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.

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.