Healthcare down by the river

The Washington Post had a great article on how Idaho has tried to do something on Medicaid expansion eligible populations without actually accepting the federal money to just expand Medicaid eligibility to 138% of the Federal Poverty Line.  I have some sympathy for Idaho policy makers who actually want to do something in a state that is controlled by fantasists and Tea Party Republicans.  I’ve always though that health policy and working poverty policy  is tough work with lots of interacting factors.

Silly me, I could never have come up with this proposal that would have solved all economic and health policy problems:

One senator lobbed the idea of offering the working poor tax incentives if they use a life coach to motivate them to get higher-paying jobs. None of the proposals caught on.

Chris Farley down by the river is not a systemic solution.

Health policy is tough and there are few easy wins.

Open Thread



4.29% enrollment loss is the cost of Trump’s First Day EO

I’ve been playing a bit more with the 2016 and 2017 QHP data in an attempt to figure out the incremental cost of the Trump Executive order.  I think 4.25% is a good lower estimate.

My data is still here:

Data and Methods

I again excluded Kentucky and Louisiana.  Kentucky was switching from Kynect to Healthcare.gov while Louisiana had a mid-year Medicaid expansion.  I wanted to isolate the effect of the executive order from whatever the general trend in enrollment was.  I used the CMS enrollment snapshot for 2016 and 2017 that contained January 14th.  2016 was goes through January 16 while 2017 only goes through January 14th.  The 2016 report contains two extra days worth of data and more importantly, 2016 contains a deadline day as people who buy coverage by the 15th would see their policy start on February 1st.  We know deadlines spur enrollment.

CMS recognized this problem:

More than 8.8 million Americans were signed up for 2017 coverage through HealthCare.gov as of January 14, 2017. This compares to about 8.7 million sign-ups as of January 14 last year, as Americans continue to demonstrate strong demand for 2017 Marketplace coverage.

So on the 14th of each year, 2017 was running slightly ahead of 2016.  My data due to timing constraints will show 2016 running slightly ahead of 2017.   This is fine as the known flaw in the data favors the argument that the executive order had no impact.

So the question is what was the deviation from 1/15 to 1/31? If the Executive Order and the dropping of advertising and potentially elite knowledge networks disseminating anti-enrollment messaging or more likely fear, uncertainty and doubt about PPACA being a good play?

Analysis and Conclusion

2017 using my known flawed data was running .96% behind 2016 on the January 14th inclusive update.  2017 ended up running 5.25% behind 2016 on Healthcare.gov states.  The increment (using favorable to the null hypothesis data) slowdown in pace that can be attributed to Trump Administration actions is 5.25-.96 or 4.29% of enrollment was lost due to the executive order and other Trump administration actions such as shutting down some outreach and advertising in the last eleven days of enrollment.

4.29% is a minimal level of enrollment loss.  Using the January 14th pace, 2017 was running 1.1% ahead of 2016.  Charles Gaba is collecting data from the state based exchanges.  The state based exchanges ran their own marketing campaigns that did not get shut off on 1/20/17.  He is showing at least a 1.5% enrollment increase.  So more aggressive baselines can credibly argue that the Trump Administration actively discouraged 6% of the market from signing up.

Finally, here are some charts that I had fun creating as I worked through this problem.



Sport Open Thread

I want to highlight a couple of things from yesterday’s sporting events.

First, just for John:

Secondly, look at the scoreboard:

 

Let’s think about who goes to NHL hockey games for a second (especially in Dallas). The crowd tends to be white, middle class or higher income, and more likely to be male and older than average. That sounds like a core Trump demographic especially in Texas. And the Jumbotron is mocking Trump. Whoever put that up there thought they had at least implicit permission to mock. And it is only week one. Our objective is to get Trump and the Republican Party competing with syphilis in terms of popularity. Mockery will help (and it is a lot of fun anyways)



Trump’s EO on the ACA

The Trump administration issued its first executive order. The subject is the ACA. The order seeks to destabilize the non-subsidized and off-Exchange portions of the risk pool by minimizing enforcement of the individual mandate.  Dan Diamond at Politico had the first link to the actual order that I saw:

Section 2 is the critical component for the individual market. Section 3 has significant impact for both Exchanges and Medicaid.

Analysis below the fold:
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#NotallAssholes

Besides either pointing and laughing or cringing and looking at our fellow countrymen with abject fear and uncertainty, what is on the agenda today

#NotAllAssholes



Sunday Evening Open Thread: NFL Protests & Other Stuff

General notification: I normally use a FireFox analog, Pale Moon, as my browser. As many of you already know, Balloon Juice is currently blocked for FF users, so I’ve had to resort to IE, which sucks seventeen ways, none of them enjoyable. There will be crankiness.

Latest upgrade I can find on HRClinton’s incident this morning, from the NYTimes:

Mrs. Clinton was taken from the morning event at ground zero to the Manhattan apartment of her daughter, Chelsea. About 90 minutes after arriving there, Mrs. Clinton emerged from the apartment in New York’s Flatiron district and waved to onlookers, posing for pictures with a little girl on the sidewalk.
“I’m feeling great,” Mrs. Clinton said. “It’s a beautiful day in New York.”

Mrs. Clinton left in her motorcade without the group of reporters that is designated to travel with her in public. A campaign spokesman, Nick Merrill, indicated that she returned to her Chappaqua, N.Y., residence after 1 p.m., but did not give an exact time.

Mr. Merrill described the Democratic presidential nominee only as feeling “overheated” during the commemoration ceremony that morning…

[Rep. Peter T.] King said it was hot enough that officials working at the event offered the dignitaries bottles of water as they stood. But he noted that he did not see anybody accept a bottle.

The congressman, who served alongside Mrs. Clinton when she was in the Senate, said he could not recall Mrs. Clinton suffering any medical episodes at any of the public events he had attended with her…

***********

In other news, I had intended to post this before today’s game:

According to the Palm Beach Post [warning: autoplay], the Seahawks players modified their protest with a plan for all players to stand with their arms interlinked during the anthem. Some of the players on the opposing teams, the Dolphins, chose to protest themselves by kneeling. The usual suspects are taking this very, very seriously.

What else is on the agenda for the evening?



Risk Adjustment:Vox::Narrow Networks:538

There are two recent health policy articles by interested lay expertise sites that have me scratching my head. In Vox’s case, I am seeing a conclusion without context. For 538, I can not figure out the model that leads to a core assumption. These sites’ jobs are to inform the public and in these cases I think they can do a better job of their job.

Let’s start with Vox as Sarah Kliff looks at a Society of Actuaries analysis of risk scores on the individual market. She draws a very strong conclusion.

Between 2014 and 2015, SOA finds that Obamacare’s average risk scores went up by 5 percent. This means that the overall pool of people on the marketplace were sicker in 2015 than 2014. You can see the data here, in a table from the report.

The Society of Actuaries draws a much weaker conclusion

Risk measures published in the CCIIO release show that the average measure of risk increased from 2014 to 2015. Increased risk scores may be a combination of identification through better coding as well as a measure of the actual population health….

The program is still too immature to draw conclusive inferences about the future of the pool or marketplaces.

Vox saw a number that went up (bad) and wrote a story with no context.
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