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The Health Reform Catch-22

Posted by Timothy McBride on Tuesday, February 28, 2017, In : ACA 

Ever since the election, the President and members of his party in Congress have been focused on one of the central promises nearly all of them made in their campaigns, to “repeal” Obamacare and – perhaps – to “replace” it as well.

Repealing and replacing Obamacare has proved as difficult to accomplish as passage of health reform was in the first place.  After all, it took President Obama about 15 months to get the Affordable Care Act (ACA) through Congress, and sign it, and to acc...


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New estimates of uninsured to be released 9/13/16

Posted by Timothy McBride on Tuesday, September 13, 2016, In : ACA 
Another milestone in the release of federal data will come Tuesday, 9/13/16 and Thursday 9/15/16 when the U.S. Census Bureau releases results from two surveys that are widely used to estimate the number of people in the U.S. with and without health insurance.

The Bureau will release estimates from the Current Population Survey and the Annual Social and Economic Supplement (CPS/ASEC) and the American Community Survey (ACS).  The former survey provides national estimates of insurance coverage wi...

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Health Insurance Marketplaces: Premium Trends, 2014-16

Posted by Timothy McBride on Thursday, May 12, 2016, In : ACA 

There has been a great deal of attention recently to the premiums in the Health Insurance Marketplaces (HIMs), and the potential shape of the marketplaces in 2017. The recent announcements by some insurers that they may pull back from their role in the marketplaces authorized by the Patient Protection and Affordable Care Act (ACA) has fueled this interest, along with the annual period when insurers submit their preliminary bids for premiums in the marketplaces, with fears that the growth in p...


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IMPORTANT MILESTONE: Insurance, uninsurance estimates for 2014 to be released Wednesday 9/16

Posted by Timothy McBride on Tuesday, September 15, 2015, In : ACA 
A big milestone in the release of federal data will come on Wednesday when the U.S. Census Bureau releases results from two surveys that are widely used to estimate the number of people in the U.S. with and without health insurance.

The Bureau will release estimates from the Current Population Survey/Annual Social and Economic Supplement (CPS/ASEC) and the American Community Survey (ACS).  The former survey provides national estimates of insurance coverage with breakdowns by demographics, inco...
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Supreme Court upholds Obamacare again

Posted by Timothy McBride on Thursday, June 25, 2015, In : ACA 

The Supreme Court decided today on the “Obamacare” case, called “King v. Burwell” and ruled in a 6-3 decision to support the Administration’s position on the law, that subsidies should be allowable in federal marketplaces.  The Chief Justice Roberts and Justice Kennedy joined the four liberals (Breyer, Ginsburg, Kagan and Sotomayor) in the decision.  Find the decision here.

The decision is important for the continued implementation of the Affordable Care Act, and means that perhaps a...


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Awaiting SCOTUS case on subsidies: liberal justices on majority opinions all year

Posted by Timothy McBride on Tuesday, June 9, 2015, In : ACA 

Today I was looking at a New York Times article, which listed how the justices voted on "major" cases this session, and one thing struck me -- on each and every case all four so-called liberal Justices (Ginsburg, Breyer, Kagan and Sotomayor) voted in the MAJORITY on each and every case, sometimes joined (of course) by 1-5 other justices, most frequently Kennedy, Roberts.  The three most conservative justices (Thomas, Scalia, Alito) were least often on these cases.

This led me to think about th...
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Is the Sky Falling? Let's Wait

Posted by Timothy McBride on Wednesday, May 27, 2015, In : ACA 
So it's that time of the year on the calendar when private insurers who offer plans in the Health Insurance Marketplaces (HIMs) start to submit their "rate bids" for the next year, and some reporters have obtained information on these bids.  This is leading to some rather hyperbolic headlines, and reaction, about how the marketplaces may be falling apart under a cost explosion.  In fact, this is an annual experience that needs to be calmly understood, and we need more time -- and data -- to u...
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Growth in Missouri Medicaid 3.5% since ACA began

Posted by Timothy McBride on Wednesday, May 6, 2015, In : Missouri 
As others who follow trends in Missouri Medicaid enrollment know, Missouri is a state that has shown sluggish growth in Medicaid enrollment over the last year, even while other states have seen significant growth -- including states that have also not expanded Medicaid (experiencing the so-called "Woodwork" effect).  In fact, for several months, the growth in Medicaid in Missouri was flat or negative, and Missouri had one of the slowest rates of growth in Medicaid in the country.

It appears fr...
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Backlog facing Missouri Medicaid nearly erased

Posted by Timothy McBride on Wednesday, May 6, 2015, In : Missouri 

There is good news for Missouri’s Medicaid program.  In the last few months, the program (called MOHealthNET in Missouri) has really turned the corner on a challenge the program faced in the recent year – a backlog in processing applications to the program.  However, in the last 4-5 months, concerted efforts by state workers, working hard with many around the state has led to a huge drop in the backlog.

As this figure shows, the number of days it is taking for an applicant to Medicaid to...


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"Grubergate" (II): The contracts

Posted by Timothy McBride on Tuesday, November 18, 2014, In : ACA 

In the latest attempt to attack Obamacare, opponents think they have a juicy new target, Prof. Jonathan Gruber, from MIT.  In addition to pulling his quotes from academic musings out of context, the opponents have a new line of attack: that supposedly Gruber "netted" millions of dollars in contracts from the federal government (the Obama administration) to do his work.  The impression left, often said directly, is that Gruber himself was paid these dollars, or that the total dollars from the ...
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Grubergate

Posted by Timothy McBride on Tuesday, November 18, 2014, In : ACA 

In the last few days -- essentially since the election -- the Republicans have launched a new line of attack on Obamacare (the Affordable Care Act).  They are attacking what they call the "architect" of the ACA, who is quoted on video of making a handful of comments, which when they are heard out of context, seem quite damning. 

This latest line of attack on the ACA is rather bizarre in many ways.  Why? Here is why:

  • Everyone who closely followed the development and then passage of the ACA knows...

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SCOTUS (III): Smoking gun (CBO score) proves plaintiffs case has no merit

Posted by Timothy McBride on Monday, November 10, 2014, In : ACA 

As I mentioned in two previous posts, the Supreme Court (SCOTUS) this past week decided to take the case of an appeal of a ruling by the 4th Circuit US federal court of appeals (King v. Burwell), in a case where the plaintiffs allege the Affordable Care Act (ACA) is ambiguous or conflicted on whether subsidies can be offered to lower-income persons who obtain coverage through Marketplaces established and run by the federal government.

Earlier I pointed out two huge flaws in the argument of the...
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SCOTUS (II): Legislative intent of ACA always clear, key Senate-House chairs say

Posted by Timothy McBride on Sunday, November 9, 2014, In : ACA 
As I noted earlier, the Supreme Court (SCOTUS) this past week decided to take the case of an appeal of a ruling by the 4th Circuit US federal court of appeals (King v. Burwell), in a case where the plaintiffs allege the Affordable Care Act (ACA) is ambiguous or conflicted on whether subsidies can be offered to lower-income persons who obtain coverage through Marketplaces established and run by the federal government.

My earlier post pointed to some fatal flaws in the arguments of the plaintiff...
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SCOTUS (I): Why the case against the ACA at Supreme Court has no merit

Posted by Timothy McBride on Sunday, November 9, 2014, In : ACA 

The Supreme Court has decided to take a case, ruling on another aspect of the legality of a key provision of the Affordable Care Act (ACA), whether it is legal for the federal government to provide subsidies for insurance coverage under the federal Marketplaces.  Though nearly every scholar has cast serious doubt on the logic of the case made by the plaintiffs, the Court has decided to take the case, likely because at least four Justices have certainly expressed their strong skepticism on the...


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A short political comment

Posted by Timothy McBride on Wednesday, September 10, 2014, In : Politics 

Sometimes it amazes me how pundits seem to not either understand math, polls, or perhaps pretend not to do so.

Case in point:  pundits seem hyperbolic these days about President Obama's job approval ratings, saying how "historically low" they are, and how he is experiencing the "worst period" of polling in his presidency.  Evidence of this?  They cite just one data point, that the President has a low job approval rate of roughly 40-42%, depending on the poll.  Sounds not that great, right?

Well...
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Missouri Medicaid enrollment dropping

Posted by Timothy McBride on Monday, September 1, 2014, In : Missouri 

An article in today’s St. Louis Post-Dispatch points to a serious issue facing Missouri’s Medicaid program.  As the article points out, enrollment in the Medicaid program (called MOHealthNET in Missouri) has been dropping in the state for several months.  As reported by the Centers for Medicare and Medicaid Services (CMS) in their latest reports, with data through July, Medicaid enrollment is down -4.4% in Missouri since last year (from about 866,000 to about 830,000). This is the second ...


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The "Other St. Louis" and the Roots of Ferguson

Posted by Timothy McBride on Sunday, August 31, 2014, In : Ferguson 

During the turmoil that gripped Ferguson and St. Louis (and captured the attention of much of the nation) after the tragic shooting of Michael Brown when violence broke out (usually late at night) many turned to the famous quote of Martin Luther King Jr., who said: “a riot is the language of the unheard.”

We now know that the looting and violence that took place in Ferguson was quite limited, and by all means did not broadly characterize the protests that happened in the wake of Michael Br...


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The 2014 Senate Election Still Too Close to Call

Posted by Timothy McBride on Friday, August 29, 2014, In : Politics 
As I said in an earlier post, I am a contrarian compared to pundits and others who seem to believe the odds are very high that the Republicans will take over the Senate.  In part, as I have written about before, I think Obamacare is much less unpopular than people think (and there is increasing evidence now of that) and I think it will become more popular over time. Also, I think the candidates who are vulnerable will do better than people think (e.g. Landrieu, Hagan).

As I have pointed out be...
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Missouri shows very small change in uninsured rate in latest Gallup survey

Posted by Timothy McBride on Wednesday, August 6, 2014, In : ACA 

Gallup has released its latest results from its survey of how the Affordable Care Act (ACA) is faring nationwide, and it shows rather stunning (though in most cases likely unsurprising to health policy analysts) results of how this grand policy change is rolling out state by state.  Their main finding is that in states that implemented most of the features of the ACA the drop in the uninsured rate (which was already lower in the states that chose to implement the core mechanisms of the ACA) w...
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My contrarian view on 2014 senate election

Posted by Timothy McBride on Monday, August 4, 2014, In : Politics 

I have long believed the pundits have it wrong (as they often do J ) on whether the Senate will flip to the Republicans, in their gloom and doom scenarios.  Mostly my view on this is because the press and pundits have so badly understood the Affordable Care Act (ACA) for so long, and how the public views it, and how it will be viewed by November.  In particular, I think the popular press view is that ACA is very unpopular and that therefore the Democrats and incumbent Senators will be punishe...


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Here is something about the response to the Health Reform (the Affordable Care Act) I don't get...

Posted by Timothy McBride on Saturday, June 28, 2014, In : ACA 
So here is something that has perplexed me for a long time, watching the (largely successful) rollout of health reform (the Affordable Care Act).

For months now, many very bright people (pundits, reporters, Legislators) have been fixated on one part of the Affordable Care Act (ACA)'s rollout and using it as a ruler to measure the law's success: the number of people enrolled in the MARKETPLACES -- whether the law would reach the target of roughly 8 million people enrolled in the "Marketplaces" ...
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UPDATE: Layoffs continue in Missouri-near 1,000 layoffs in health sector since April 2013?

Posted by Timothy McBride on Friday, June 27, 2014, In : ACA 
In an earlier post, I laid out data I have been accumulating from press reports on job layoffs in the health care sector, mostly affecting hospitals and health systems.  Today (6/27), 60 more layoffs were announced in Springfield (MO) by Ozarks Community Hospital.  

Thus I am updating the table I presented earlier (attached here), which shows almost 1,000 jobs affected in Missouri 
(including layoffs, jobs eliminated that are vacant but will not be refilled, and jobs where hours will be reduced...
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Does the new GDP report pass the smell test?

Posted by Timothy McBride on Thursday, June 26, 2014, In : ACA 
After sleeping on it, I have to wonder whether the third revision of the 1st Quarter GDP report actually passes the smell test any more than the first one did.  When the first one came out -- and it said that health utilization grew by 9.9% at an annual rate (even when GDP was growing just 0.1%) many of us did not believe this passed the smell test.  We subsequently learned that the Commerce department did not have real use numbers to back this up, but it was based on projections.  And even i...
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Understanding what is driving the downward trends in GDP in 2014 and what is going on in the health sector

Posted by Timothy McBride on Wednesday, June 25, 2014, In : ACA 
Today the third revision of the first quarter GDP report was released and it shows a rather remarkable downward slide in the health care sector's share of GDP, according to the Commerce Department that counts this up.  As I discussed in my previous blog report and is shown here in a good post on the Council of Economic Advisors web site, the revision has overall health utilization down -1.4% (on an annual rate), prices up only a very slow 0.5% (on an annual rate), so overall health care fell ...
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Is the Health Care Cost Curve Being Bent? Third Revision of GDP

Posted by Timothy McBride on Wednesday, June 25, 2014, In : ACA 
As I discussed earlier, I did not believe the first report for the first quarter quarter of 2014 for GDP, which showed a whopping increase of 9.9% annual growth in health use, attributed all to the ACA (see my previous blog posts on that).  We later learned that this was all based on projections and not on any real data.  Most of my health economics friends expected this to be revised downward.

Well it has been, twice.  The third revision of the GDP was announced today (June 25, 2014), and it ...
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Job Layoffs in Health Care Sector Continue to Plague Missouri

Posted by Timothy McBride on Sunday, June 22, 2014, In : ACA 
Missouri continues to be plagued by job layoffs in the health care sector.  Though it is admittedly hard to track these job layoffs specifically without exact details (reports I have on these are based on press reports which are notoriously lacking in detail, for good reasons) -- and it could be that some of the job layoffs have not been reported at all publicly, this post will be based on what I have been able to find in the news over the period April 2013 to June 2014.

Over that period as th...
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Missouri's Medicaid eligibility determinations continue to drop, April 2014

Posted by Timothy McBride on Thursday, June 5, 2014, In : Missouri 

A new report out from CMS indicates that applications for Medicaid in Missouri continued to drop in April, relative to March, from 829,585 to 806,639, a drop of -2.8%.  This means Missouri remains an outlier, with a drop of -4.7% in Medicaid determinations since before the open enrollment period started for the Affordable Care Act (ACA) as the report shows -- the drop in Missouri is the second lowest in the country, second only to Wyoming since before the open enrollment period.

As I reported ...

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Missouri's Medicaid Enrollment Dropping, And Unemployment Declines do not Explain the Drop

Posted by Timothy McBride on Sunday, June 1, 2014, In : Missouri 

A recent release from the Center on Medicare and Medicaid Services shows that across the U.S. Medicaid enrollment grew by 5.8 million from right before the open enrollment period (July-September 2013) to March 2014, a growth rate of almost 10%.  However, as would be expected most of this growth occurred in states that chose to expand Medicaid coverage.  Nevertheless, even the remaining states have experienced growth of over 640 thousand (or about 2.6%).

However, the report highlights a perplex...


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The Great Lamping-Silvey debate continues (this time on Twitter!)

Posted by Timothy McBride on Saturday, May 24, 2014, In : Missouri 
Those of us in Missouri, and who follow the Medicaid expansion debate closely, know that a couple key turning points that happened (in public at least) were when, first, a handful of Republican Senators (led by Sen. John Lamping) took to the floor right after their Spring break and declared their solid opposition to the Medicaid expansion, and vowed to fight this even to the point of filibusters. Shortly after that, one of Sen. Lamping's colleagues, Sen. Ryan. Silvey took to the floor and eng...
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Health Spending, the GDP Report, An Update

Posted by Timothy McBride on Saturday, May 10, 2014, In : ACA 

Since the GDP report came out for First Quarter 2014 and there was much attention to this from many quarters, including in the press (see column by Los Angeles Times columnist Michael Hiltzik and column by Peter Orszag, to cite a couple examples).

In the last week or so, a couple more pieces have come out to weigh in on this.  For example:

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Health Use up 9.9% in Early 2014: What does this mean? Was this Expected?

Posted by Timothy McBride on Thursday, May 1, 2014, In : ACA 

[UPDATED 630 am Central, 5/1; updated May 2, 3 pm to include link to new Altarum report]

The first quarter 2014, gross domestic product (GDP) numbers were released Wednesday April 30, and other than the report gaining headlines for being so dismal (largely attributed to the terrible winter weather), the other big headlines were for the large increase in medical care utilization (9.9% annual rate, even when medical inflation rose only 0.1%).

Certainly it WAS EXPECTED that the total health spendi...
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Crunch Time: Is it time for Gov. Nixon to behave like Gov. Brewer?

Posted by Timothy McBride on Monday, April 28, 2014, In : Missouri 
So there is less than three weeks left in the Legislative session. The Missouri Legislature has yet to give Governor Jay Nixon the leading initiative he has asked for the last two years, much to his credit. As a result, the state is losing billions of dollars, losing thousands of jobs, and low-income people still don't have the coverage they need.

Maybe it is time for Gov. Nixon (who after all has always had a huge positive popularity rating) to adopt the strategy that Republican Gov. Jan Brew...
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New Gallup results: most encouraging yet to set aside concerns about adverse selection?

Posted by Timothy McBride on Friday, April 18, 2014, In : ACA 

First, the caveat: at this very early stage in the implementation, and more to the point, the rollout of the data on the Affordable Care Act (ACA), we should all proceed with caution.  That is especially true when we get several studies, or surveys from different sources, with different samples, using different methods, and in particular using samples that are in general relatively small in comparison to social scientists and health researchers are used to seeing in doing health policy analys...
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Perplexing State Policy Decision: Tax Cut Yes, Medicaid Expansion: No?

Posted by Timothy McBride on Thursday, April 17, 2014, In : Missouri 

Today (April 16th, 2014), the state of Missouri Legislature passed a $620 million tax cut with an annual price tag.

What is rather flabber-gasting about this decision is that this Legislature has been dragging its heels for two years on another decision: to expand Medicaid to about 300,000 low-income uninsured Missourians.  By recent reports, the legislation working its way through the Legislature is not as likely to pass.

Now someone needs to explain to this economist why:

  • the Legislature would...

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The politics of the ACA is widely misunderstood

Posted by Timothy McBride on Saturday, April 12, 2014, In : ACA 
It has become widely accepted, it seems, in the popular press, and in Washington, for a long time that the Affordable Care Act (ACA) is unpopular and will hurt the Democrats in the midterm elections in November 2014. My belief is that this stems from at least a couple misunderstandings of the polls.

First, most polls ask a lead question about the ACA, simply asking a question about whether people favor or oppose the ACA.  For a long time a plurality has been more against the ACA than in favor ...
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Three surveys show uninsured dropping rapidly since ACA open enrollment period started

Posted by Timothy McBride on Friday, April 11, 2014, In : ACA 

Three surveys recently released are now showing significant increases in the number of people insured in just the last six months (September 2013 to March 2014), roughly showing the same effect:


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Uninsured in States with State-Based Marketplaces Twice as Likely to Obtain Coverage

Posted by Timothy McBride on Thursday, March 20, 2014, In : ACA 

·  ·    The ACA left the important decision of whether to create a state-based marketplace or not up to the states, and the Supreme Court gave states the option to expand Medicaid or not.  

Fifteen states (representing about one-third of the uninsured in the U.S.) have chosen to create state-based marketplaces, 10 states are using the federally-facilitated marketplaces (FFM) but are expanding Medicaid, while the remaining 26 states have chosen to use the federally-facilitated marketplace and...


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Additional comment on Patrick Ishmael's commentary

Posted by Timothy McBride on Saturday, March 8, 2014, In : ACA 

Earlier I commented on Patrick Ishmael's comments on Medicaid in Missouri posted on Forbes website.  In my previous comments I dealt with several of the issues he raises in that commentary, except the last one.  At the end of his piece he makes this comment:

"Keep in mind that this enrollment conversation doesn’t even touch on the abysmal Medicaid health outcome record that Avik Roy, Michael Cannon and others have talked about for years. That’s no small matter. Combine the outcomes problem...


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Response to Forbes/Show-Me Take on Missouri Medicaid Situation

Posted by Timothy McBride on Saturday, March 8, 2014, In : Missouri 
Given that we are in the middle of the implementation of the Affordable Care Act (ACA), and a full verdict on what is happening will not really be known for a short while, it is a prudent idea to wait before making definitive comments on what is happening out in the field.  The reality is that the "data" on the implementation of the ACA is still coming in, and none of us can be 100% sure at this point what is happening.  

However, a commentary by Patrick Ishmael (of Missouri's Show-Me Institut...
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Where is Paul Ryan?

Posted by Timothy McBride on Thursday, December 5, 2013, In : ACA 
It has occurred to me that in all the news reports I have seen, with many Republicans out front and center attacking the rollout of the Affordable Care Act (ACA), one person I have not seen speaking about it is Paul Ryan.  I wonder why this is the case.  But I have a hypothesis.

Ryan made a Medicare Exchange the centerpiece of his policy changes to Medicare in his proposal outlined in "Path to Prosperity" (see pages 39-40 of the document at the link).

It has been pointed out before, most notabl...
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A Tale of Three Markets: How ACA implementation by state is affecting the uninsured's ability to obtain coverage

Posted by Timothy McBride on Monday, December 2, 2013, In : ACA 

After passage of the ACA, and the decision by the Supreme Court, states have faced important implementation decisions that will profoundly affect the effectiveness of health reform in reaching the previously uninsured.   As the Affordable Care Act (ACA) is being implemented, it is becoming clear that the experience for those trying to obtain health insurance coverage is influenced by two major decisions made by the states: whether the state chose to operate their own state-based marketplace, ...


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Media narrative on the ACA: is it over the top?

Posted by Timothy McBride on Saturday, November 30, 2013, In : ACA 
It seems we cannot open up a newspaper, or listen to a newscast these days without hearing reference to how troubled the "rollout" of "Obamacare" is.  This seems a dominant media narrative, deserved or not.  

Just for kicks, I did a quick and (I am sure not exhaustive) search on "Lexis/Nexis" to see how many references I could come up with to this.  Using just the parts of the database limited to "all news (English)" and "broadcast transcripts" and limiting the search to articles posted on Oct...
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Interesting preliminary data on age distribution of ACA enrollees

Posted by Timothy McBride on Friday, November 29, 2013, In : ACA 
A Reuters report (link sent to me by Chris Conover; thanks Chris) reports that in four states where they have reports about 20% of new enrollees are 18-34 years old (ranging from 19% in KY to 27% in MD). The report indicates that "The Obama administration is aiming to enroll about 2.7 million 18-to-35 year olds in the exchanges by the end of March, out of 7 million total, or about 38 percent."

The age distribution seems actually better than I might have expected at this early stage.  Many repo...

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Why is media minimizing impact of ACA?

Posted by Timothy McBride on Friday, November 29, 2013, In : ACA 
Persistent reports on the impact of the rollout of the new insurance options for 2014 under the Affordable Care Act (ACA) have fixated on the enrollments in the new Marketplaces, where private plans are being offered. 

Why is it that the media is not reporting widely the TOTAL number of previously uninsured who are obtaining coverage through all sources, including the marketplace plans as well as Medicaid coverage?

The recent updates from Kaiser show that over 741,000 people are now enrolled, a...
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What if all states had adopted State-Based Exchanges?

Posted by Timothy McBride on Thursday, November 21, 2013, In : ACA 
In the many things to dissect about the Affordable Care Act (ACA), one thing we will study is the decisions by states not to operate their own Marketplaces, and states not adopting Medicaid expansion. 

Given the problems to date with the federal website, it is notable that this likely has hampered many people in the 36 states not operating a state marketplace.  One measure of this is that of the 993,635 people who applied for coverage in the state marketplaces, only 21% were enrolled in market...
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Enrollment in ACA starting to accelerate?

Posted by Timothy McBride on Wednesday, November 20, 2013, In : ACA 
As is being reported in some media outlets, in November the enrollment in the Affordable Care Act (ACA) may be accelerating.  

This is being shown by preliminary data reported by the Kaiser Family Foundation, which is tracking state enrollment where it can get regular updates from the states.

In the three states where Kaiser has new updates since the administration released the nationwide report (of enrollment through November 2), there is a 28% increase in enrollment of 36,641 persons.  It bre...
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About 75% of new Medicaid enrollment in states expanding Medicaid

Posted by Timothy McBride on Tuesday, November 19, 2013, In : ACA 
Based on the report published last week, about three-quarters (74.2%, or 293,984 people) of the new enrollment in Medicaid (from October 1 to November 2) occurred in the 26 states (including D.C.).  This means that the remaining increase in enrollment -- 25.8%, or 102,277 people -- has occurred in the 25 states that have not expanded Medicaid so far.

This may not seem like a surprise, because perhaps some might ask: of course the new enrollment is occurring mostly in the states that expanded M...
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State Based Marketplaces Much More Successful in Enrolling People under ACA

Posted by Timothy McBride on Monday, November 18, 2013, In : ACA 
Last week the administration released data on the number of people who have applied for, and been enrolled in, insurance through the Affordable Care Act (ACA).  As has been widely reported, 106,185 people enrolled in the state and federal Marketplaces, and 396,291 enrolled in Medicaid plans, for a total of 502,446 enrolled.

How well are these state-based and federal Marketplaces doing in enrolling people, especially relative to the number of uninsured in the states?  Some overall impressions, ...
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Making sense of Enrollment reports: State Based Marketplaces

Posted by Timothy McBride on Wednesday, November 13, 2013, In : ACA 
There are now several places tracking and reporting numbers enrolled in the state-based Marketplaces.  For example, the New York Times this morning reported on what is happening in the state-based Marketplaces which are generally working better than the much-maligned federal Marketplace (healthcare.gov).  

I have put together a table to compare the estimates from the New York Times, Avalere, and Advisroy Board, all that are reporting numbers on a semi-regular basis.  Just to be clear, not all ...
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Get ready for a wild ready on enrollment numbers

Posted by Timothy McBride on Tuesday, November 12, 2013, In : ACA 
We are starting to see early reports on "enrollment" numbers in the Affordable Care Act (ACA) Marketplaces in various places.  It could be a real wild ride, and as in any reports on data, it could get very confusing.  And, unfortunately, when numbers are confusing, and all over the place, that could lead to a situation where pundits or politicians pick and choose the numbers they want to choose to make the numbers look bad, or good, depending on their point of view.

Officially the federal gove...
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The Health Reform Have- and Have-Not States

Posted by Timothy McBride on Monday, November 11, 2013, In : ACA 
As the press and pundits rush to judgment (apparently) on deciding how "Obamacare" is going they ought to actually stop to ponder that the Affordable Care Act is not just one program, not a federal program, rolling out the same in every part of the country.  In fact, what we are witnessing is essentially 51 different health reforms being rolled out in the 50 states and D.C., and taking on different forms everywhere.

One way to characterize the way this is rolling out is on two major dimensions...
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Politics will leave some uninsured

Posted by Timothy McBride on Monday, November 11, 2013, In : ACA 
It is worth remembering that because of policy and political decisions many of the uninsured will not have access to the options for coverage available under the Affordable Coverage Act (ACA).  At least two major groups are important:

Thus about 14 million (see Table here) are not ev...

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Press is missing the boat on ACA by not covering State-Based Marketplaces?

Posted by Timothy McBride on Sunday, November 10, 2013, In : ACA 
There has been much hyperbole in the press about the "failure" of "Obamacare" because of the problems with the federal healthcare.gov website.  The focus on this website and perhaps few enrollments through this website and many mentions of this seems odd given that in 17 states individuals will enroll through state-based Marketplaces.

The Kaiser Foundation is reporting preliminary data on these state-based Marketplaces on their website, at least for 15 of these states.  They report that 227,81...
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Reports of Job Losses in Missouri Health Care Sector Continue

Posted by Timothy McBride on Monday, June 17, 2013, In : Missouri 
This past week two major health systems in Missouri announced job cutbacks: the BJC health system in St. Louis (announcing 160 layoffs for the first time in their history), and the University of Missouri Health Care system (announcing reduced hours for 35 employees, and that they will not fill 90 positions).  

If I have kept track correctly this is the fourth time in the last two months cutbacks, affecting jobs.  The PDF document posted above lists each job loss, with references.

Although it is...
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Equal Access for EGGS (but not for the Uninsured?)

Posted by Timothy McBride on Thursday, May 16, 2013, In : Missouri 
Well, one of the pictures below depicts items that gained a lot of attention and led to passage of legislation in the Missouri Legislature this session (which ends tomorrow).

On the top are hundreds of uninsured persons (and there are at last count about 877,000 uninsured persons in Missouri). On the bottom are pictures of Turkey, Duck and Goose EGGS. 

You guessed it! House Bill542 passed, which has this important change in it: "Section 196.311 RSMo, (6) "Eggs" means [eggs in the shell from] t...

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Missouri Obamacare Myths #2: Medicaid Expansion Costs Money

Posted by Timothy McBride on Monday, March 18, 2013, In : Missouri 
Earlier I described the proposal by Missouri Governor Jay Nixon to expand the Medicaid (MOHealthNet) program in Missouri to cover about 260,000 persons in 2014, according to the state's estimates [ http://dss.mo.gov/mhd/oversight/pdf/130129-healthcare-expansion.pdf ].

It has often been said in response to this proposal that expansion of Medicaid would not be affordable to Missouri.  For example, Rep. Jay Barnes said "Missouri taxpayers cannot afford a straight Medicaid expansion." [ http://www...

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Why we have political gridlock

Posted by Timothy McBride on Wednesday, March 13, 2013, In : Politics 
Many people ponder why we have political gridlock in Washington DC and in the states.  There are several theories on this, and some of these make make a lot of sense.  More on other theories later.

But one of the important ones that I want to discuss here is what I hear quietly in private, but that these folks will not say in public.  

Politicians who would otherwise be "moderates," especially in the Republican party (but sometimes Democrats too) have been afraid for at least 2-3 political cycl...

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The obsession with the "Deficit"

Posted by Timothy McBride on Wednesday, March 13, 2013, In : Deficits 
The two parties have been locked in a battle for about a year now (if not longer) over the budget deficit.  Is that really what we should be arguing about?  Is that really what the issue is.  I say no, and that is not what what we should be arguing about.

First, the real issue should still be economic growth and jobs.  The recovery still is continuing, but it sluggish.  The National Bureau of Economic Research (NBER), which keeps track of these things, marked the official end of the recession ...

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Ryan "Budget": Where's the Missing $Trillion?

Posted by Timothy McBride on Tuesday, March 12, 2013, In : Deficits 
So many people are citing the many political and math problems with the newly revised (but hardly so) Ryan budget plan, 2013 edition, released today 3/12 [http://budget.house.gov/uploadedfiles/fy14budget.pdf ].

I have many of the same problems other have (about which I will likely write later) -- such as the at about 60-70% of the cuts come from health care, he starts with a non-starter that the Obamacare plan will be repealed which just will not happen, the plan has zero dollars of new revenu...

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Missouri Obamacare Myths: Myth #1, Corollary

Posted by Timothy McBride on Thursday, March 7, 2013, In : Missouri 
Yesterday I wrote about the myth that the primary vote taken in August 2010 (called Proposition C), which has been characterized by some people as an overwhelming vote by the state of Missouri "against Obamacare" cannot be characterized that way because in fact the proposition was a vote on a very narrow part of the law -- only the individual mandate provision.  That is well-known to be the least popular provision of Obamacare, so it is in fact no surprise that a proposition against it was pa...
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Missouri Obamacare Myths: Myth #1

Posted by Timothy McBride on Wednesday, March 6, 2013, In : Missouri 

For many months now, I have been hearing many myths about Obamacare in Missouri, which compels me to deal with them.  The first one I want to deal with is this one:

Speaker Timothy Jones is one of many that say this.  For instance, Jones told a reporter earlier this year: "that Missouri voters have repeatedly come out against the federal Affordable Care Act. The Missouri Health Care Freedom Act, also known as Prop C, which passed with more than 70 percent in a statewide vote in 2010." http:/...
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Short-Term Deficits vs. Long-Term Deficits

Posted by Timothy McBride on Tuesday, March 5, 2013, In : Deficits 
Do people like Joe Scarborough really NOT understand the difference between short-term deficits and long-term deficits?  Apparently not.  [  http://www.huffingtonpost.com/2013/03/05/joe-scarborough-paul-krugman-charlie-rose_n_2810389.html?utm_hp_ref=business&ir=Business ]  The brain should be able to carry two thoughts at once, but maybe not in Washington DC.

In the short- and medium-run, deficits are falling, and rather fast.  The deficit as a percent of GDP is falling from a high of 10.1% of...
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The Unnecessary Agony of Student Evaluations

Posted by Timothy McBride on Monday, March 4, 2013, In : Miscellaneous 
OK, this is not on health policy or health economics, I know.  But for the academics in the audience I feel compelled to share this.  A fascinating article that will likely ring true, "On the Unnecessary Agony of Student Evaluations", from the Chronicle of Higher Education: http://chronicle.com/blogs/conversation/2013/03/01/the-unnecessary-agony-of-student-evaluations/?cid=wb&utm_source=wb&utm_medium=en

It makes the point I expect all of the professors reading this know: that student evaluatio...
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What is driving the deficit?

Posted by Timothy McBride on Monday, March 4, 2013, In : Deficits 
It is worth repeating this every so often, because this seems to have not sunk in.  People seem not to have figured out that the deficit is mostly -- almost entirely -- driven by a few factors: (1) the Bush-era tax cuts now mostly extended, (2) the wars in Iraq and Afghanistan, (3) and the great recession.  Now, the TARP and stimulus are not contributing much at all to the current deficits.  

A few years ago, the stimulus and measures to deal with the recession contributed much more to the def...
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What Medicare Problem?

Posted by Timothy McBride on Thursday, February 28, 2013, In : Medicare 

Yesterday's New York Times included a fascinating article by Eduardo Porter on Medicare financing.  Porter makes the point that with the drop in the growth in health spending that we have recently seen (at least three, if not four years in a row of less than 4% growth in health spending), the projections already show Medicare spending will be $143 billion less over the next decade.  This is what the CBO now projects, compared to what they projected just last August.  Wow.  And that is without...


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How to Fix Entitlement Programs? Fix the Economy First!

Posted by Timothy McBride on Monday, February 11, 2013, In : Deficits 
Many folks seem fixated on solving the long-term budget deficit, RIGHT NOW.  And of course that means focusing in on the big problems of Social Security, Medicare and Medicaid.  Thus, the so-called deficit hawks say that we must cut these entitlement programs now.

But other economists say this is a mistake because the economy is still fragile and we should not focus on significant deficit-cutting until the economy has recovered.

What seems to have been also missed in this discussion is that inc...

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Poppycock about "Not Passing a Budget"

Posted by Timothy McBride on Wednesday, February 6, 2013, In : Deficits 
It has become a common attack point that the Senate has "not passed a budget" in years -- according to the "Morning Joe" program (Joe Scarborough is fixated on this) for over 1,300 days.  People want to point to this as somehow an indicator of the fundamental flaw in our Legislative process.  Several points.

First, budget historians would know that until the early 1970s that Congress NEVER actually passed a budget bill.  So we actually survived as a Republic for almost 200 years without a budg...
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January Employment Report Upbeat

Posted by Timothy McBride on Saturday, February 2, 2013, In : Miscellaneous 

Although it is not getting as much attention as the top line numbers of the unemployment rate (7.9%, up slightly) and new jobs created (157,000, which was about the number expected, the best news in the January employment report were in the revisions to the November and December jobs reports.  

The Bureau of Labor Statistics added 129,000 jobs to the estimates from those jobs reports so that in November and December 256,000 and 202,000 jobs were created, a total 458,000 jobs, not the previousl...


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How to Fix Medicare?

Posted by Timothy McBride on Saturday, February 2, 2013, In : Medicare 

A local reporter, James Gallagher, sat down and did a long interview with me to discuss how to reform entitlement programs, focusing mostly on Medicare.  A transcript of some of what we discussed is here:

 http://www.stltoday.com/print/business-section/wu-health-economist-talks-about-fixing-medicare/article_46130c66-b69c-5f76-b9eb-50b8c20814a6.html

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More Interesting Analysis from the Employment Report, September 2012

Posted by Timothy McBride on Saturday, February 2, 2013, In : Miscellaneous 

There has been a lot of excellent analysis written on the employment report today.  Of course, as always, much of the best quick-turn around analysis has appeared on the "Wonkblog" by Ezra Klein and his colleagues:

The young are leaving the Labor Force and the Old are flocking to it:

  http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/09/07/the-young-are-leaving-the-labor-force-the-old-are-flocking-to-it/ 

Discouraged workers are NOT why unemployment rates fell
  http://www.washingtonpost.co...

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Why has Paul Ryan Suddenly become Factually Challenged?

Posted by Timothy McBride on Saturday, February 2, 2013, In : Deficits 

A lot of people are scratching their heads about what "has happened to Paul Ryan?" After all before the last week, he was supposed to be like Robin to Batman, a wizkid, the savior -- he had a great reputation on Capitol Hill for being a deficit hawk, a numbers guy. He wowed the press. So now, all of the sudden he cannot tell anything factual. So what happened? Jonathan Chait has a very good theory. It is worth considering. Here are the operative paragraphs:


"The thing about Ryan is that he has...

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About Me


Timothy McBride Timothy D. McBride, Ph.D. is a Professor at the Brown School, Washington University in St. Louis. Here you can find musings on health policy and other issues. Opinions are my own, and not those of my employer. Contact: mcbridetd@gmail.com