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Need some more good news on Obamacare? How about some mixed news instead? Here it is:
Congressional Budget Office (CBO) estimates released last week show that health reform’s Medicaid expansion, which many opponents wrongly claim will cripple state budgets, is an even better deal for states than previously thought….CBO now estimates that the federal government will, on average, pick up more than 95 percent of the total cost of the Medicaid expansion and other health reform-related costs in Medicaid and the Children’s Health Insurance Program (CHIP) over the next ten years (2015-2024).
The good news is obvious: the Medicaid expansion is an even better deal for states than we thought. The federal government will pick up nearly the entire cost of expansion, and when you account for money that states will save from reduced amounts of indigent care and greater help with mental health costs, the net cost of expansion gets very close to zero.
The mixed nature of this seemingly good news comes from the reason for CBO’s more optimistic budget projection: it’s because they think the program will cover fewer people than they previously projected. There had always been a fear among states that lots of people who were already eligible for Medicaid—but had never bothered applying for it—would hear the Obamacare hoopla and “come out of the woodwork” to claim benefits. Since these folks weren’t technically part of the expansion, states would be on the hook to cover the bulk of their costs.
CBO now believes this fear was overblown. Apparently most people who didn’t bother with Medicaid before Obamacare took effect aren’t going to bother with it now either. That’s good for state budgets, but obviously not so good for all the people who could be getting medical care but aren’t.
For what it’s worth, this is a tradeoff we’re going to see a lot of. Unless the actual cost of medical care comes down, the budget impact of Obamacare is always going to depend on how many people benefit from it. If lots of people sign up, that’s good for public health but costly for taxpayers. If fewer people sign up, then government spending goes down but fewer people receive medical care. There aren’t very many ways around this iron law.
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If you have a good memory, you may recall that a couple of years ago I had an unexpectedly positive reaction to Paul Ryan’s latest Medicare reform plan. His 2013 edition was still based on premium support (i.e., vouchers), but he’d made some changes. Instead of simply capping the vouchers at the rate of overall inflation, which wouldn’t come close to keeping up with medical costs, Ryan proposed that insurers would bid for Medicare business. Vouchers would be set at the cost of the second-lowest bid, and seniors could use their vouchers to buy into traditional Medicare if they preferred.
Not bad. In fact, it was basically Obamacare with a public option. But there were still problems. Ryan kept his inflation-based cap, which suggested he didn’t really believe in the power of competition after all, and seniors would still end up paying more under his plan than they do now.
But over at TPM, Sahil Kapur points out something I missed: Ryan’s 2014 Medicare plan is different still. The voucher is now based on the average bid, not the second-lowest bid, and the inflation cap is gone. The market will either produce savings or it won’t.
That’s good news. But it also goes to show the difficulty of truly reforming Medicare, especially if you don’t tackle the broader problems of health care costs at the same time. The CBO has analyzed the effect of Ryan’s 2014 changes, and they conclude that by 2020 the Ryan plan would save a grand total of $15 billion per year. That’s 2 percent of net Medicare spending.
Now, this is nothing to sneeze at. Savings are savings. However, like the cost containment proposals that are part of Obamacare, this represents a highly speculative estimate. We might get the 2 percent, we might get nothing.
The bottom line is this: Without root-and-branch changes to our health care system, you’re simply not going to get big cost savings. If you make radical changes, as Ryan originally tried to do, it comes out of the pockets of seniors. If you keep seniors whole, you’re going to get small savings at best. Ryan’s 2014 plan might be a good one, but is it worth the experiment for such a small and questionable payback? Hard to say.
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Two abortion providers sued a Dallas hospital on Thursday, after the hospital revoked their admitting privileges. Because Texas law now requires doctors who perform abortions to have admitting privileges at a local hospital, the revocation would mean that these doctors could no longer legally perform abortions. In a letter to the doctors, Chuck Schuetz, CEO of University General Hospital–Dallas, said they were disrupting the hospital’s “business and the reputation” by providing abortions at their own facilities miles away. The lawsuit filed by the doctors, Lamar Robinson and Jasbir Ahluwalia, contends that the hospital discriminated against them because they perform abortions.
Last month, anti-abortion rights activists announced plans to hold a demonstration outside the hospital to protest its association with Robinson. But on March 31, the day before the protest was to take place, Schuetz canceled the doctors’ admitting privileges. “Your practice of voluntary interruption of pregnancies…creates significant exposure and damages to UGHD’s reputation within the community,” Schuetz wrote to Robinson and and Ahluwalia. In the letter, Schuetz characterized providing abortions as “disruptive behavior.” He claimed that the hospital was not equipped to treat complications related to abortion and that the doctors were increasing “the probability of malpractice.” Robinson and Ahluwalia allege that Schuetz yielded to pressure from anti-abortion rights activists, promising them the hospital would be “pro-life” and not associate with abortion doctors.
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Lawsuit: Texas Hospital Caved to Anti-Abortion Activists’ Demands
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The open enrollment period for Obamacare is finally (almost) over, and today the White House announced the final figures for signups via the exchanges:
8 million people signed up for private insurance in the Health Insurance Marketplace. For states that have Federally-Facilitated Marketplaces, 35 percent of those who signed up are under 35 years old, and 28 percent are between 18 and 34 years old, virtually the same youth percentage that signed up in Massachusetts in its first year of health reform.
That’s a little better than I expected. I was figuring the final number would be around 7.7 million or so. We Americans sure do like to procrastinate, don’t we?
Anyway, once some of these new enrollees drop out for not paying their premiums, the final number will be around 7 million, which matches the CBO’s original estimate—the one they made before the website debacle. That’s pretty amazing. It suggests that either the CBO was overly pessimistic or else that the website problems really didn’t have any effect at all. I suppose the latter is plausible if you assume that hardly anyone was ever going to sign up in the first couple of months anyway.
And the 28 percent number for young enrollees is pretty good too. It’s below the administration’s goal, but Jon Cohn points out that what really matters is whether it matches what insurance companies expected:
The worry has always been that older and sicker people would sign up in unusually high numbers, forcing insurers to raise their prices next year and beyond.
But insurance companies didn’t expect young people to sign up in proportion to their numbers in the population. They knew participation would be a bit lower and they set premiums accordingly. Only company officials know exactly what they were projecting—that’s proprietary information—but one good metric is the signup rate in Massachusetts, in 2007, when that state had open enrollment for its version of the same reforms. According to information provided by Jonathan Gruber, the MIT economist and reform architect, 28.3 percent of Massachusetts enrollees were ages 19 to 34, a comparable age group.
So what were insurance companies expecting? As Cohn says, we don’t know for sure, but there’s good reason to think that it was around 28 percent. First, there’s the Massachusetts precedent. And second, we learned yesterday that insurance companies are now expected to raise premiums a modest 7 percent next year. This suggests that that the age and health profile of exchange enrollees is pretty close to their projections.
All in all, another day of pretty good news for Obamacare.
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Last week, an 18-year-old bartender in North Yorkshire, England, was serving drinks when a colleague’s electronic cigarette exploded, setting the bartender’s dress on fire. This was not the first reported incident of an e-cigarette exploding—over the past few years, there have been more than a dozen similar reports.
Specifically, it’s e-cigarettes’ lithium-ion batteries that combust. These batteries are also found in laptops and cellphones. But with e-cigarettes, the batteries are especially prone to overheating because smokers use incompatible chargers, overcharge the e-cigarettes, or don’t take sufficient safety precautions. For example, many e-cigarettes are made to plug into a USB port, which smokers may take to mean the devices can be safely charged with a computer or iPad charger. But if left too long in a common USB port, some e-cigarette batteries can fry.
The industry acknowledges that explosions are a possibility. “I’m aware of 10 failures in the last year,” Thomas Kiklas, who represents the Tobacco Vapor Electronic Cigarette Association, told NBC Chicago last October. “When you charge them, they are 99.9 percent safe, but occasionally there will be failures.”
The Food and Drug Administration, which oversees tobacco products, does not currently regulate e-cigarettes. An FDA spokesperson says the agency is working to change that.
Here is a brief history of notable e-cigarette explosions and fires:
Niceville, Florida, February 2012
A 57-year-old Vietnam veteran was smoking an e-cigarette when it exploded in his face, knocking out his teeth and part of his tongue, according to ABC News. A fire chief told the news outlet that the accident was most likely caused by a faulty lithium battery, which exploded like a “bottle rocket.”
Muskogee, Oklahoma, April 2012
Shona Bear Clark bought an NJOY e-cigarette from Walmart to help her cut back on smoking half a pack a day. Clark says it exploded when she tried to remove it from its package. “It was as loud as firing a gun, but a gun fired right in your face,” she recalled.
Corona, California, March 2013
Jennifer Ries and her husband, Xavier, were driving to the airport, with their VapCigs e-cig charging in the car. “I looked around and I saw the battery to the e-cigarette dripping,” she told CBS Los Angeles. “I went to unscrew it and the battery started shooting fire toward me and then exploded and shot the metal pieces onto my lap…A blowtorch type of fire and then an explosion.” Ries suffered second-degree burns, and the the couple later sued the e-cig manufacturer.
Tulsa, Oklahoma, June 2013
Kyle Czeschin’s e-cig was plugged into his laptop. Guess what happened next? “Everything was on fire, my laptop was on fire, my lamp was on fire, the shades,” he told News On 6.
Sherman, Texas, July 2013
Wes Sloan wanted to kick his habit, so bought what he assumed would be a safer, electric alternative to cigarettes. “The battery was into about a two-hour charge and it exploded and shot across the room like a Roman candle,” he said. Sloan was charging the e-cig in the USB port of a Macbook. He says he suffered second- and third-degree burns, and that he and his wife, Cathy, were treated for smoke inhalation.
Mount Pleasant, Utah, September 2013
A Utah mom was charging her e-cigarette in her car when she said there was “a big bang, and kind of a flash, and smoke everywhere,” according to Fox 13 News. The e-cigarette reportedly released a hot copper coil that landed in her son’s car seat, burning the boy. The mom was finally able to put the fire out with an iced coffee. A fire marshal told the news outlet that the mom’s charger was standard and factory-issued, and it was a “catastrophic failure of the device.” He also noted this was the second e-cigarette explosion he’d investigated recently in the region.
Atlanta, September 2013
A woman in Grant Park plugged her e-cigarette into her computer to charge it, according to WSB-TV Atlanta. Fortunately, she was home when she says it began to shoot four-foot flames across the living room. (A screenshot in the above link shows the rag that the woman used to unplug the e-cigarette as it was burning.) “If I hadn’t had been home, I would have lost my dogs, I would have lost my cats, I would have lost my house,” she told the news station.
La Crosse, Wisconsin, September 2013
The La Crosse Fire Department explains how they’re learning to deal with e-cig fires:
Blaine, Minnesota, October 2013
A man was charging his e-cigarette through his computer when his wife noticed that it was “sparking like a fountain firework,” according to KMSP Fox 9. The device then “shot out like a missile” from the computer, she said. The owner of a nearby e-cigarette business told the news outlet that the battery didn’t have overcharge protection, and that’s likely why it overheated.
Kootenai County, Idaho, November 2013
An e-cigarette started a fire in an Idaho household’s living room while the family of four slept. The device, which was charging through a laptop, overheated and exploded. “If that smoke alarm didn’t go off, none of us would have woken up, you know, none of us would have been able to get to the door, ’cause it would have been blocked by the flames and we would have all died,” the son said.
Queen Creek, Arizona, November 2013
Just four days after Kyler Lawson bought his Crown Seven Gladiator e-cigarette, it exploded while charging. “It shot out like a bullet, hit the window, dropped from the window to the carpet,” he said. “Caught the carpet on fire…If you’re going to charge it, be there. Be present when you’re charging it because you never know what can happen.”
Eugene, Oregon, November 2013
Judy Timmons had been charging her e-cig in her car for two hours when it exploded. “I’m just glad my grandkids weren’t in the backseat because it could have exploded at any time,” she said. “It had enough power and momentum to shoot all the way to the backseat,” Larry, her husband, said.
Colorado Springs, Colorado, November 2013
A man in Colorado Springs was charging his e-cigarette when it exploded, setting his bed on fire, according to KRDO NewsChannel 13. He used a blanket to smother the flames, suffering burns on his body and face. The manufacturer of “Foos” e-cigarettes told the news outlet that this was the first time he’d heard of their products malfunctioning. The man said that nonetheless, “I’m back on normal cigarettes now.”
Sneads Ferry, North Carolina, January 2014
A North Carolina man who spent over 20 years working as a firefighter was injured after his e-cigarette exploded in his face. He described the incident to the Jacksonville Daily News as feeling like “a bunch of hot oil hit my face.” After spending the night in the hospital, the newspaper reported that he continues to suffer from the incident: “The bottom of his left eyeball is sensitive to light, hard to see out of, and will need to be looked at by an optometrist.”
Springfield, Missouri, January 2014
Last Christmas Eve, Chantz Mondragon was sitting in bed with his wife when his e-cig overheated and burst into flames. The device was charging via a USB port on his laptop. He described the explosion as “a searing hot blinding light like a magnesium sparkler, like whenever you see a person welding.” Mondragon also said the fire burned through his bed, and caused second-degree burns on his leg and foot.
North Yorkshire, England, April, 2014
Eighteen-year-old Laura Baty was serving a customer at the Buck Inn Hotel when her coworker’s charging e-cigarette exploded behind the bar. “I started crying hysterically and my arm was all black,” she told the Press. “My dress caught on fire as I ran away, and I just didn’t know what was happening.”
London, April 2014
A woman who used an incompatible charger to charge her e-cigarette caused a major fire that took about 40 minutes to get under control, according to the London Evening Standard. A member of the London Fire Brigade told the paper that, “As with all rechargeable electrical equipment, it’s vitally important that people use the correct type of charger for their e-cigs to prevent fires which can be serious and could even result in death.”
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Burt’s Buzz
EVERYDAY PICTURES/FILMBUFF
Jody Shapiro’s documentary profiles Burt Shavitz, the thick-bearded, staunchly frugal, middle-aged Maine beekeeper who cofounded Burt’s Bees, following his rise from hip 1960s photographer to the unlikely brand ambassador for a multimillion-dollar skin and body care empire. As a portrait of the compelling curmudgeon, Burt’s Buzz isn’t quite as penetrating as one might hope for. But it’s an oddly charming peek into the world of corporate celebrity through the lens of a guy who apparently wants nothing to do with it. “No one has ever accused me of being ambitious,” Shavitz says. And, of his intrusive fans: “I’d like to point the shotgun at them and tell them to be good or be gone.”
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Today brings yet another take on Obamacare from Rand’s latest survey of the health insurance market. Rand’s sample size is fairly small, so there are large error bars associated with their numbers, but they also break them down in interesting ways. The number we’ve been tracking most closely in the other surveys on insurance is the number of uninsured who got coverage via Medicaid or the exchanges, which Rand displays in the top row of this table:
About 5 million previously uninsured people got coverage via Medicaid and the exchanges. This is slightly lower than other estimates, but only slightly. When you account for the March surge and the sub-26ers on their parents policies, you’re probably back up to about 8 million. We’ll have a better idea about this next month, but so far this is roughly consistent with other surveys we’ve seen.
But there’s one stunning number in the Rand survey that we haven’t seen before: the dramatic surge in people who have employer insurance (ESI). According to Rand, 8.2 million new people—7.2 million of them previously uninsured—have gotten employer insurance since mid-2013. Adrianna McIntyre is agog:
I can’t overstate how stunning this finding is if it’s true; CBO expected that ESI gains and losses would pretty much break even in 2014 and that employer coverage would decline modestly in future years.
If it’s correct, it was probably motivated multiple factors—I hate the word “synergy” on principle, but it comes to mind. The economy has been improving, so some of the previously unemployed have secured jobs with benefits. But CBO built in expectations about economic recovery, so I don’t think it’s quite right to try pinning all (or even most?) of the 8.2 million on that. The individual mandate, while weak in its first year, might be a stronger stick than we expected, nudging people to take their health benefits where they’d previously been opting out. Employers could be helping this move this trend along; the University of Michigan, for example, eliminated “opt out dollars” in 2014 (cash compensation for employees who declined coverage).
If this finding is confirmed, it’s a genuine shocker. Although CBO projected that ESI would stay steady, there’s been a lot of chatter about the likelihood of employers dropping coverage thanks to Obamacare. But that sure doesn’t seem to have happened. So in addition to the usual sources of coverage—Medicaid, exchanges, sub-26ers—it looks like Obamacare has yet another big success story to tell, one that was almost completely unexpected.
For now, this should all be considered tentative. We’ll have firmer numbers in April and May, once the March surge is fully accounted for and we know how many people have paid for coverage. But for now, it looks as if Obamacare is not merely hitting its target, but in a broadly unforeseen way, it’s wildly exceeding it. This is terrific news.
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Here’s Some Stunning and Unexpected Good News About Obamacare
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