The Case of American Meritocracy, and Other Links
More sex is associated with higher wages.
4.8 million people uninsured with drug or alcohol problems. But how many will actually sign up in the exchange?
Tag: "Uninsured"
Aug 19, 2013 | 11 comments | by John Goodman
Getting Frank with Frank
This is Robert Frank in The New York Times:
We must ask those who would repeal ObamaCare how they propose to solve the adverse-selection problem. That problem is not an abstraction invented by economists to justify trampling individual liberties. As experience in most countries around the world has confirmed, it is a profound source of market failure that renders unregulated insurance markets a catastrophically ineffective way of providing access to health care.
And what is the problem of adverse selection?
Uninsured people with pre-existing conditions often face tens or even hundreds of thousands of dollars in out-of-pocket medical costs annually. If insurers charged everyone the same rate, buying coverage would be far more attractive financially for people with chronic illnesses than for healthy people. And as healthy policyholders began dropping out of the insured pool, it would become increasingly composed of sick people, forcing insurers to raise their rates.
And all this is under the heading, “For ObamaCare to Work, Everyone Must Be In.”
The answer to Frank is surely obvious: don’t charge everyone the same rate or put everyone in the same insurance pool. For the past several years, federally sponsored risk pools all over the country have allowed people with pre-existing conditions to pay the same premiums as healthy people and obtain health insurance. And about 107,000 people have been able to do this without interfering with the premiums of anyone else.
Voilà! We solved the problems of 107,000 without requiring anything (other than about $6 billion in taxes) from the other 330 million.
Amazing what a little common sense can accomplish.
Aug 06, 2013 | 27 comments | by John Goodman
ER vs. Doctor’s Office, and Other Links
Patients in Medicare Advantage plans got expensive balloons and stenting to clear coronary arteries at a rate 31 percent lower than patients in traditional Medicare, and angiography procedures were 36 percent lower. But geographical variation is still large and we don’t know if this was good for patients.
Jul 11, 2013 | 18 comments | by John Goodman
CBO Forecasts Keep Getting Worse
Chris Jacobs summarizes the deterioration:
- The Congressional Budget Office (CBO) estimated in May that the employer mandate would raise $10 billion in revenue in its first year. (Because the employer mandate is a tax penalty, firms will pay the penalties the following year…) That $10 billion in employer mandate revenue projected for fiscal year 2015 will almost certainly disappear.
- In its most recent economic forecasts in February, the CBO estimated that unemployment would average 7.8 percent in 2014. That number is nearly three percentage points higher than the CBO’s estimate of 2014 unemployment at the time of ObamaCare’s passage.
- The CBO now projects that, if firms do drop health coverage, insurance subsidies on exchanges will average $5,290 per enrollee next year. By comparison, shortly after ObamaCare passed, the CBO projected subsidies would average $3,970 in 2014.
- As we documented last week, since ObamaCare’s enactment, the CBO has increased the number of projected uninsured and decreased the number of individuals projected to retain their employer coverage.
Jul 09, 2013 | 12 comments | by John Goodman
Exchanging Medicaid for a Better Option in Georgia
A Washington Post article paints a dire picture for safety net hospitals in states that don’t expand Medicaid. The article uses Atlanta’s Grady Memorial Hospital as an example the plight of a hospital without expansion:
If Georgia expanded Medicaid, Grady chief executive John Haupert says it would cover more than 27,000 uninsured patients now seeking free medical treatment at the hospital. It also would have helped the hospital with an estimated $60 million economic boon.
What the article neglects to explain is that many of the people who would be forced into Medicaid will now have the opportunity to enroll in highly-subsidized, private coverage in the health insurance exchange. Private insurers in Georgia pay physician fees that are about 40% higher than what Medicaid pays for the same service. Using this ratio as a proxy for the higher insurance reimbursement, according to NCPA analysis Georgia doctors and hospitals would enjoy more than $2 billion over a decade in additional spending on the uninsured living at or above poverty compared to Medicaid if they had private coverage rather than Medicaid.
Jul 01, 2013 | 13 comments | by Devon Herrick
Study: The Uninsured Are Healthier
They also get less medical care:
Compared with those already enrolled in Medicaid, uninsured adults were less likely to be obese and sedentary and less likely to report a physical, mental, or emotional limitation. They also were less likely to have several chronic conditions. For example, 30.1% (95% CI, 26.8%-33.4%) of uninsured adults had hypertension, hypercholesterolemia, or diabetes compared with 38.6% (95% CI, 32.0%-45.3%) of those enrolled in Medicaid (P = 02). However, if they had these conditions, uninsured adults were less likely to be aware of them and less likely to have them controlled. For example, 80.1% (95% CI, 75.2%-85.1%) of the uninsured adults with at least 1 of these 3 conditions had at least 1 uncontrolled condition, compared with 63.4% (95% CI, 53.7%-73.1%) of adults enrolled in Medicaid. (JAMA study)
Jun 28, 2013 | 11 comments | by John Goodman
What If They Gave an Exchange and Nobody Came?
With almost one in five of its residents lacking health insurance, officials in Palm Beach County thought they had hit on a smart solution. The county launched a program that offered subsidized coverage to residents who couldn’t afford private insurance, but made too much to qualify for Medicaid, the state-federal program for the poor. Enrollees would be able to buy policies for about $52 a month — far cheaper than what private insurers were offering. But a year after the program began, fewer than 500 people had signed up — less than a third of the number expected.
More examples from Kaiser Health News.
Apr 02, 2013 | 12 comments | by John Goodman
Boy Dies — Because He Was Insured By Medicaid
Deamonte Driver died not because he was uninsured. Indeed, Deamonte Driver died because he was insured — by the government. Deamonte, it turns out, was on Medicaid…
Although Deamonte was insured, he never received routine dental care. It turns out that only 16 percent of Maryland dentists accept Medicaid patients. Fewer than one-sixth of Maryland kids on Medicaid have ever had a cavity filled…
You’d think that many mothers in Alyce’s position would find a way around this problem, that she could offer to supplement Medicaid’s penurious fees in order to gain access to a better dentist for her two sons. But that would be illegal.
Mar 28, 2013 | 12 comments | by John Goodman
Uwe Reinhardt Does Something I Like
He describes it here:
Five months after the commission [Chi aired by Reinhart] filed its final report, Governor Corzine introduced and New Jersey’s State Assembly passed Assembly Bill No. 2609. It limits the maximum allowable price that can be charged to uninsured New Jersey residents with incomes up to 500 percent of the federal poverty level to what Medicare pays plus 15 percent, terms the governor’s office had negotiated with New Jersey’s hospital industry.
I don’t favor government price fixing. But if an uninsured patient enters a hospital, somebody has to figure out what fee should be paid. The hospital’s list prices are phony prices that other customers are not paying and that were basically selected in order to maximize against third-party payment formulas, given the wacko way that Medicare pays. When the hospital tries to charge the uninsured patient list prices it is implicitly pretending that these are market prices, when they are not. So if I were on a jury having to decide who owes what, the New Jersey solution is about what I would decide.
Mar 15, 2013 | 16 comments | by John Goodman
