California's Aliso Canyon Disaster and Regulating Methane Leaks

The big news from California regards a massive leak from Southern California Gas Company's Aliso Canyon storage well. The leak, which has been ongoing since October 23, is accounting for roughly a quarter of California's methane emissions.

This is bad news for numerous reasons: Methane is a greenhouse gas 20 times more potent than carbon dioxide in its heat-trapping effect over a 100-year period (and 75 times as potent over 20 years). Unburned hydrocarbons are also a noxious pollutant in their own right, causing respiratory distress, headaches and other health problems.

Worse yet, is that that SoCal Gas has proven unable to plug the leak and expect that it will continue until the spring of 2016.

What's perhaps the most infuriating for me is that this sort of leak doesn't appear to be covered by the state's Cap-and trade apparatus designed to limit emissions, since methane leaks from wells do not need to be reported as emissions under state law.  That's too bad, because as EEnews  notes, the leak is the equivalent to about three percent of the state's TOTAL annual greenhouse gas emissions.

If the leak had been covered under the California Air Resources Board's last auction (which calculates methane's impact at 20 times the, SoCal Gas would have needed to purchase SoCal Gas approximately 1.67 million permits at $12.73 per ton of CO2 equivalent to cover the amount of methane leaked at the time writing this. That's $21.3 million. Of course, applicable environmental damage and public health fines, compensation for victims, as well as medium-sized terms in state minimum-security prisons for relevant SoCal Gas executives would be layered on top of that. 

I'm not holding my breath -- though California is much more diligent about these sorts of things than my current residence of Texas.

The good news is that the state has been thinking very concretely about these sorts of emissions and I would imagine they likely will be deploying regulations and countermeasures on leaks in the near future. Colorado was the first state to regulate well and pipeline leaks in 2014.  The federal government is finalizing regulations (though these will certainly be challenged in court) as well. However, the federal regulations apply to new pipelines and wells and not existing ones.

Expanding the Umbrella: Medicaid Expansion 2015 Review and New Year's Preview

With 2016 right around the corner, and several new governors moving into office, it's as good of time as any to take stock of where the Medicaid expansion has gone and the prospects for progress in the new year.  Despite massive Democratic setbacks at the state level in the 2014 midterm elections, Medicaid expansion fared reasonably well in 2015, and 2016 posts several opportunities for new states to expand as well, as well as one at risk of backsliding.

First, we visit the ghosts of Medicaid expansion past:

As Chart I shows,  the ACA Medicaid expansion has proceeded at a similar overall pace to the original Medicaid take-up in the late 1960s, though the holdouts to Obamacare are likely to offer stiffer resistance than the late adopters of the initial program.

Democratic defeats in the 2014 elections likely prevented expansions in Maine and possibly Florida, and may have influenced resistance to expansion plans in several other states, including Tennessee, Utah and Wyoming. However, Four new states joined the expansion -- Indiana, Pennsylvania, Alaska, and Montana -- which increases the number of states fully expanding Medicaid from 26 to 30. 

Head below the fold for state-by-state analysis and a peak at 2016.

End-of-Year judicial confirmation update

On the judicial appointment front, there was good news and bad news before Congress skipped town last week. 

The good news was that the Senate confirmed two of President Barack Obama's long-pending judicial nominations.

The bad news was that the two were for the D.C. Superior Court, the local trial court for the nation's capital and not one with federal jurisdiction.

Overall, 2015 proceeded about as poorly on the judicial confirmation front as possible without a complete blockade of Obama appointees. The Senate only got around to confirming 10 District Court judges and only one Circuit Court Nominee. 

Compare that record with the 12 circuit court and 76 District Court Appointees confirmed in 2014 with a Democratic-controlled Senate and no filibuster for lower-court appointees.

And we won't even talk about the Court of Federal Claims appointees lying fallow.

Yes, elections matter, why do you ask?

Obama has compounded this problem by not nominating any more circuit court judges (though he has continued to nominate considerable numbers of district court judges). Granted, this is something of a chicken-and-egg problem, as McConnell has hinted the Senate wouldn't confirm any new circuit judge appointments anyway. However, it would still be nice to try -- especially given two long-standing openings on the Fifth Circuit, currently controlled 10-5 by GOP appointees and having a median justice somewhere to the right of Atilla the Hun, especially on reproductive rights.

Mitch McConnell has agreed to schedule final votes for four more district court judges by President's Day and Luis Felipe Restrepo on January 11.

It ain't much, but it is a start.

How do we use bikeshare in the Sun Belt?

The Kinder Institute at Rice University has an interesting report out comparing four Bike-Share Systems in four "Sun Belt" cities.  Three are in Texas (Austin, Houston, Fort Worth), while the other is in Colorado (Denver).  The report's central idea is to get a snapshot of bike share in newer cities with lower density and planning optimized for the automobile -- in contrast to the old urban areas in the Northeast with high density.

The study, which covers the first five months of 2015, notes that most kiosks and most trips are still of the two-way weekday variety (i.e. from one-Kiosk to another), indicating that most users use the system for work trips.  However, there is a greater percentage of users in Houston and Fort Worth -- especially Houston -- who use the systems for round trips (i.e. they start and end at the same Kiosk). I'd be interested to see how this compares with bike share systems in older, denser cities.

The study is a good first stab and thinking about how we use bike share in newer cities, but I do have several additional points to make here, including a criticism or two. 

First it's interesting to note that the broad pattern of trips in these Sunbelt cities still is two-way weekday trips, which indicates that many residents here use the program for similar purposes to those in older cities -- though the report doesn't explicitly compare the two.

Second, I think that the report misses a rather obvious explanation for the differences in trip types between the cities. The authors do suggest several useful variables to explain the differences in usage across kiosks and cities. For example, they note that cities with greater numbers of kiosks have more two-way work trips. Also, the kiosks with more round-trips tend to be located near bike paths or in large parks. Also, Houston allows for a full hour of use before additional surcharges kick in, unlike the traditional pay system which gives a free half hour to the first members.

However, the report misses the idea of density.  Denver's and Austin's systems seem at first glance to be more closely spaced in a tight network, facilitating two-way commuter or errand trips. In contrast Houston and Fort Worth's systems are more spread out, limiting the utility of the system and leading to people treating it like a bike rental than bike share. They don't have any measurements on density, which would be interesting to see as well (maybe a median distance between adjacent kiosks, or a distribution of distances would be a good measure here....)

Density of the network is also rather valuable to total usage, as a National Association of City Transportation Professionals study has noted. So as Houston looks to expand this year, while I hope officials expand the scope of the bike share (please, please come to Rice Village!), I also hope they reinforce its density in its existing footprint (more stations in the Museum District!). This will expand its utility as a short-distance commuting tool.

And it goes without saying that expanding the bicycle infrastructure on the ground (more and better bicycle lanes please...) will help bring more cyclists on to the roads and keep cars moving at more reasonable (and safer) speeds.

But with this gripe aside, the report is a nice initial foray into how bike share works, and has nice nuts-and-bolts data on the use of each kiosk in all the cities and some good basic visualizations of usage in each city's network.

The invaluable Charles Kuffner, as always, has a summary and extensive analysis of a Houston Chronicle article on the subject.  He also makes the trenchant point that while knowing how people use bike share is useful, the fact that they are using it widely is the most important point.

Amen to that.

Union contracts, what are they good for?

Last week, Erik Loomis posted a summary of an article about the ongoing pilots' union negotiations with Southwest.  Loomis' point (and the excellent article he links to) are that union negotiations are about more than money -- they are also about the conditions under which employees work.  In this case, pilots voted down a proposed contract that offered them a large raise in part because Southwest demanded far more flexibility on duty hours to match other airlines  (which had managed to force those concessions from bankruptcy judges).

With the constant refrain we hear about unions being all about grabbing money, this idea of the employment environment is extremely important. I would also add that rules about firing and hiring are very important as well. My old union at the University of Michigan just settled (and essentially won) a grievance filed by a Graduate Student Instructor named Alex Chen who was offered and accepted a job in the bargaining unit, before having that offer yanked by her supervisor for spurious reasons. 

Of course, Chen lost her health insurance and tuition waiver in addition to her salary. This situation is deadly to a graduate student, who probably would have to drop out of school facing a tuition bill of more than $10,000. I've known several students in situations like this; and the psychological stress they face is extreme.

Chen reached out to the union and found out that not only did contract language back her position, but that she also scores of fellow members willing to protest on her behalf.  That article, which details what happened in the meeting, contains several fabulous anecdotes about a department program chair behaving like a stubborn child who has been caught lying about doing her homework.

An interview with Chen outlining her particular situation is here.

Anyhow, I highly recommend Loomis' post -- and the excellent comment thread, which features a really good discussion of the nuts and bolts of work rules in a contract led by a freight pilot (Major Kong) who is often found in the comment threads of progressive blogs. The thread is doubly worthwhile because it brings in information from the union and not just from Southwest, as well as discussing how issues like codeshare and subcontracts with regional airlines can undercut airline unions.

And remember -- work rules and hiring practices are just as important as wages.

With Bel Edwards win, Louisiana set to expand Medicaid

A quiet legislative maneuver from last Spring combined with an unexpected triumph of Democrat John Bel Edwards in the governor's race makes it nearly certain the Louisiana will become the 31st state -- and second in the former confederacy --  to expand Medicaid.

On Saturday, Edwards, who strongly favors expansion, easily defeated sitting U.S Sen. David Vitter in Louisiana's gubernatorial run-off election (after throwing this haymaker on the airwaves). Edwards' replacement of Bobby Jindal in itself removes a massive obstacle to the Medicaid expansion, as Jindal is an implacable (and inexplicable) foe of covering 242,000 uninsured Louisianans.

However, the state legislative majorities remain firmly in GOP hands in Louisiana. This phenomenon has stalled governors who have wanted to accept the expansion: just ask Jay Nixon in Missouri, Terry McAuliffe in Virginia and (until recently) Steve Bullock in Montana.

But the good news is that the legislature in Louisiana already has acted. Well, sort of. The legislature has rejected multiple bills expanding Medicaid in 2013, 2014 and 2015. However, in 2015 both houses passed a joint resolution laying out circumstances under which the state can expand Medicaid. The resolution creates a mechanism under which -- if a new governor assents -- the department of health and hospitals will set a fee on hospital systems to fund any state portion of the Medicaid expansion. Hospitals will likely be fine with this, as the bill exempts the smallest providers and in any case accepting federal Medicaid dollars will pump a much greater amount of funding back into the system.

In short, the legislature isn't exactly pushing for an expansion, but it is devolving its power to set up a mechanism under which a governor can chose to take it. That's exactly the opposite of what Texas did in 2013, when it took away the governor's power to accept the expansion in order to make it less likely that the state would take it.

So in any case, at least we're stumbling forward toward doing the right thing -- after we've tried everything else, of course, but I'll take it.  

Finally, note that this happening is further evidence of two important points.

First, Republican resistance to the Obamacare remains strong and widespread, but continues to slowly erode at the state level.

Second, quite simply is that elections still matter. Each of the four major contenders in the Louisiana gubernatorial race, including the three Republicans, expressed openness to expanding Medicaid. However, Edwards was the most consistent and strident supporter of expansion and is the least likely to impose conditions on expansion that would hurt recipients.

How much would expanding Medicaid help in states that haven’t accepted the expansion?

Perhaps the single biggest story about the implementation of the Affordable Care Act has been the battle in states deciding whether to accept the Medicaid Expansion. The expansion is perhaps the single most important tool in the ACA’s coverage expansion tool kit. It takes 50 state-based single payer systems and drastically expands eligibility for them, which is the single largest progressive victory in politics since the Great Society. Other important Medicaid reforms drastically streamline the application procedures and eliminated asset tests to draw out formerly eligible people who might have gotten tangled up in the system or not bothered applying because the state made you apply in person on Tuesday between the hours of 2:30 p.m. and 3:04 p.m.

However, the expansion is not some magical talisman that instantly enrolls all eligible individuals. Some people will remain ignorant of the program despite the best outreach efforts, while other will not enroll for any variety of reasons. And more to the point, 24 states hadn’t fully taken advantage of the Medicaid expansion by the beginning of 2015. Pennsylvania, Indiana, Montana and Alaska have all signed on this year, leaving 20 holdouts (half of whom were in the former Confederacy – but I digress).

The cool thing that we have some real data of how ACA has actually performed on the ground over the last two years, we make some interesting dynamic projections of what would have happened had some states accepted the Medicaid, instead of simply discussing the number of people who would be eligible for help under the expansion.

I mean, heck, this Charles Gaba fellow has been counting the people who actually signed up for coverage for two years, I might as well take one shot at figuring out who would have signed up if they could have. 

To accomplish that, follow me below the fold, where I build a simple interactive regression model to project the reduction in the uninsured population in states that haven’t expanded Medicaid. Don’t worry; I’ll label the scary part where I work through the model so you can skip the simple summary where I discuss the results in plain English (but you really should read the model section, it’s rather of important and it makes fun of Bobby Jindal).  

Some follow-up technical notes on State-based exchanges

When I reposted the last post as a DailyKos diary, a commentator engaged me a bit on a few ideas to improve the basic concept. He suggested for controlling for partisan control of the state government as a binary variable (cooperative == full Democratic control=1; non-cooperative==full Republican control=0). I thought a tertiary variable (0=GOP 1=split 2=Dem) might be a bit better.

Having an independent variable for partisan control might soak up some of the variation for cooperation with implementing the ACA, but the problem is that any partisan control variable would be extremely highly correlated with State-based exchanges. There were very few complete Democratic states without at least a shared exchange (West Virginia and Illinois jump to mind), and only one GOP controlled state (Idaho) with an exchange. I'm not sure how useful it would be in practice at sorting out variation not associated with exchanges since the two are so strongly correlated.

In any case, it was a thoughtful piece of feedback and definitely worth the brief conversation we had.

Another idea I thought of was to take quarterly data for each state to increase the number of observations for each state from one to six to track changes from the end of 2013 through the second quarter of 2015. Taking the data from cross sectional data to cross-sectional-time series in this manner would create 300 observations (vs. 50) and increase leverage dramatically, while allowing us to track over-time change in states setting up and taking down exchanges and or expanding Medicaid at different points.  Of course, as my old methods prof John Jackson used to stay "No good deed goes unpunished" and we'd have to control for the serial correlation in the states with either a fixed or random-effects model.  At least we wouldn't have to worry about panel-corrected standard errors, seeing that we're dealing with the universe of states, not a subsample.  And there would also be the problem of increase error within states for each quarter, since the Gallup sample would slip to alarmingly low levels for some states, increasing the margin of error around the uninsured rate for a given quarter.

And that's assuming that I could even get the more specific data out of Gallup.

I don't really have the time to try out either of these ideas right at the moment, but anyone in Internet land can feel free to try and report back. I'm rather interested.

Does having a state-run exchange improve health insurance access under the ACA?

With the ruling in King vs. Burwell behind us, focus on the differences between state sponsored health exchanges vs. the federal exchange has fallen away. But as state-based data has been rolling in from Gallup, the CDC, and the Urban Institute on declines in people without health insurance, I began wondering whether providing a state-based exchange has any advantages over a the federal marketplace. Gallup’s comments and tables in particular seem to push the idea that states with state-based exchanges seem to have had more success with reducing the uninsured rate.

Of course, the real reason that state-based exchanges exist is political. The original House of Representatives bill had a national marketplace, while the Senate Bill incorporated state-based marketplaces. This particular breakdown shouldn’t surprise anyone, since Senators represent entire states, and all states are equally represented. The general state-based structure of the Senate bill won out. The final ACA incorporated a mechanism that defaulted to a federal backstop, but the markets themselves were still based on state boundaries.

However, despite that structural political reason, there might be some practical reasons why state exchanges might have superior performance to a unified federal exchange. First, commentators often refer to states as “laboratories of democracies” that can innovate and try numerous different ideas. Over time, the theory goes, good ideas from some states will diffuse across other states naturally and more quickly than if the federal government had installed and tried to improve a clunky national idea. Second, there’s the idea that differing conditions and preferences across states mean that state-based exchanges will allow individual states to customize their exchanges to best fit the needs of their state.

We would have to hold these potential advantages against some very real drawbacks. First, there’s administrative complexity and cost of constructing and running an exchange for a state-level. With federal grants to construct exchanges running out, several smaller states are already transitioning back to the federal marketplace, while others are having trouble paying the upkeep costs. Also note that there’s a question of whether several states even have enough potential subscribers to form a healthy individual insurance market to begin with.

With these ideas in mind, I used Gallup’s state-based data to build an extremely simple statistical model to predict the effects of a state-based exchange on improvements in health insurance coverage.  Follow me below the fold for more details.

Medicaid Expansion gets entrenched in Arkansas -- even with a conservative GOP government

The latest news out of Arkansas offers more evidence that the Medicaid expansion will durable even in the most conservative states once it gets entrenched.  

I argued this point tentatively in March when new Republican Governor Asa Hutchinson and large GOP majorities in the state legislature reauthorized the expansion, which had been put in place under Democrat Mike Beebe’s administration, for the current fiscal year while putting together a task force to examine long-term tweaks in the system.

Arkansas has an unusual expansion: instead of simply enrolling everyone eligible in traditional Medicaid, the expansion provides subsidies to fully pay for private health insurance sold on the exchanges. As Richard Mayhew notes, commercial policies have higher costs than Medicaid, so the plan is a more expensive piece of “performance art,” albeit one that still accomplishes the primary goal of getting people covered.

The Arkansas Times picks up the story from there. As the federal match starts dropping in 2017 (and Arkansas enters new negotiations for a waiver with the Feds), the state found its was going to be on the hook for an extra $50-60 million, and Hutchinson implored the task force to cut costs.

Last week he met with the Task Force and made a speech with three major parts.

First, he engaged in the usual right-wing Kabuki ritual of complaining about how horrible Obamacare was and that it was taking away health insurance and….

(insert Charlie Brown trombone sounds here).

Oh, sorry, nodded off there. 

Second, he offered several of the usual conservative pet rocks to cut costs: notably requiring  more premium cost sharing for people above the poverty line (Iowa does this and the Feds would likely approve it in a waiver), requiring some sort of job search requirement for people on Medicaid that wouldn’t require a new waiver (this Feds won’t tolerate much here, and most of the people on expanded Medicaid work anyway) and making sure that working people with access to health insurance take that rather than enrolling in Medicaid (this will affect almost no one).

Finally, after emphasizing his anti-Obama bona-fides, he got to the real point: The Medicaid expansion had covered more than 220,000 of “our friends, our neighbors and our families,” and that rejecting it would cut them off of health care and drain more than $1.4 billion from the state economy. He also made the biggest policy proposal, which would be to shift everyone below the poverty line from private plans to the cheaper (and just as comprehensive) traditional Medicaid.

So the big conservative plan to tweak the “private option” Medicaid expansion in Arkansas and be fiscally responsible is to …. move more people into traditional Medicaid, just like Obamacare originally envisioned. I swear HHS Secretary Sylvia Burwell and President Obama just exchanged knowing glances and an extremely restrained fist bump in the Oval Office.

---

ACA reduces uninsured in Texas, but would do more if state expanded Medicaid

Shockingly (not really), failure to expand Medicaid continues to cost poor Texans access to health insurance.

The Baker Institute at Rice University the Episcopal Health Foundation have released their latest issue brief on the latest results of the Health Reform Monitoring Survey, a quarterly survey which tracks the effects of the Affordable Care Act on individuals.  The Institute and  the Foundation implement the survey for Texas.

This report contains absolutely no surprises for anyone with more than three functioning brain cells and who hasn’t been living under a rock for the last five years.

First, the good news: The percentage of uninsured working-age adults (ages 18-64) estimated by the survey declined by nearly one third, from nearly 25 percent to 17 percent between September 2013 and March 2015. Most encouragingly, Hispanics – though still the higher proportion of uninsured in Texas – had the largest decline, with a drop of 38 percent.

This indicates that the health exchange model, supported by federal subsidies, is helping a large number of uninsured individuals get coverage.

The bad news of course, is that poor people who fall into “Medicaid gap” – those who earn income less than 100 percent of the poverty line necessary to obtain subsidies on the exchange, but higher than current Texas cutoffs for Medicaid -- are still left out in the cold.  The memo notes that respondents under 138 percent of the poverty line have increased from roughly 63 percent to 67 percent of those uninsured in Texas. This change in the two surveys isn’t statistically distinct from zero, but almost surely understates the impact of the state’s failure to expand Medicaid, because individuals between 100-138 percent of the poverty line qualify for subsidies.

Two other nuggets in the report are of interest.  First, the potential tax penalty for health insurance, also known as the individual mandate -- appears to have some effect on driving the uninsured to seek insurance. More than half (53 percent) of uninsured respondents say that the prospect of a fine for not purchasing insurance is “somewhat” or “very” important to them. (Note that the IRS is waiving the fine for households that fall into the “Medicaid gap.”

Finally, uninsured respondents overwhelming say that they can’t purchase insurance because they can’t afford it (57 percent) instead of because they don’t want it (17 percent). That’s useful because it undermines (again) the talking point that uninsured people are satisfied in their current state and that the government should just butt out.

To sum up then: Texans generally want health insurance, the ACA is effective in helping them get insurance, and the ACA would help a lot more Texans get insurance if the state were to expand Medicaid. Absolutely all these things were predicted by proponents of Obamacare.

Montana on cusp of passing Medicaid expansion

In breaking news yesterday, the Montana House of Representatives passed a Medicaid Expansion Bill to a final reading by a 54-46 vote.

The expansion called the Health and Economic Livelihood Partnership Act (HELP Act), is a slightly  amended version of Senate Bill 405, which was approved in that chamber on March 30 by a 28-21 vote. The amended House version, slated for final approval today is almost certain to pass the Senate next week, after which Democratic Governor Steve Bullock will be extremely likely to sign the HELP Act into law.

The bill is slightly different from a traditional Medicaid expansion in that it will require some beneficiaries to pay co-pays; and has a job search component. However, as Section 6 of the bill notes, those co-pays will not exceed caps and regulations established by law.  The job-search component (Section 14) also appears to not affect eligibility for expanded Medicaid and only asks the state labor and industry department to partner with the state health department to match up HELP beneficiaries with potential job openings.

This should get through the Federal Department of Health and Human Services with few problems.

In both chambers, a moderate Republican sponsored the bill. In the House, Democrats managed to get the bill out of a hostile committee that had bottled up both it and Bullock's own expansion proposal this year by using a legislative stratagem called the "Silver Bullet": Under a gentleman's agreement during this session that each party gets to move six bills of their choice that have been blocked in committee on to the House floor for a straight-majority vote. Eleven Republicans helped the 41 Democrats in the chamber get the bill on the floor, while 13 GOPers joined the Democrats to advance the bill to final passage.

There are four things about this that are great news:

1. Poor Democratic Representative Tom Jacobson will finally get to forget about his accidental vote that killed expansion in 2013.
2. These guys spent a lot of money on an astroturf campaign that is going to fail.
3. 29 states now will have expanded Medicaid coverage.
4. Best of all, 27,000 to 45,000 people are going to get access to health insurance.

Obama judicial appointments slow to a crawl

Much of the focus in the Senate right now is justifiably on the GOP majority's slow-walking Loretta Lynch's confirmation vote for attorney general on the Senate floor. 

But what's getting a lot less attention is the predictable lack of traction that President Obama's judicial nominations are getting.

The Senate has not confirmed a single judicial appointment this year in three months of work.

Contrast that with the first three months of 2014, the Democratic majority confirmed three circuit court judges and 16 district court judges.

In the first three months  of 2007, the incoming Democratic majority confirmed two of George Bush's circuit court nominees and 13 district court nominees.

Four rather uncontroversial district court nominations are waiting for a floor vote --three in Texas and one in Utah -- all which easily cleared the Judiciary committee in February. They'll get through the Senate eventually, but somehow I don't think Mitch McConnell has them as a priority.

Just another reminder that elections matter.