Medicaid Expands

If the present trend continues the most significant result of the PPACA will be its expansion of Medicaid:

Federal health officials announced on Wednesday that some 1.2 million people selected plans on federal or state exchanges during the months of October and November. That included 803,000 people who applied to the exchanges and were found eligible for Medicaid or a related Children’s Health Insurance Program that provide public insurance for the poor — in addition to nearly 365,000 people who chose private plans.

Outside the exchanges, there has also been an increase in applications sent directly to state agencies that run Medicaid and CHIP. Applications were up 15.5 percent in October in states that are expanding their Medicaid programs and up 4.1 percent in states that are not.

Roughly a third of those enrolling newly for Medicaid were eligible under the old rules which means the federal government won’t be picking up the tab for them as it is for enrollments only possible under the new rules for eligibility in states that have elected to expand Medicaid under the PPACA. Medicaid alreadys accounts for about a quarter of states’ budgets.

States are already hard-pressed to pay their Medicaid bills. In Illinois, for example, it can take as much as a year for the state to pay providers under Medicaid.

I wonder how the states will get the money to pay these new bills? Increasing nominal rates is hard enough but increasing actual revenues is even harder.

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Joan Fontaine, 1917-2013

Joan Fontaine has died:

Joan Fontaine, the coolly beautiful 1940s actress who won an Academy Award for her role in Alfred Hitchcock’s “Suspicion” and who became almost as well-known for her lifelong feud with her famous older sister, Olivia de Havilland, died Sunday. She was 96.

Fontaine died of natural causes at her home in Carmel, said her assistant, Susan Pfeiffer.

In addition to winning an Academy Award as best actress for “Suspicion,” Fontaine was also nominated as best actress for her role in Hitchcock’s “Rebecca” (1940) and, three years later, for Edmund Goulding’s “The Constant Nymph.”

She appeared in a number of other notable films including Gunga Din, Jane Eyre, and Letter from an Unknown Woman. Only IMDB’s obit mentions her appearance in Damsel in Distress, a musical with Fred Astaire, notable for a P. G. Wodehouse screenplay, tunes by George Gershwin (the last such film during Gershwin’s lifetime), and George Burns and Gracie Allen.

She is survived by her sister, Olivia DeHavilland, a daughter, and a granddaughter. One by one these last few remnants of Hollywood’s Golden Age of glamor are passing from the scene.

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Connecting the Dots

In an article at Salon Joan Walsh rails against a system that consigns too many Americans to low wage jobs. What is the target of her ire? The Earned Income Tax Credit:

It would also be nice for Obama to recognize: The fact that so many Americans “work their tails off and are still living at or barely above poverty,” receiving public assistance, is not just an unhappy accident. It’s the result of public policy supported by many Democrats — and he hasn’t done much to change or challenge it. In fact, the chair of Obama’s Council of Economic Advisors has made the most spirited defense of it.

The truth is, a bipartisan consensus emerged in the 1990s, that a job, practically any job, was better than long-term public assistance for so-called “able-bodied” adults, including mothers with young children. It led to controversial 1996 welfare reform legislation that had ramifications way beyond the realm of welfare.

Republicans demanded work from welfare recipients; (most) Democrats went along, but demanded new support for low-wage workers: an expanded Earned Income Tax Credit, wider Medicaid and food stamp eligibility, new (though not nearly sufficient) child care subsidies. (As an Illinois state senator, Obama was critical, but later endorsed the deal.) The new support programs also helped millions of low-wage workers who never relied on welfare; as wages continued to stagnate and even decline, more people became eligible.

suggesting that all of these moves are forms of corporate welfare that have allowed the McDonalds and Wal-Marts to dominate the employment landscape.

What she supports is a higher minimum wage.

Unfortunately, she never connects the dots. Most of the working poor earn more than the minimum wage—it’s earned by only 3% of the population and most who earn it are not heads of household. Would the working poor be better off with a higher minimum wage and without the EITC? Would lower Medicaid or food stamp eligibility improve the lot of the working poor? Would eliminating or curtailing these policies while increasing the minimum wage improve their lot or make it that much harder?

While I agree that bad policies have lead to too many people without jobs or just barely able to scrape by on jobs that don’t pay enough, I think that Ms. Walsh needs to look farther afield for policies that have synergistically produced the world she decries. These include immigration policies that have lead to the importation of large numbers of non-skilled and semi-skilled workers, putting downwards pressure on the lowest income earners. There’s a lot that’s controversial about immigration but that isn’t.

It includes trade policies that have abolished import duties on most goods, allowing other countries to export their goods here without importing our goods in return, putting downwards pressure on employment here. It includes monetary policy that encourages the sale of interest-bearing bonds to foreign governments. Holding dollars is one thing. That’s something completely different.

To believe in a higher minimum wage is objectively either to believe that a higher minimum wage will have no effect whatever on employment or that the unemployment rate among black teenagers, already at around 35%, is too low. How’s that for a “low wage swamp”?

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The Budget Deal

I’m still pondering the incipient budget deal that’s already been approved by the House. I have some questions. First, will the deal pass the Senate? Second, what do you think of it?

My tentative conclusion is that it’s the beginning of a return to the “Washington consensus”. Whether you think that’s good or bad depends on whether you think that consensus is working.

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Knowing the Ropes to Skip

James Taranto takes Michigan media functionary Jen Eyer to task for her guidelines on how not to discuss racial issues in the comments of her organization’s site. The things to avoid include:

  1. Overt racism
  2. Accusations of racism
  3. Generalizations
  4. Thread-jacking
  5. False equivalence
  6. Racial descriptions
  7. Crime statistics

Now if there were an automatic filter that could screen out the first six in that list plus “guilt by association” I am convinced that it would reduce the number of web comments by 90% or more. Not to mention blog posts.

After addressing the shortcomings of her formulations of 1—6, Mr. Taranto devotes substantial column space to a consideration of her aversion for crime statistics in discussions of race. If you’re interested in Mr. Taranto’s views, I urge you to read his column in full. I’d like to make a few remarks about the FBI crime statistics.

First, facts are not themselves racist and, when you find that facts make you uncomfortable, it’s probably time to reconsider your assumptions.

Second, sometimes it’s hard to identify when facts actually are facts. Not all statistics represent facts. Sometimes it takes a bit of digging through methodology do determine how factual the statistics actually are. However, in the case of the FBI crime statistics, my confidence that they do represent facts is pretty fair.

Third, I’ve examined the FBI crime statistics and have reached a different conclusion than Ms. Eyer has. It is incontrovertible that there is a strong racial differential in the commission of violent crimes and that the rates per 100,000 population are much higher among blacks than among whites or Hispanics. However, while race is a factor the facts do not support the view that it’s the only factor and I don’t believe that violent crime can be reduced to poverty or even race plus poverty.

Rural blacks are not notably more violent or criminal than rural whites. But the incidence of crime among urban blacks is much higher than among urban whites. My conclusion from this is that the problem is gangs and that the problems presented by gangs are particularly virulent among blacks.

We’ll never be able to cope with the problems of violent crime, problems that fall particularly heavy on blacks who form most of the victims of crimes perpetrated by blacks, without facing the facts squarely and unflinchingly. First, figure out what they are. Look at all of the facts. Then comes the hard part: doing something about it.

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There’ll Always Be a Morning After

In an editorial USA Today defends the PPACA on the basis of what it might do:

Unsurprisingly, this slow-motion disaster has soured Americans on Obama and his signature law. A new USA TODAY/Pew Research Center poll shows disapproval for Obamacare at its highest point since Pew began polling on the law in 2010; 45% say it will have a mostly negative effect on the country, and just 39% say it will be mostly positive.

The news could get worse before it gets better. Many people who buy their own insurance are just finding out that their new plans might charge higher premiums and might not cover familiar doctors, hospitals or prescription drugs. No wonder Obamacare opponents think they have the law on the ropes.

And yet, the latest enrollment numbers are a reminder that the health care law has the potential to help millions of people and is worth salvaging. As the HealthCare.gov website and state exchanges began to function better, more than four times as many people signed up in November as in October, the administration said Wednesday. Nearly 1.2 million people are getting insurance, either through private policies or Medicaid.

Until now, the law’s benefits have been mostly theoretical.

I’d have more confidence in the law if people were defending it on the basis of what is has done than on the basis of what it might do. It isn’t potential, sincerity, or commitment that will determine whether on balance the law is good or bad but its results.

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Are We There Yet?

Writing at Bloomberg Megan McArdle ends her post on the PPACA’s “never-ending fix-a-thon”, the last minute fixes, rule changes, and so on, on a bright note:

Day by day, the administration is putting more of the onus on insurers to make this market work — voluntarily, out of the goodness of their hearts or at least out of mutual self-interest. In some ways, that may be a good thing; insurers are pretty good at delivering insurance, so giving them a freer hand may make sense.

However, her title assumes something that is only an assumption. We should all be able to agree that the PPACA has undergone a hurried “fix-a-thon” since October 1, not just in the incompetently constructed Healthcare.gov but in a host of rules associated with the law, especially as they relate to enrollment.

Megan is assuming that process will be never-ending. The law’s supporters assume precisely the opposite: that the rough edges of the law will be smoothed out through prudent implementation and regulations and that eventually attention can be turned towards expanding the law. For that to happen I think you must further assume that more attention will be paid to the law going ahead than occurred in the past.

I don’t honestly know what will happen. In the new year the small group plans that don’t meet the standards required by the PPACA and its evolving regulations will be eliminated and the waivers issued to large group plans will expire. The law doesn’t come into full effect until 2018 and I don’t think it’s unreasonable to expect that we’ll be seeing revised regulations and hurried fixes until 2020.

Ten years may not be forever but ten years of vacillation between inattention and panicked activity will make it feel as though it were never-ending.

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The Ignorant Armies

There are two conflicting views of how the PPACA wil play out. One of the views, which you will hear from the White House, from the New York Times and most other major media outlets, and from, probably, most Democrats is that it will all work out. The problems with the portal, Healthcare.gov, will be worked out. The missteps will be corrected and become fewer and fewer over time. The PPACA will prove to be an enormous improvement over the healthcare insurance situation that prevailed before it, Americans will be very happy with it, and it will become an indispensable part of the political and social fabric. Criticism is just crazy talk.

Today I stumbled across what I think is a very succinct expression of the opposite view at a blog called “And Still I Persist…”. Here’s the meat of it:

I believe that over the next several weeks, the ‘cold equations’ of Obamacare as it actually exists and is currently implemented – as opposed to the magic thinking version on the Left — are going to lead to more and more unavoidable disasters — train wrecks, in the metaphor that Jim Geraghty has been using since before Healthcare.gov went live. Vastly more Americans will have both their bank accounts and their personal health damaged than those that will benefit under Obamacare.

This did not need to happen. There have been multiple points all the way back to 2009 when a different course could have been pursued, one founded in reality-based reasoning about math, software, and social change. Instead, we are witnessing the mother of all train wrecks.

but I recommend you read the whole thing.

I don’t honestly know which of those views (or something in between) will actually happen. As I’ve been saying for some time we’ll know in due course.

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If Ignorance Were Bliss

Vice President Joe Biden apparently knows very little about the history of U. S. immigration laws:

Vice President Joe Biden said Wednesday that some of his ancestors came to the United States illegally and said it’s fruitless to compare the immigration system of the 1800s to today’s.

“My great-great grandparents came escaping the famine and they didn’t all come here legally,” Biden said in response to a questioner who said her family came to the country legally from Ireland in the 1800s. “They didn’t all come legally. And the existence of the system isn’t all truncated like it is now. I’d check your ancestry to make sure that they did come legally if that’s a concern to you.”

Hmm. The first law limiting immigration to the United States was enacted in 1875 and that didn’t have any effect on the Famine Irish who emigrated to the U. S. between 1845 and 1852 when there were no laws limiting immigration into the United States.

I see only two possibilities here. Either he means “they would have been illegal under current law” which is a meaningless noise or he doesn’t know what the heck he’s talking about. I vote for Door #2.

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But What Do You Want to Do?

The one thing I would do if I could magically put it into place is for there to be a nationwide recognition that no government employee and no professional whose income is primarily paid by the government has a right to an income that’s greater than the community that he or she purports to serve can afford to pay. IMO one of the logical consequences of this is that they should live in the communities they plan to serve.

I’d limit those incomes to three standard deviations above the median income but that’s just my own rule-of-thumb.

In Chicago the median income is about $38,000.

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