Thursday, June 9, 2016

Transitional plans and insurance exchanges II

One day after my last post, the New York Times ran an article on Geisinger Health, an insurance company requesting a large rate increase on the PA exchange. One reason why? Because the transitional plans are keeping considerable numbers of healthy people out of the exchanges. It would have been nice if the article had mentioned it before three paragraphs from the end.

Wednesday, June 8, 2016

Are transitional insurance plans driving losses on state exchanges?

The ACA's insurance exchanges have generally been successful in helping to reduce the ranks of uninsured in the United States, while providing reasonable quality insurance to its policyholders.

However, several challenges still remain. Most notably, a good number of insurers have had problems with breaking even on the exchange products (though some are making money). That stems from several problems, notably Marco Rubio blowing up the risk corridor reinsurance program that undermined many insurer's business plans, especially non-profit co-ops trying to break into the market. Other insurers, like United Health, have just tended to be bad at competitively designing and pricing plans.

However, the risk pools for the exchanges have also proven to be somewhat older and sicker than predicted, which has also tended to drive up prices in 2016 and will likely do so more in 2017. I haven't seen a great explanation for this other than "predicting new risk pools is hard," -- which it undoubtedly is.

However, the New England Journal of Medicine last week featured a very interesting Perspectives piece (gated unfortunately) by John Hsu that fingers grandmothered plans as the culprit.

Tuesday, June 7, 2016

Two-tiered justice

On the recent Stanford rape case, I think Scott Lemieux makes a valuable point that helps clarify something I've been struggling with: does asking for a stronger sentence for a privileged person who has gotten off lightly undermine the broader push to make the U.S. criminal justice system less punitive?

Lemieux argues that it doesn't. Indeed, he suggests that the two are complementary goals: If you hold privileged (read: white and rich) defendants to the same standards the you hold underprivileged ones, people with power won't be able to ignore how draconian the system is and push to change it, instead of being able to close their eyes to it because those close to them escape its clutches. Think about the differences in the ways we've treated the opioid addiction problem and cocaine (abused broadly by middle and upper-class whites) in comparison to the way we treated the meth, heroin and crack problems (used disproportionately by the poor and/or minorities).

Finally, good on the survivor for her statement to the court and defendant during the sentencing. I have much respect for her.



Thursday, April 28, 2016

GOP's near-total blockade on Obama's appointments continues -- but you can help a bit

While we were all focused on the primary elections on Tuesday, something interesting happened on the Senate floor when Democrats made a conscious, polite and ultimately futile effort to get a few judges confirmed.

Hawaii Senator Mazie Hirono (D-Hawaii) asked for unanimous consent to vote on Obama's eleven district court nominees that have been approved by the Senate Judiciary Committee -- without objection -- and have been awaiting the action of the full Senate (see the full Senate Calendar here).

Sen. Majority leader Mitch McConnell (R-Kentucky)  objected to the request.

Then Chuck Schumer (D- New York) asked for unanimous consent to vote on the seven that have been approved by Judiciary -- again without opposition -- and have been waiting on the floor since November 5. 

McConnell again objected.

Then Ben Cardin (D - Maryland) said, OK, could we vote on the four that have been  waiting on the floor since  October 29 -- six months ago. Those are

Paula Xinis, District of Maryland,
Brian R. Martinotti, District of New Jersey, 
Robert F. Rossiter, Jr., District of Nebraska,
Edward L. Stanton III, Western District of Tennessee

John Cornyn (R-Texas) objected.

Finally,  Cardin said, could we maybe just vote on the Xinis nomination, since she was approved by Judiciary in September, no one has raised any opposition to her and she has been awaiting floor action for seven months?

Cornyn objected again.

We all know about the near complete refusal of Senate Republicans to even meet with, let alone hold hearings for, vote on or even, gasp, approve President Obama's Supreme Court nominee Merrick Garland. 

But we can't forget about the rest of these nominations either that are facing nearly a complete blockade by Republicans. In addition to the eleven awaiting floor action, 41 nominees are awaiting action in the Judiciary Committee.

In the 2015-2016 Congress to this point, the GOP-controlled Senate has only confirmed two circuit court appointments and fifteen district court judges.

For comparison, in the 2007-2008 Congress through April 30, the Democratic-controlled Senate had confirmed seven of George W. Bush's circuit court nominees and 38 of his district court nominees.

And in 2013-2014, by April 30, the Democratic controlled Senate had confirmed fifteen nominations to the circuit courts and 54 to the district courts.

It's reasonable that the GOP wants to scrutinize Obama's appointments a bit more (and even reject a few),  but these 11 judges have had been scrutinized. They've been waiting for confirmation between seven and 14 months.  They have all cleared a GOP-controlled Judiciary committee by voice vote. There is no opposition -- reasonable or otherwise -- to giving them their commissions. This is only about delay.

These are judges that are uncontroversial and needed to help the government perform their basic functions. Unlike Garland, they don't represent huge ideological stakes in themselves, so a bit of pressure might get the Republicans to let a few go.

Consider calling your state's Senators, especially if they are Republicans -- and especially if you're from Texas and have Cornyn as your Senator. (Don't e-mail, that's useless). Here's a list of numbers for their Washington offices. State your name, and give  a brief, polite (don't be a jerk) message asking them to hold a vote on the 11 district court nominees that await floor action.

The 11, including their numbers on the executive calendar are:

#307 Paula Xinis, District of Maryland,
#357 Brian R. Martinotti, District of New Jersey, 
#358 Robert F. Rossiter, Jr., District of Nebraska,
#359 Edward L. Stanton III, Western District of Tennessee
#362 Julien Xavier Neals, District of New Jersey
#363 Gary Richard Brown, Eastern District of New York
#364 Mark A. Young, Central District of California
#459 Marilyn Jean Horan, Western District of Pennsylvania,
#460 Susan Paradise Baxter, Western District of Pennsylvania,
#461 Mary S. McElroy, District of Rhode Island
#508 Clare E. Connors, District of Hawaii

Friday, April 22, 2016

Boring Bureaucrats help save the world: energy edition

When it comes to stopping global climate change, you probably don't think much about vending machines. Fortunately for all us, a lot of non-descript civil servants do.

Don't worry, the government is on it. (Really.)
Nor have you probably ever heard of the Department of Energy's Appliance and Equipment Standards Program (AESP). I'm sure it's staffed by lovely, if slightly nerdy khaki-wearing personnel.

But it's one of the Obama administrations most effective secret weapons in the fight against global warming.

Let's start with the two million beverage vending machines in the United States. Rules issued by AESP in 2015, will lead to machines coming online in 2019 required to be 16 percent more energy efficient in 2019 than today's. Over 30 years, it will save 7 million metric tons of carbon dioxide emissions, an average 233,000 tons a year. That's the equivalent of  shutting down Ohio's First Energy's Lakeshore Power Plant, which is a medium-sized coal plant in Ohio.

It will also save businesses at least $210 million in electrical bills over the same time.

Big deal, you say. The US emitted 6.8 billion tons of CO2 equivalent in 2014,  cutting 233,000 tons a year is a nice gesture, but hardly serious climate reduction.

We're just getting started. Read on to see efficiency standards really start to add up.

Sunday, April 17, 2016

If Dems get a chance to confirm Garland in the lame duck session, they should take it

Merrick Garland
At last Thursday's Democratic debate, moderators asked Democratic presidential candidates Hillary Clinton and Bernie Sanders a question from NY Daily News reader Hannah Green regarding Obama's nomination of Merrick Garland to the Supreme Court vacancy left by the death of Antonin Scalia.
Hannah Green (ph) wants to know your position, Secretary Clinton, regarding President Obama's nomination of Merrick Gaarland to the Supreme m Court. President Obama said earlier this week that he would not withdraw the nomination, even after the presidential election. If elected, would you ask the president to withdraw the nomination?
Both Clinton and Sanders said that the currently support the nomination and strongly denounced Sen. Republicans for obstructing Garland's appointment. But they differed on whether they would ask Obama to withdraw the nomination if they were elected president: 

Clinton indicated acceptance of Obama's pick:
I am not going to contradict the president's strategy on this. And I'm not going to engage in hypotheticals. I fully support the president.
Sanders said he would ask Obama to withdraw the nomination:
...obviously I will strongly support that nomination as a member of the Senate. But, if elected president, I would ask the president to withdraw that nomination because.... I think that we need a Supreme Court justice who will make it crystal clear, and this nominee has not yet done that, crystal clear that he or she will vote to overturn Citizens United and make sure that American democracy is not undermined.  
(Debate transcript from CNN.)
I want to be careful about extrapolating inaccurate meanings from their words, but it seems that Clinton is indicating that she'd be open to having Garland confirmed to the court in a lame duck session if Democrats retain the presidency and retake the Senate. Sanders, on the other hand, would want to wait to get a better judge (meaning younger, more liberal and perhaps non-white or female.)

I agree with Clinton.  I think the costs of passing up a chance to get Garland on the bench are greater than the gains of holding out for some one potentially better (in the admittedly extremely low chance that Garland ever actually gets a vote).  Hit the jump for my reasoning.

Wednesday, April 6, 2016

Cost sharing blocks access to health care


The notion that health cost containment requires people to put “skin in the game” has a long pedigree. Requiring people to pay something through premiums or co-pays for health care, the theory goes makes them more discerning consumers about health services and eliminates unnecessary health care.
The problem is that they also stop  seeking care for things that require medical attention.