Fighting Crime With Health Care

 Health Care  No Responses »
Jan 162014
 

The Atlantic examines how Obamacare could drastically improve the lives of former prisoners. Many will be eligible for Medicaid if they live in a state that has chosen to expand the program, while others may be able to purchase subsidized coverage from the exchanges. Most of the people coming out of prison are men without children at home who, in the past, would not have qualified for any public health care program. They often had access to health care only when they were incarcerated. A significant percentage of this population suffers from mental illness and chemical dependency, access to health care in the community could go a long way towards reducing recidivism rates. As the article notes, it may be challenging to actually connect former inmates to health care services, but that’s a better problem to have than a total lack of coverage options.

Medicaid And The Emergency Room

 Health Care, Wonkery  No Responses »
Jan 022014
 

A new study in Science finds that expanding Medicaid increases emergency room visits, undercutting previous claims from lawmakers and policy wonks that expanding Medicaid would decrease ER use. these findings shouldn’t be a complete surprise to those who are familiar with the program and the people it serves. Many of those who are newly eligible for Medicaid likely have medical conditions that have gone unadressed for long periods of time. They also didn’t have an existing relationship with a physician, which probably explains why they turn to the ER as soon as they have coverage.

These findings shouldn’t be interpreted as a reason to not expand Medicaid. Access to Medicaid results in better mental health and increased financial stability, which are no small things. But as health economist Jonathan Gruber notes, making people healthy shouldn’t be framed as a cost-saver. States should expand Medicaid because it’s the right thing to do. And perhaps state Medicaid programs can do a better job of connecting new enrollees with primary care physicians.

Heads Should Roll

 Health Care  No Responses »
Dec 172013
 

It’s certainly good news that a former Microsoft executive will assume leadership of the ongoing repairs to healthcare.gov. The website’s functionality has already improved significantly and an experienced tech manager is sure to push further enhancements. But I’m still frustrated that the White House didn’t hire someone in this capacity three years ago, thus avoiding a huge self-inflicted clusterfuck. As Ezra Klein observes, somebody really needs to be fired at some point to demonstrate that this administration holds people accountable. It can wait until the open enrollment period ends in March, but Obama can’t afford to stay his hand indefinitely. The public may have an unfairly dim view of government employees, but surely a few people at CMS have earned their contempt.

The Expansion Expands

 Health Care, Wonkery  No Responses »
Dec 102013
 

Iowa may be the latest Republican controlled state to expand its Medicaid program. The federal government is poised to approve a waiver that will allow Iowa to use federal funds to purchase private insurance for individuals eligible for the expansion while charging some a premium for their coverage. I’m not thrilled with the idea of requiring people who live near the poverty line to pay a premium for Medicaid. But if this is the kind shell game conservatives need to play to convince themselves that they’re remaining true to their skewed free-market principles, then fine. It’s a better option than completely denying health coverage to people for no other reason than geography. And perhaps the feds’ flexibility on the mechanics of the expansion will encourage other red states to follow suit and do the right thing for their citizens.

Failing At Good Governance

 Health Care, Politics  No Responses »
Dec 022013
 

The Times ran a great piece over the weekend that pulled back the curtain on the unfolding disaster that was the healthcare.gov website. It details the bureaucratic bungling and poor oversight that led to the disastrous rollout of the site. The website’s performance seems to have improved as a result of the administration’s intensive repair effort, but problems could still crop up on the backend components that are responsible for transmitting enrolling information to insurers and for processing subsidy payments to insurers.

As President Obama has already admitted, he and his appointees badly mishandled this crucial task. Presidents shouldn’t be micromanagers, but Obama’s hands-off approach and the general insularity of this administration only served to undermine his credibility when it counted most. The politics of this clusterfuck are transitory; what really matters is whether the underlying policy succeeds. I still think success is likely, but I worry about our collective willingness to take bold action on other issues like climate change and income inequality. Government must constantly demonstrate its effectiveness and relevance to people’s lives. Unforced errors like this only give fodder to those who would be too happy to live under a government that stands an army, paves the roads, and not much else.

Slow Start

 Health Care  No Responses »
Nov 132013
 

The federal government released its first ACA enrollment figures and, as expected, they reflect the troubled rollout of the healthcare.gov website. Less than 27,000 people have enrolled in a private health plan through the federal exchange. Compare that with approximately 35,000 people who enrolled in a health plan through the California exchange. In fact, California alone accounts for a third of the total enrollment in private plans (about 106,000). On a more positive note, nearly 400,000 people have enrolled in Medicaid, supporting my theory that the Medicaid expansion will prove much more critical to expanding access to health care than most people realize.

The enrollment numbers are certainly low, but I’m not going to worry unless the trend continues for another couple months. And the best way to increase enrollment is to fix the website.

 

Medicaid Matters

 Health Care, Wonkery  No Responses »
Nov 062013
 

MNsure, Minnesota’s insurance exchange, released its October enrollment numbers today. Nearly 11,000 people have enrolled in coverage; over 9,000 have enrolled in Medical Assistance or MinnesotaCare. This is consistent with enrollment data from other states indicating Medicaid enrollment that far exceeds enrollment in private health plans. It’s too early to draw conclusions from one month of enrollment data, but it will be interesting to see whether the trend persists. It could be that low-income people are more motivated to enroll in coverage and that these numbers will even out as the enrollment deadline approaches. It may also indicate that the Medicaid expansion is more critical than we first realized. The data also raises questions about increasing health care disparities between states. A low-income family in Minnesota will have much better access to health care than a low-income family in South Dakota.

Demanding The Freedom To Suck

 Health Care, Wonkery  No Responses »
Oct 292013
 

Having failed in their efforts to repeal the Affordable Care Act, conservatives are now trying to blame Obama for the health plan cancellation notices that are now going out to customers. They point out that Obama previously stated that people who liked their current plans could keep them and that those statements must have been either deceitful or ignorant.

First, Obama and Democrats have never been great at explaining the details of the law. Politicians generally aren’t wonks and they don’t like making wonkish qualified statements like “Most people will be able to keep their current plans.” Second, the cancellation of these plans is a feature of the law, not a bug. These plans didn’t comply with the ACA because they didn’t offer certain essential services or they had excessive cost-sharing requirements. The ACA-compliant plans will offer richer benefits and stronger cost-sharing protections. Yes, some people may end up paying higher premiums than they do now, but this seems like an acceptable trade-off to me. It’s not as if most people on the individual market were terribly happy with their current individual plans.

If people want to argue that we should be allowed to pay for crappy coverage, that’s fine. It’s just not a terribly compelling argument.

Failure To Launch

 Health Care  1 Response »
Oct 142013
 

Ezra Klein calls the launch of Obamacare a failure. It’s difficult to dispute that assessment, at least in regards to the federal insurance exchange. The Times ran a great article detailing the various missteps behind the failed launch. It’s a discouraging but familiar story involving miscommunication, lack of resources and accountability, and political hedging. Things are going somewhat better in the states operating their own exchanges where they can respond more nimbly to technical issues.

The feds need to fix these problems and hold the appropriate people accountable. But it’s worth pointing out that the fierce opposition to the ACA likely contributed to its rocky implementation. The administration didn’t plan on creating an exchange for 36 states, but the political circumstances gave them no choice. It doesn’t excuse the massive implementation failures, but it does provide context.

There’s still time to fix these issues. The administration can’t afford to dither, though. People already have a shaky trust in the government and screw-ups like this only weaken that trust further.

Banana Republicans

 Fucked Up, Health Care, Politics  No Responses »
Oct 012013
 

Most people don’t have the time or patience to understand the political dynamics that led to today’s government shutdown. But let’s be clear about the root cause: the federal government is closed because Republicans do not want people to have access to affordable health insurance. It’s that simple. Republicans love to frame their zealotry as a defense of freedom; namely, the freedom to be bankrupted by a heart attack or car accident. It is this distorted, nihilistic, utterly fucked-up notion of “freedom” that has transformed the GOP into a party that is incapable of governing responsibly.

Republicans promised to unveil an alternative to the Affordable Care Act back in 2011. Two years later, they have still offered nothing because Republicans are fundamentally uninterested in health care reform. For them, the old, dysfunctional, highly uncompetitive insurance regime worked just fine. And if you were excluded from that system, well, you just weren’t deserving in the first place.

This shutdown will eventually end (hopefully, without a cataclysmic debt default) and the exchanges will continue to enroll people in coverage. Unfortunately, we’ll have to endure an extended conservative tantrum and the pointless idling of a million workers first.

 

 Older Entries  Newer Entries