Wednesday, October 2, 2013

Moving day

So we're moving to a another blog. It's a bit more unique, so visitors can perhaps find it more easily (As it turns out, there are already several academics in exile blogging away).

Other than that, business as usual.

We're at  The Makeshift Academic now, so all of my readers (both of you) can update your links.

My blog is dead. Long live my blog!

Ignorance is bliss: How Americans' low political knowledge may help "Obamacare" work better

For those of you nervous about the success the health-care exchanges, take a look at this letter:

It's a boring HR letter. That's actually the point. 

(Photo by Patrick O'Mahen)

It comes from the benefits office of my most recent employer, the University of Michigan, with which I am still nominally affiliated. The letter describes coming options under the Affordable Care Act. It indicates that UM offers many employees health care benefits that meet standards for the ACA, and indicates that other employees can go get health insurance on the exchanges.
Polls suggest that Americans don’t particularly love the ACA. Most polls also suggest that they don’t understand it. With uncertain roll-out and the loud and well-funded campaign encouraging people not to sign up on the exchanges, many of the law’s backers (including me) are a bit nervous. But it’s reassuring that a letter like this that will be many Americans’ first contact with the health care law. 

Follow me below the fold for my reasoning.

Tuesday, October 1, 2013

"The Sound of Freedom"

When Texas Gov. Rick Perry officially marked the opening of the Katy Freeway expansion in 2008, he declared that the roar of traffic in the background was "the sound of freedom."


10 mph, thousands of unnecessary of tons of carbon emissions and particulate pollution, thousands of wasted hours sitting in traffic. Freedom, indeed. Didn't George Orwell write a few things about this?

Sure, technically that's is the Southwest Freeway I snapped walking home a few days ago, but I guarantee that I-10 looked the same or worse. And yes, that bumper-to-bumper center lane is the HOV toll lane. At least the toll-authority was collecting $4.75 for every non-HOV vehicle to recoup some of the costs for ramming this monstrosity through a residential neighborhood. (The rich white neighborhoods got expensive trenching and soundproofing -- African American communities didn't make out so well in highway construction.)

Thank God I can walk home -- it's faster.

And thank God that (some parts of)] this region has finally started to get serious about transportation planning over the last decade -- because if 13- and 18-lane freeways can't handle the volume, I doubt that it's cost effective or desirable to build any road that can.

The University Light Rail Line can't get here fast enough.

Monday, September 30, 2013

Compromising on Medicaid Expansion: Real Alternatives, or GOP trap?

Tomorrow, the big news for the Affordable Care Act will be the opening of the state-level insurance exchanges. But the other major part of the law, Medicaid expansion, proceeds apace. Republican governors in many states have simply rejected Medicaid increases, presumably on the grounds that providing poor people with health insurance is a nefarious communist plot. However, some GOP-dominated states like Michigan or divided-control states like Arkansas are working with the Department of Health and Human Services to develop alternative routes for expanding Medicaid coverage to the working poor. The challenge for the Obama administration (and progressive activists) is to determine which plans stay true to the spirit of the ACA and which ones may dangerously undermine it.

Obviously, the biggest goal is to increase coverage, but we also need to be mindful of the various strings that conservative governors and legislators might attach to the modified plans seeking waivers from the Department of HHS. 

Medicaid expansion was originally supposed to automatically apply to all states, but the Supreme Court’s 2012 ruling on the Affordable Care Act made it optional. Not surprisingly, 14 states with unified Democratic control immediately signed up for the expansion; the opportunity to provide universal health insurance to residents under 138 percent of the poverty line fulfilled a longstanding progressive dream – all made possible by the federal government picking up 90 percent of the long-term costs.

Of 24 states under complete GOP control, only two took the traditional expansion (North Dakota and Arizona) while 17 rejected it entirely. Six of the 12 states with divided control governments agreed to the standard expansion, while three have passed for now. (Here's a handy map with the state decisions)

That leaves six states under GOP control (Pennsylvania, Ohio, Michigan, Indiana, Tennessee and Florida) and three states under with split control (Arkansas, Iowa and New Hampshire)  that are either still actively considering the expansion or have proposed a non-traditional style of expanding Medicaid more agreeable to Republican majorities.

And that’s where things have gotten interesting. Follow me below the break for details.

Sunday, September 29, 2013

Adjusting to Texas Part I

So I traded this:

For this:

That's an Omar-Vizquel-for-Felix-Fermin-level trade. Rust Belt wins this one.

Wednesday, September 25, 2013

A good ACA info source

Balloon Juice has a new front pager named Richard Mayhew. He's a bureaucrat at some private insurance company someplace and a political liberal. He's also been using his inside knowledge of health insurance to write a serious of very informative posts  about the nuts and bolts of why health insurance works the way it does and how the Affordable Care Act changes incentives. The comment threads that follow are also unusually thoughtful and informative with real questions from real people about real situations.

I highly recommend checking him out. Here's a link to a collection of all of his posts.

On specific topics, see a list below:

How and why deductibles and co-payments work the way they do.

What networks are and how they affect costs.

The problem of adverse selection and how it hampered reforms in New York and other states

An explanation of the rationale behind Medicare Part D doughnut hole and why it doesn't work out well in practice. 

This is how the Internet ought to work.

The Affordable Care Act: Obama's greatest achievement on gender equality?

As we count down the days to the opening of the health-care exchanges, it's worth mentioning that the Affordable Care Act is easily the biggest law promoting gender equality since the Violence Against Women Act of 1994 for the Family Medical Leave Act of 1993.

Barrack Obama has taken his share of flack on women's issues. Most recently, people have challenged his record of high-level executive-branch appointments for women, which has been considerably better than George W. Bush's but weaker than Bill Clinton's. On the other hand,Obama has appointed a record percentage of female judges -- by a country mile. (He's still not appointing women at their prevalence level in the population, but he's getting close)  And the pay gap between men and women is stubbornly constant, with women (still) making roughly 77 cents on average for every man.

But starting January 1, 2014, the ACA will remove several billion dollars in annual gender discrimination.