California By the Numbers

Robert Laszewski takes California’s healthcare exchange enrollments by the numbers:

  • California has 5.3 million uninsured eligible to buy in the exchange with half estimated to be subsidy eligible.
  • California is cancelling another 1.1 million people of which Covered California has estimated 510,000 qualify for a subsidy they can only get if they go to Covered California. At least 80% need to act by December 23 to avoid losing their coverage.
  • The state is spending $250 million in federal money to get people signed up––dramatically more than any other state.
  • The Covered California goal is to sign-up 500,000 to 700,000 subsidy eligible people by March 31.

Why should we be so impressed with Covered California because they have signed-up 80,000 people so far? Or, even that their goal is to sign-up 500,000 to 700,000 of the state’s 6.4 million people––half subsidy eligible––who are uninsured or having their insurance canceled?

Looking at these numbers, if they don’t have well more than 500,000 people signed up by December 31, I would have to think the number of uninsured in California would have grown.

It’s too early to declare victory.

If there aren’t fewer people without healthcare on April 1, 2014 than there were on January 1, 2010, I think it’s fair to consider the entire project as a flop. If a substantial number of the newly-covered people are enrolled in Medicaid and were qualified under the old rules, I think it’s fair to consider it a pyrrhic victory.

Even if securing healthcare insurance for more people is a roaring success, that still leaves the task of getting healthcare for them. That getting more people covered by insurance will result in more people receiving care is an article of faith. Not my faith but an article of faith nonetheless.

28 comments… add one
  • PD Shaw Link

    California has the most uninsured, so its success is the most important. 15% of all uninsured live in California, 12% live in Texas, and 8% in Florida. Source: Kaiser.

  • Red Barchetta Link

    “15% of all uninsured live in California, 12% live in Texas, and 8% in Florida.”

    Sounds like Obamacare is really IllegalCare.

  • My recollection is that something like two-thirds of all the uninsured are in just a handful of states that in aggregate have quite a bit less than two-thirds of the population. Most are concentrated in the West and Southeast. Maybe add Nevada and North Carolina to the three listed above?

    And, yes, illegal immigrants constitute a big chunk of the uninsured. A third? Something like that. The PPACA does nothing about them.

  • PD Shaw Link

    Any resemblance to the Southern border is purely coincidental. Any persons pointing out similarities between Southern California and South Carolina are obviously racists and should be identified to the proper authorities.

  • ... Link

    The state is spending $250 million in federal money to get people signed up––dramatically more than any other state.

    Is it dramatically more if adjusted for population or, more critically, uninsured population? If that’s the case I don’t really think it is dramatic at all.

  • ... Link

    If there aren’t fewer people without healthcare on April 1, 2014 than there were on January 1, 2010, I think it’s fair to consider the entire project as a flop.

    I don’t even think that is necessarily a complete success. If someone’s insurance gets cancelled so that they aren’t covered after 12/31/2013 and can’t get another policy until 4/1/2014, that isn’t good. If that happens to enough people (and as I read the bit above it looks like California will count it a success if only 500,000 fewer people have insurance come 4/1/2014), then some of them will inevitably have serious medical issues in the meantime, which will crush them financially, at the very least. That’s a lot of collateral damage that the Administration and Congress DEMANDED that is completely unnecessary.

  • ... Link

    I don’t even think that is necessarily a complete success.

    In fact, it still wouldn’t necessarily be a complete success, even if the new people can all get health care to go with their health insurance. Some ways it could still be a failure:

    (A) Allegedly, this whole thing is to force healthy people to pay for the costs of less healthy people. If it turns out that those signing up aren’t as healthy as advertized on the whole, this could be a failure on the cost side.

    (B) If an inordinate amount of time, money and effort is spent just to get a relatively small additional percentage of people covered, it will be a financial, political and organizational boondoggle.

    (C) If the disruptions in health CARE are extensive, even for those that previously had insurance, then it will be a failure even if the programs meet enrollment and financial goals.

    That’s three ways off the top of my head that the program could meet nominal goals and still be a failure.

    One thing is certain: The President’s claims that this was going to lower everyone’s health insurance costs were every bit as dishonest as his claims that everyone could keep their plans and doctors if they liked them.

  • ... Link

    One final thing: What if, after all of this, measurable health CARE results do not improve? That will take years to determine, most likely. But in that case, can the whole thing be declared a failure? What would those measures be, and how would one account for the incredible number of variables involved?

    I don’t think the technocrats in charge have thought very hard, or at all, about what they’re actually doing and whether or not it will achieve any useful, measurable goals.

  • ... Link

    An example of variables: One could see an increase in many infectious diseases simply because the federal government is trying to import thirty or forty million more third world peasants in the next ten years. That would be a negative health result that would happen even if the PPACA worked exactly as advertized. Separating stuff like that out to determine the impact of the PPACA would be a project that would give the Rand Corporation pause, I would think.

  • Cstanley Link

    Regarding health stats and whether or not they will improve…

    Two off cited statistics of our healthcare systems failings relative to other developed nations are longevity and infant mortality. Both claims of US inferiority are easily debunked; average lifespans here are shorter than in some EU nations but their lead evaporates when you factor out violent and accidental (read: highway) deaths. For infant mortality, the difference is due to a larger number of premie births being counted ( more premature live births here in general, and more infant births are recorded as stillbirths in other nations which clearly affects the overall survival rate.)

    Neither of those stats truly reflect on the quality of our healthcare system, and it will be interesting if the powers that be suddenly start adjusting the measurements accordingly, which could artificially raise our ratings post- PPACA.

  • Andy Link

    Dave,

    In the OTB thread you mentioned how most HC spending in the US is for old people. I remembered the chart you posted here, but I went looking for others.

    I found this:

    http://blogs-images.forbes.com/danmunro/files/2012/12/HCcostsbyAge.png.

    As well as this, which quanifies things:
    http://www.nber.org/papers/w11833.pdf

    See especially figures 1 & 2.

  • Zachriel Link

    CStanley: Both claims of US inferiority are easily debunked; average lifespans here are shorter than in some EU nations but their lead evaporates when you factor out violent and accidental (read: highway) deaths.

    That is incorrect. The misinformation is based on an overly simplified regression by Ohsfeldt & Schneider.

    Ohsfeldt said we’re “not trying to say that these are the precisely correct life-expectancy estimates. We’re just trying to show that there are other factors that affect life-expectancy-at-birth estimates that people quote all the time.”
    http://blogs.wsj.com/health/2009/08/25/violence-traffic-accidents-and-us-life-expectancy/

  • Zachriel Link

    CStanley: For infant mortality, the difference is due to a larger number of premie births being counted ( more premature live births here in general, and more infant births are recorded as stillbirths in other nations which clearly affects the overall survival rate.)

    Not sure if resuscitating a baby with very poor survival chances is a plus. In any case, most countries in the developed world have *comparable* lifespans, though the U.S. spends much more for healthcare. Much of this excess spending is on people with little prospect of continued quality of life.

  • Zachriel Link

    Dave Schuler: It’s too early to declare victory.

    Or failure.

  • Andy:

    Thanks. Those are valuable contributions.

    Zachriel:

    Or failure.

    Absolutely.

  • PD Shaw Link

    @Andy, I think that first line graph suffers from too much smoothing. The second link to the paper is strongly suggestive of U.S. healthcare expenditures increasing dramatically at age 65, and perhaps U.S. healthcare costs are lower than other countries prior to age 65.

  • Red Barchetta Link

    “And, yes, illegal immigrants constitute a big chunk of the uninsured. A third? Something like that. The PPACA does nothing about them.”

    That’s the point. My comment was really just a crack. All this, for that?

  • steve Link

    Infant mortality has bee looked at to see if the way we report things makes a difference or if it is accounted for by our trying to save babies other wold not. This does not account for the difference.

    “The high rate of adverse birth outcomes in the United States does not appear to be a statistical artifact, such as a difference in coding practices for very small infants who die soon after birth (MacDorman and Mathews, 2009). Indeed, country rankings remained identical even when Palloni and Yonker (2012) recalculated the rates to exclude preterm births (less than 22 weeks of gestation).”

    The big difference is that we have a lot more premature and low birth weight babies.

    Steve

  • Yeah, I wrote a post on that very subject a number of years ago. My hypothesis was that maternal drug and alcohol abuse in the United States was a substantial contributing factor.

  • Cstanley Link

    @zachriel- I will look at the critique on lifespan stats, but it remains that the point of non- healthcare factors affecting longevity is valid. Some can’t easily be factored out ( lifestyle, genetic variance of the population) but violent and accidental deaths are factors that can be adjusted.

    And whether or not infants should be resuscitated is irrelevant to the manner in which the stats are skewed. Countries’ infant mortality rates can’t be compared if the denominator is measured differently.

    I agree that the real metric relates to our spending and whether we get enough bang for the extra bucks. But clearly you are well versed enough to know that many people have also argued not only that our spending is too high, but also that our healthcare system doesn’t compare favorably on non- economic measures. My speculation is that the comparisons might now get unskewed, in order to create an illusion of better health outcomes under PPACA.

  • PD Shaw Link

    I think this might be the original Ohsfeldt & Schneider report, the table is on page 18.

    http://www.aei.org/files/2006/10/17/20061017_OhsfeldtSchneiderPresentation.pdf

    I think the cancer survival rates on page 19 are more impressive.

  • steve Link

    The point we keep making is that the denominators are not measured differently. The problem is that we have a worse population to begin with. No one knows the cause, there are just guesses. Drugs and alcohol are probably part of it.

    Steve

  • CStanley Link

    @steve- my last was cross posted with the exchange between you and Dave, so I apologize if I appeared to persist in a claim that was shown to be inaccurate. Do you have a link for the Palloni and Yonker paper? I’d be interested to read more.

    I don’t doubt the worse population scenario, and lower birth weights in general. Is it true that we have more multiples due to higher rates of IVF, which would contribute statistically to lower birth weight?

  • Zachriel Link

    PD Shaw: I think the cancer survival rates on page 19 are more impressive.

    Those statistics are also skewed. For instance, the U.S. used PSA screening, which resulted in the discovery of cancers, most of which didn’t need treatment. Lung cancer is very susceptible to smoking patterns.

    Cstanley: many people have also argued not only that our spending is too high, but also that our healthcare system doesn’t compare favorably on non- economic measures.

    It’s reasonable to say that the different systems have roughly comparable results, though the U.S. still has a lot of people who would benefit from more regular care.

  • CStanley Link

    Zachriel- agreed.

  • steve Link

    Th ePalloni and Yonker paper is at link. Note that as a correlate, our maternal mortality is also very high. (Nice paper.)

    http://www.ssc.wisc.edu/cde/cdewp/2012-04.pdf

    Steve

  • PD Shaw Link

    From steve’s link: “Focusing just on deaths before age 50, the main causes contributing to US life expectancy disadvantage (for females
    and males) were: (1) accidents, homicides, and suicides; (2) congenital anomalies and diseases of infancy; and (3) circulatory system diseases.”

  • steve Link

    It is a longish paper. Under the infancy section it goes over coding issues and the claim we treat while other countries just let them die. They find this not to be true. On circulatory system illnesses, it is commonly thought that a lot of that is diabetes related.

    Steve

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