Evidence based care in Medicaid

We want to do evidence based care.  We want to do things that work and avoid things that don’t work.  This sounds simple.  Let’s look at two very good natural experiments on unintended pregnancy rates:

Colorado:

    Since 2008, Colorado has successfully increased access to family planning services throughout the state, particularly for the most effective contraceptive methods, such as intrauterine devices (IUDs) and implants.

  • The Colorado Family Planning Initiative has increased health care provider education and training and reduced costs for more expensive contraceptive options, enabling more than 30,000 women in the state to choose long-acting reversible contraception….
  • When contraception, particularly the long-acting methods, became more readily available in Colorado between 2009 and 2013, the abortion rate fell 42 percent among all women ages 15 to 19 and 18 percent among women ages 20 to 24.
  • Colorado is a national leader in the use of long-acting reversible contraception, and reducing teen pregnancy and repeat pregnancies.

    • Teen birth rates in our state have declined more rapidly than in any other state or the nation as a whole.
  • The birth rate for Medicaid-eligible women ages 15 to 24 dropped sharply from 2010 to 2012, resulting in an estimated $49 million to $111 million avoided expenses in Medicaid birth-related costs alone.

More reliable and effective contraception was made available to Colorado women who had the choice to elect Long Acting Reverisble Contraception (LARC) or do something else.  A significant number of women elected to use LARC and the increased autonomy and reliability produced amazingly good results.

Texas

 

Reducing contraceptive availability led to higher abortion rates and higher unplanned pregnancies. Earlier live births have massively negative multi-generational repercussions for both the parents and kids.

The evidence strong suggests that significant improvements in quality of life can be made and significant expenditures reduced if contraception is made readily available.

And guess what Congress will consider to be a high priority:

House Speaker Paul Ryan announced Thursday that Republicans will move to strip all federal funding for Planned Parenthood as part of the process they are using early this year to dismantle Obamacare.

Wahoo… the evidence will strongly support the hypothesis that this policy will lead to more unintended pregnancies, more abortions and far worse outcomes for far more Americans.

Evidence based policy making — Hoo Yaa



Open Thread: Could Not Happen to A More Deserving Zombie-Eyed Granny Starver

ETA:


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All You Need To Know About Paul Ryan

This:

…the speaker is torn between his personal feelings about the tape showing Donald Trump discussing grabbing women by the genitals and his desire to preserve the historic GOP majority in the House of Representatives.

My reaction:

A) Profile in Courage.

edouard_manet_-_the_rabbit_1866

B) Put his picture in the dictionary next to “Party Before Country”

I have many dreams about this election. One that is very unlikely — but less so than a week ago — is that the GOP loses the House, and Ryan loses his seat.

A boy can dream, can’t he?

Image:Éduoard Manet, The Rabbit 1866.

ETA:  I’ll confess. This post was motivated in part by a desire to use that picture in association with today’s GOP.



Of Course It Is, You Fucking Asshole

These sanctimonious pricks:

Paul Ryan called the Democratic lawmakers’ sit-in Wednesday to protest inaction on gun laws a “publicity stunt,” saying that House liberals were more interested in headlines than solving the problem.

The speaker of the House also told CNN’s Wolf Blitzer on “The Situation Room” that he was not planning on actively fundraising for Donald Trump’s cash-strapped campaign, and that he saw possible agreement between his pro-trade message and Trump’s protectionist sympathies.

But the sit-in that began earlier in Ryan’s chamber earned his scorn.

“This is nothing more than a publicity stunt,” Ryan said, saying House Democrats would infringe on Second Amendment rights and do nothing to prevent terrorist attacks. “This is not about a solution to a problem. This is about trying to get attention.”

Of course it’s a fucking publicity stunt. They are trying to publicize the fact that the house won’t even vote on stuff that 85% of the god damned country wants to happen. They’re trying, in vain, most likely, to shame you shameless sociopathic motherfuckers into doing something.

Not to mention, the Republicans have been sitting on their asses in the house for how many years now? Where’s that fucking jobs bill?



Donald Trump for Rubber Stamp

Journalists who use the words “serious” or “thoughtful” or “integrity” should be first against the wall in the revolution:

Donald Trump and I have talked at great length about things such as the proper role of the executive and fundamental principles such as the protection of life. The list of potential Supreme Court nominees he released after our first meeting was very encouraging.

But the House policy agenda has been the main focus of our dialogue. We’ve talked about the common ground this agenda can represent. We’ve discussed how the House can be a driver of policy ideas. We’ve talked about how important these reforms are to saving our country. And we’ve talked about how, by focusing on issues that unite Republicans, we can work together to heal the fissures developed through the primary.

Through these conversations, I feel confident he would help us turn the ideas in this agenda into laws to help improve people’s lives. That’s why I’ll be voting for him this fall.

It’s no secret that he and I have our differences. I won’t pretend otherwise. And when I feel the need to, I’ll continue to speak my mind. But the reality is, on the issues that make up our agenda, we have more common ground than disagreement.

For me, it’s a question of how to move ahead on the ideas that I—and my House colleagues—have invested so much in through the years. It’s not just a choice of two people, but of two visions for America. And House Republicans are helping shape that Republican vision by offering a bold policy agenda, by offering a better way ahead.

Donald Trump can help us make it a reality.

They always fall in line. Always. There is never anything too disgusting for them to sign on to if it has an (R) after it.



Their Brand Is Crisis

Valued commenter Rikyrah draws our attention to a post at No More Mr. Nice Blog in which Steve M argues that the Beltway press is setting Paul Ryan up to be the reedy voice of reason if the GOP goes down in flames in the coming election. An excerpt:

There’s a widespread belief that Democrats are likely to win this year’s presidential election no matter what, and that the GOP is utterly doomed if Donald Trump is the nominee. I don’t share that belief — but even if it’s accurate, even if a Trump-Clinton or Trump-Sanders race ends in a Democratic landslide, I can guarantee you that the GOP will recover from the Trump campaign almost instantly.

How? The press will do what it always does when Republicans stumble: It will give the GOP a do-over. Don’t believe me? Go to Politico today and read about Paul Ryan, who’s positioning himself to be the face of that do-over…

I think Steve is correct on both counts: 1) the upcoming election won’t be a gimme for the Dems no matter which hairball the GOP horks up, and 2) even if the GOP loses in a Goldwater-class epic fail, the political press will rehabilitate the party in time to regain any lost ground in 2018.

Recent history shows this to be true: The rebranding of the GOP in the wake of the Shrub’s utterly disastrous presidency is one of the most unheralded brand management feats of all time, and it couldn’t have happened without the enthusiastic participation of the Beltway media.

Think about the magnitude of that accomplishment: In just two short years, the DC press helped rehabilitate a party that had ignored warning signs and presided over the most deadly terrorist attack in US history, lied the country into a pointless war that cost upwards of a trillion dollars and needlessly killed tens of thousands and oversaw the worst economic collapse since the Great Depression.

Of course they lost the subsequent election, but all it took to flush the GOP’s catastrophic failure down the memory hole was a handful of Koch-funded operatives in powdered wigs and moth-eaten Colonial togs and a scrum of shouty folks disrupting town hall meetings to shriek about socialized medicine, and voila! — a midterm landslide in the other direction.

Overcoming a Trumpism hangover will be child’s play in comparison.



Many Bothans Died To Bring Us These Tax Cuts

The practical upshot from the chaos in the House GOP with Orange Julius now gone and Paul Ryan now Speaker of the House is that the Austerity Death Star will soon be fully operational.

The Wisconsin Republican who claimed the gavel last week is one of Congress’ preeminent tax experts, an ardent advocate of rewriting the code with lots of ideas on how to do it. Over the years, he’s gone further than most lawmakers in pushing politically fraught changes that have gone nowhere, such as wiping out a major tax break for employer-provided health plans and making it harder for the wealthy to claim the hugely popular mortgage-interest deduction.

But now Ryan has far more power to put the issue on Washington’s agenda — and the latest budget deal between congressional leaders and the White House should give him ample room to launch his speakership without being distracted by constant battles over funding the government and raising the debt limit. So some advocates are recalibrating the odds of a long-elusive tax overhaul that they say could spur new jobs and bring corporate money back from overseas.

Sweeping tax change won’t happen this year, supporters say, with lawmakers still staring at a stack of unfinished business — or next year, when the 2016 election will loom even larger. But they say it’s suddenly a lot more likely in the early years of the next presidency, especially if the Republicans win the White House.

It certainly comes as close to guaranteeing it as possible,” said a top Republican staffer. “It’s his No. 1 priority — it’s what he cares about most.”

The sort of ambitious reform Ryan has in mind, which would be the first since 1986, promises to cut both individual and corporate tax rates in exchange for junking scores of credits, deductions and other special provisions. Any rewrite would be hugely controversial, with an array of powerful interest groups sure to line up to defend their favorite provisions, not to mention many Democrats who’ve long complained that Ryan’s plans amount to a giveaway to the rich.

In a speech to the House just before his swearing-in Thursday, Ryan named tax reform as one of his top priorities.

It was bad enough when the Ryan Austerity Budget was a club used to get sequestration into play in 2013.  But as Speaker, Ryan now has significant power as far as bringing his austerity monster to life.  If you still had questions as to what’s at stake a year from now, better hope the GOP doesn’t have the keys to both Congress and the White House when Congress gets called into session in January 2017.

Otherwise, the Austerity Death Star is going to do a pretty good job of blowing America up.