picked up in October, and casting decisions (Meryl for Hillz, obvs), etc., will keep this publicity train on track clean through the election.

Dogs Suck

I rarely go outside this time of year because it’s too goddamned hot, but thanks to that little tropical depression in the Gulf, it’s breezy and pleasant today, so I temporarily moved Cracker Inc. to the tiki bar. While setting up my workstation, I noticed one of the dogs rooting around in the bromeliads and told her to stop.

She stopped, alright — drawing back from the flower bed with a snake in her mouth! I screamed, of course, which caused her to drop it, and she and the other dog were snapping at it while it lashed at them with fangs bared, causing me to scream myself hoarse until the dogs came to see what was wrong with me.

I grabbed their collars and wrestled them back into the house, then ran to fetch my laptop and other accoutrements. The cops are probably on their way since any neighbor within half a mile must have immediately assumed someone was being murdered.

It was a black snake, so not poisonous, I’m pretty sure. The dogs seem uninjured. I believe the snake survived, as I can no longer see it — from a great distance, of course. I am never going outside again. The end.

Sounds like she’s got this…

From an article on debate prep in today’s NYT:

The Clinton camp believes that Mr. Trump is most insecure about his intelligence, his net worth and his image as a successful businessman, and those are the areas they are working with Mrs. Clinton to target.

Bingo. Trump, meanwhile, isn’t doing much prep at all, according to the Times piece. He’s convinced it’s not necessary since he easily vanquished the Republican field.

Do y’all enjoy watching presidential debates? I do in the primaries, but I dread them during the general election season. There’s just too much at stake, and I’ve seen too many debates turn on stupid and meaningless soundbites and media spin, so I watch them much as I’d view a slasher movie — peeking through my fingers and muttering, “Dear God, what are you thinking?!? No! Don’t go into the basement!!!”

Risk adjustment overcharging

Public Integrity has a good report on Medicare Advantage over-coding. The Center for Medicare and Medicaid Services (CMS) conducts annual audits of Medicare Advantage carriers to see if the chart data supports the diagnosis codes that build a case that a member is more expensive and needs a bump payment from CMS to make the insurer whole. CMS conducted 37 audits in 2007 and thirty four of the plans had at least 10% of their claimed risk adjustment cases judged to be unsupported by the medical records. One carrier had, in my mind, de minimis variation (2%) and two carriers were spot on. On the other hand seven carriers or about 20% of the sample had at least 60% of their risk adjustment claims judged to be unsupported by documentation in the chart.

Why is this important?

It is important for a couple of reasons. First, this is a rip-off of public money. Medicare Advantage has a history of upcoding the risk adjustment model. The same patient in traditional Fee for Service Medicare looks a lot healthier based on claims data than if they are in an aggressively upcoded Medicare Advantage plan. That means the Medicare Advantage plan gets extra bump payments that are either sent back to members as added benefits, sent to provider as higher payments or consumed by company insiders and owners as hookers and blow.

Secondly, there has been tentative industry discussion/advocacy to move the Exchange/QHP risk adjustment model of revenue neutral flows towards the Medicare HCC bump payment system. That would change the Red Queen race incentive that rewards technically sophisticated coding operations at the expense of naive or data poor coding operations towards a Cash Dash against the Federal government. I’m not too thrilled with this idea.

So how does CMS stop it? There are three ways that limit overpayments and one that could reduce legitimate discrepancies.
Read more

Meaningful difference, APTC Hacking and optimization problems

The loose meaningful difference regulation produces some desirable, from Center for Medicare/Medicaid Services (CMS) point of view, outcomes. The biggest positive outcome from CMS’s point of view and the point of view of PPACA supporters is a good Congressional Budget Office (CBO) score. The subsidies are based on the price of the second lowest Silver. Using these loose meaningful difference regulations, insurers can Silver Spam so that the #1 and #2 Silver are either priced at the same level or there is a minuscule gap. Silver Spam strategies are attractive to carriers that offer low cost on-Exchange plans that won’t sell well off-Exchange so that usually implies a very low cost provider network where the providers are paid at near Medicare rates. The other way of reducing total costs and thus achieving a better CBO score is the low level of gap between the #1 and #2 Silver means fewer people sign up so total subsidies are fairly low.

If CMS was to enact one of two sets of strict significant difference criteria (the first would be a clear price difference of X%, while the second would standardize benefit structures while allowing variance on plan type and network) the CBO score would get worse because PPACA would become more expensive. The level of subsidy would increase because the second least expensive Silver would most likely become more expensive and the Bronze offerings may become comparatively less expensive on-Exchange for subsidized individuals. And if carriers adapt either a pure Silver Gap where a single carrier owns both the #1 and #2 Silvers or a soft Silver Gap where there is a large spread between Company A’s #1 Silver and Company B’s #2 Silver, the covered population will increase significantly as the post-subsidy price will make Bronze much more affordable for individuals earning over 200% FPL.

Right now the regulation is optimizing to minimize bad CBO score headlines. The Silver Gap strategy, from the CMS perspective, maximizes enrollment at the cost of bad CBO headlines.

The Silver Spam and Silver Gap strategies both derive from the very broadly defined “meaningful difference” regulation. CMS for Healthcare.gov is supposed to insure that the plans offered on Exchange are different enough for people to be able to make an informed choice. Loose interpretation by CMS has enabled the Silver Spam strategy. This is a problem as it takes away real choice from buyers as well as limiting the health and size of the risk pool. Slowly it looks like CMS is tightening the regulation.

Read more

Tuesday Morning Open Thread:

whereaway kitten nest

A note from the Whereaways:

Wanted to let you know our rescued kittens went off to their new homes this past weekend. You Balloon Juice readers came through for them, and we are incredibly grateful.

Ideally, we wanted them to be adopted in pairs, so they’d always have a buddy, and that’s how it worked out. Thank you, thank you, thank you!!!

Apart from being happy for the kittens / jealous of their new humans, what’s on the agenda for the day?

Late Night Horrorshow Open Thread: So Weiner Is A Dick — Why Is That “Our” Problem?

Dave Weigel, in the Washington Post, “What kind of tragedy was Anthony Weiner?“:

The Anthony Weiner saga — which, if not over, has finally been officially demoted to a farce — has been with us for five years. Weiner tweeted a photo of his packed underwear to a West Coast fan on the sleepy weekend around Memorial Day in 2o11. Huma Abedin, his wife since 2010, announced that their marriage was over at the start of the lead-up to Labor Day in 2016, another news doldrum. Plenty of politicians make crippling personal mistakes. Few have been cursed with Weiner’s timing.

Today’s Weiner story is really about Abedin, and whether (to the relief of friends) she can finally shed a cad who threatened to be a political liability. But since 2011, when he resigned from Congress after news conferences hijacked by Andrew Breitbart and “The Howard Stern Show,” Weiner has become an irresistible subject for counterfactuals…

Josh Barro (in no sense a Democrat or a liberal) at Business Insider, on “the Ted Cruz of the Left”:

… The thing is: Weiner’s congressional career wasn’t exactly brought down by the sexting scandal. It was brought down by the sexting scandal and by Weiner’s status as a terrible coworker…
Read more

Overnight Open Thread: None Shall Sleep!

The aria from Turandot seems somewhat appropriate for an overnight open thread. Here’s two versions – the second is Aretha Franklin getting her opera on!