Bifurcation of America

Minnesota and New York are getting to the levels of universal coverage that most European nations have. They are tweaking their systems and prepping waiver requests to extend coverage to currently excluded populations and improve affordability.

We get graphs like the following:


And then we have Texas (via the Texas Tribune)

For the first time in more than a decade, Texas’ uninsured rate dipped below 20 percent, analysts said Wednesday following the release of U.S. Census data.

Slightly more than 5 million Texans were uninsured in 2014 — a 700,000 decrease from the year before. That represented a 3-point dip in the percentage of Texans without health insurance, to 19 percent — the largest gain in health care coverage in Texas since 1999, according to the left-leaning Center for Public Policy Priorities….

the Census sampling, known as the American Community Survey, lends new credibility to earlier claims that Texas continues to lead the nation in the raw number — and rate — of people without health insurance.

We have a framework that can reduce the ranks of the uninsured to near OECD (Organization of Economic Cooperation and Development — the industrialized countries of the world) standards.  It can be implemented and it can work.  It mainly requires political elites to give a shit.


South Carolina results thread

Be excellent to each other as the results come in

Not even hiding your disdain

The governor of Wyoming wants to expand Medicaid. Governor Mead (R-WY) has wanted to do that for a couple of years. The basic reason is that it is a combination of the right thing to do and it solves a lot of budgetary problems without any hard trade-offs. The Republican Legislature is opposed to Medicaid Expansion.  Instead they want to spend money on a study for Medicaid expansion alternatives.  This study is supposed to be fairly comprehensive:

Senate File 86 …. bill would require the Legislature’s Management Council to direct the design of a program providing medical assistance to people who cannot afford adequate health care.

That program would seek to …“shall seek to provide greater health status improvements than those provided by the Medicaid program,” according to the bill’s text.

The program also would coordinate with other public assistance programs with the aim of providing “incentive (for participants) to improve their earnings and economic status,” and would include a work requirement for those able to work.

SF 86 also stipulates the program shall consider the use of health savings accounts or similar accounts, and seek to “avoid spending monies that Wyoming does not have and … avoid the creation of any uncontrolled entitlement.”

The bill also stipulates Wyoming shall not seek approval from the federal government of any Medicaid expansion until the medical assistance program has been designed and reviewed by the Legislature.

It is a bill that freezes everything in place while a study is conducted.

This study is supposed to be looking at a lot of things.  It requires significant knowledge of the Wyoming legislative history, Wyoming social welfare policies, employment training policies, economic development policies and the Wyoming budgetary process.  This is a big scope of work.

And $20,000 is being provided for the entire study.

$20,000 is not even enough money to pay one graduate student a research stipend for a year.  $20,000 pays for a single policy analyst for a month or two of their time.  $20,000 pays for a single consultant for a month.  $20,000 is nothing.

The only way a “study” could be conducted for that amount of money is to give the money to a “research” group where their interns and junior fellows copy and paste articles into a Word document, a senior writer puts in the appropriate ideological language and hopefully has someone look at subject-verb agreement before sending it out the door.

This is pure disdain for the entire idea of society taking care of the working poor.

Thursday Morning Open Thread: It’s Not Just the Politicians…

uss attack obama morin

(Jim Morin via

Barney Frank (may he live a thousand years) takes some hard truths to Politico – “The Self-fulfilling Prophecy of ‘Government Doesn’t Work’“:

It’s easy to see American politics as a situation in which voters are all innocent victims of mistreatment at the hands of elected officials — easy, but wrong. Sure, politicians often fall short, and I’m convinced that the negative bias of the media make it harder to govern responsibly. But the voters are no bargain either…

I’m writing this not to defend my former colleagues in elected office, highly as I regard many of them, but to correct a widespread misperception that not only diverts attention from what needs to be done, but in fact exacerbates the situation. That mistake is assuming that the problem is too many ideological members of Congress, of both parties, who would rather shut things down rather than compromise.

There are two serious flaws in this description. First, it assumes a false equivalence between the parties. It is true that the center of political gravity in each party has moved further from the center. But not equally so. I believe that the recent speakership debacle and the current presidential nominating contest demonstrate that the Republicans have moved further right on the issues than the Democrats have gone left.

But even these who reject this point can’t deny that there’s a stark difference between the parties on the critical question of whether they’re willing to compromise to be sure government functions effectively. One major dividing line between the dominant factions in each party today is, literally, their commitment to government in general, over and above any specific set of policies. Perhaps the biggest shift over the past eight years is how far that commitment has fallen out of favor among those who now dominate Republican primary contests…

The more Americans tell themselves the problem lies with the politicians in office, and the less they admit it’s the responsibility of the voters who elect people unwilling to govern, the worse things will become. Blaming elected officials just deepens the degree of public unhappiness with the political system; this misplaced anger then depresses voter turnout and distorts voters’ choices when they get to the booth.

Once again there is an asymmetry when it comes to party behavior. Nonvoting is more often the response of the angry left than of the angry right. When the latter became increasingly dissatisfied with the response to the 2008 crash, they formed the tea party, the members of which actually increased their disciplined participation in elections. Meanwhile, the most militant on the left created the Occupy movement, with a focus on public displays of their personal rejection of the status quo. Not surprisingly, elected officials were more influenced by voting than by drum circles.

The more the prevailing narrative blames the failures of political insiders for gridlock, leading to voter alienation, the deeper the gridlock and the greater the advantage to the right. It is the people who voted for Barack Obama and then sat out the midterms of 2010 and 2014 who are primarily responsible for his inability to achieve his goals…

Some combination of three things will have to occur to break the logjam. Mainstream conservative Republicans will have to start voting more in primaries and take back their party; unhappy voters on the left will have to realize that being unhappy is a reason to vote, not to sulk; and all voters will have to demonstrate — by really showing up and voting for candidates actually willing to do the hard work of governing — that there is an electoral price to pay for those who believe that fealty to their ideology is the only relevant aspect of holding office.

Kynecting the elections to policy

And now that officially sucks.

Tue Nov 03, 2015 at 5:22 PM PT (David Jarman): To recap, Republican Matt Bevin (whom you might remember from losing his tea-flavored primary challenge to Mitch McConnell in 2014) has won a surprising (to the extent that no poll had given him the lead) victory in Kentucky’s gubernatorial race.

Bevin (R-Sociopath) had run on a promise to repeal as much of PPACA as he could.  That means shutting down Kynect, the Kentucky exchange and turning down the very successful Medicaid expansion.  As Charles Gaba noted, he was promising to take away health insurance from 9% of the state.  And he looks like he won going away and with coattails.

There are two major health policy implications of a Bevins win.  The first is the switch from Kynect to  This is not that big of a deal in and of itself.  It is a different portal and a different set of branding but subsidies flow to people who buy insurance from after the King case.  The biggest downside is if Kentucky wanted to go the Wyden Waiver route, having their own exchange makes plumbing a Wyden Waiver, even a very conservative Wyden Waiver a whole lot easier.

The big policy change is Medicaid expansion.  Medicaid expansion covered approximately 420,000 Kentuckians as of this morning or 9% of the state. Bevin ran against expansion.  The best case scenario is the hospital groups march into  Bevin’s chief of staff office tomorrow and tell him flat out that their books don’t balance without expansion of some sort and they’ll lay covering fire for an extremely punitive waiver application.  That is the best case scenario and I’ll give it a 10% chance of happening.  The probable case scenario is 420,000 people are fucked as of February 1, 2016 and most of Appalachian Kentucky has medical care and medical financing resembling Third Wold nations again.

Kentucky, a red state, is highly likely to return to being a purple state on the New York TimeUpshot map of uninsurance rates:

NYTIMES Uninsurance Rate

It was a good two years of actually connecting people to health insurance without the death defying worry that a toothache could either be immediately fatal or financially destroying.


Open Thread: Another One Bites the Dust

Per Politico:

Harvard University professor Lawrence Lessig abandoned his Democratic presidential run on Monday, capping a candidacy that failed to get any real traction at all.

Lessig, an outspoken academic who had been a vocal proponent of campaign finance reform, said he was dropping his bid for the White House in a YouTube video.

The Harvard academic didn’t raise a notable amount of money and failed even to get into the Democratic presidential debates. He acknowledged as much in his announcement…

I watched the video. Unless you enjoy whiny self-justification, or need a sleep aid, I wouldn’t bother.

Professor Lessig has chosen a most worthy and important issue, and if he’d had the smarts to aim his doomed candidacy at the Republican party — which even he acknowledges is the source of the big-money rot and its greatest enabler by a huge factor — I’d have had more sympathy for the man. As it is, he’s just the Goo-Goo cherry on our Second Gilded Age’s shit sundae, a high-minded bludgeon aimed at exactly the wrong target.

Obamacare a failure or Obamacare a success

Conservative healthcare connector and wonk Robert Laszewski on the failure of Obamacare:

On Thursday, the Obama administration said they expect to have 10 million people enrolled on the Obamacare insurance exchanges in 2016. They further said they expect to sign-up only one in four of those still uninsured and eligible during the 2016 open enrollment scheduled to begin on November 1.

These are astonishing admissions.

In 2013 the Congressional Budget Office (CBO) estimated that the Obamacare insurance exchanges would enroll an average of 22 million people during 2016.

Given the original expectations how can we now not say this program is a terrible failure?

Note how he elides Medicaid expansion as a means of coverage and collapses all of PPACA to the Exchanges. This rhetorical trick is a kissing cousin of the discussion about total tax burden by income decile collapsing into a discussion of top marginal federal income tax rates by income decile.

Kevin Drum on the success of Obamacare:

 In 2010, just after Obamacare passed, CBO estimated that the uninsured rate would hit 8 percent by 2016. This was based on the original law, but in 2012 the Supreme Court made Medicaid expansion voluntary and most red states opted out. In July CBO updated its projections to account for this, increasing its estimate of uninsured by three percentage points. The next CBO estimate thus projected that the uninsured rate would be 11 percent by 2016. So how does that compare to reality? In its most recent survey, the CDC estimates that in the first quarter of 2015 the actual number of uninsured clocked in at 10.7 percent, and that’s likely to decline to about 10 percent or so by the end of 2016.

In other words, once you clear away all the underbrush it looks like Obamacare is meeting or beating its goals.

The overall objective of PPACA is to reduce the uninsurance rate while at least reducing if not eliminating medical cost growth over the general rate of economic growth in the country.

The Exchanges are seeing less people because a lot more people are still on Employer Sponsored Coverage (ESI).  The CBO originally projected that quite a few employers would eat the employee mandate penalty and dump ESI coverage to send their employees onto the Exchanges.  That has not happened.  PPACA is less disruptive than originally projected while still meeting or slightly beating its goals.