Obamacare is many things. One of which is an interesting natural experiment in determining whether states shooting themselves in the foot makes it harder or easier to walk than states that don’t shoot themselves in the foot.
When PPACA passed in March 2010, the basic cash flow model would have seen increased taxes (income tax surcharges, Cadillac plan taxes, medical devices, tanning tax etc) from richer and usually bluer states as well as Medicare Advantage clawbacks from a variety of places. The Medicare Advantage clawbacks would apply to everyone but areas with higher Medicare Advantage utilization would see greater net reductions. This money, either new from taxes or reprioritized from Medicare Advantage would then go pay for either Medicaid expansion or coverage/cost-sharing subsidies. Regions with very low pre-PPACA Medicaid eligibility thresholds and high uninsured populations such as Mississippi would see more new Federal money than states with high Medicaid thresholds and low uninsured populations like Massachusetts. Massachusetts would pay more and proportionally get less back. That is expected, it is how every single social welfare program in this country works.
There are two natural experiments in action now and a future potential experiment in cash flow modeling from a regional economic activity perspective. The first natural experiment was provided by the assholes on the Supreme Court that said the Medicaid expansion deal was too good of a deal for states to pass up and therefore it was coercive and therefore it had to be voluntary without penalty. This is producing the natural experiment of Expansion states and non-Expansion states. Unsurprisingly states that expanded Medicaid are seeing uninsured rates drop dramatically as well as more robust local economy as they are now receiving an “export” cash flow of .5 to 1% of gross state product from the federal government. That will spin out to four or five local jobs in “secondary” industries from each job in healthcare that is being created or sustained by Medicaid expansion. Non-expansion states are seeing cash outflows in increased taxes or lower Medicare Advantage payment rates without any corresponding cash inflow. Their hospitals are still seeing high numbers of uninsured patients as other compensating funds have been cut. They are in trouble.
The second natural experiment is the ongoing differentiation in degrees of Exchange acceptance and resistance. Kentucky and West Virginia are states that don’t like Obamacare but they sure as hell like the Kynect Exchange or the Exchange website. There was political support to engage in massive outreach and get people health insurance even if certain names had to be elided to get people to sign up. On the other hand, Georgia engaged in massive resistance to navigator training and Florida attempted to keep outreach efforts from using any government (state or local) building. States with high Exchange penetration rates should see more money returned to their states in the form of subsidies than states that actively obstructed.
Finally, if Halbig is upheld by the Supreme Assholes, we’ll quickly see half the states that would be screwed do the Gaba two-step of buying a new web domain name to use as a splash page and then getting the summer IT intern redirecting visitors from that splashpage to Healthcare.gov. These states would see no change, while the Confederacy and Great Plains Republican base states would take multi-billion dollar hits in order to save $200 for a domain and a redirect.
Again, we’ll get a nice real world validation of import-export economic development modeling thanks to assholes on the Supreme Court and bullshit peddlers like Addler and Cannon.
Baud
Sociologists must love Obamacare.
Richard Mayhew
@Baud: It will produce massive data for thousands of dissertations yet to come in a variety of fields.
PaulW
@Baud:
The next ten years will see an increase in sociology peer-reviewed articles, true that.
Iowa Old Lady
It’s like there’s actual justice. You’re upsetting my world view.
JGabriel
@Iowa Old Lady:
If it’s any consolation, this is more like karma than justice. Justice is meted out by people, karma is the consequence (whether it’s cosmic, logical, or just a deity’s whim) of one’s own self-selected decisions and actions.
JGabriel
Richard Mayhew @ Top:
Democrats are to silver linings as Republicans are to shitstorms.
Richard Mayhew
@JGabriel: It is either that or not get out of bed this morning.
greennotGreen
Thus sayeth master of understatement Richard Mayhew.
The medical center where I work is in a non-expansion state and has been hit hard. I have wondered why the state had failed to expand Medicaid since it was 1) such an obvious financial winner and 2) so much in my behemoth medical center’ sad vantage that they must be putting some serious pressure on the governor. But it didn’t happen and I think there are at least two reasons: our legislature is bat-shit insane and the governor is near brain-dead, and because my behemoth medical center is being run by Republicans. While the board and the administration haven’t announced their political affiliations, it seems obvious in their response to the crisis: hire consultants to tell them who to lay off, lay off a bunch of lower level people, give promotions to a bunch of higher level people. It’s working great! Morale has never been lower! And just think how many fewer medical advances we’ll be making as faculty head for more welcoming institutions!
MomSense
I remember years ago my grandmother telling me about all the fuss around Social Security and later Medicare and I thought it was all the fear mongering was so crazy that must have only been possible in an environment where people didn’t have access to accurate information.
Ha! I was so wrong. When one of the major journalists for the network supposedly most supportive of the President didn’t think it was the media’s job to correct falsehoods but the President’s fault for not selling it, we were doomed from the start.
The thing that makes me so angry about this is that I keep meeting people who never bothered to even find out if they could get health insurance on the exchange because they had heard how unaffordable and bad it was. Now these people are dealing with major medical issues and are completely screwed.
There is no accountability in journalism. The reporters and pundits who got everything so wrong continue to have a platform.
greennotGreen
Weird. I couldn’t edit the previous comment, but I can edit this one. Of course I meant, “center’s advantage.”
JGabriel
@Richard Mayhew:
Heh. A dilemma I struggle with everyday.
JPL
@greennotGreen: Awhile back the local news stations blamed Obamacare for closing down hospitals in rural areas, rather than the Governor who chose not to accept federal funds to expand medicaid. At least in the south we have the freedom to be ranked last in access to quality health care.
Cervantes
@Iowa Old Lady: Justice, if you don’t count what’s happening to the people who need health care and health insurance.
Cervantes
Richard, our heroes Adler and Cannon need to be stopped. I know people are trying. Have you seen a good take-down? Or rather, what’s the most comprehensive rebuttal of their sophistry that you’ve seen? (Thanks.)
the Conster
@MomSense:
I watched a table full of pundits on Morning Joe a year or more ago, complaining about how much misinformation there was about what was in the law, and how it was Obama’s fault. My first thought was, gee, too bad there isn’t a nationally broadcast show that has 3 hours every morning with nationally known talking heads to educate people. The lack of both self-awareness and any sense of responsibility towards the electorate blew my gaskets.
Cervantes
@the Conster: Their responsibility is first to themselves, then to the corporate owners, then indirectly to the advertisers. Period.
People who don’t understand this really, for their own sake, shouldn’t be watching them.
Richard Mayhew
@Cervantes: I ask the FSM for strategically aimed meteors. The take-downs are professional reputational takedowns. One of the leagues I referee in is the regional bar association rec soccer league. I was able to talk to a player who is an admin law prof at a T-14 school and his comment was that the Adler/Cannon argument if presented to him at the end of the semester by a 2L would lead to a nice cup of coffee with the student and a friendly suggestion that maybe administrative law should not be the student’s future specialization.
But Adler and Cannon are on wingnut welfare and/or tenure so embarrassment is not a deterrant from blowing their reputations in the service of neo-feudalism.
Juju
@greennotGreen: Are you in NC?
greennotGreen
@Juju: No, but close!
Xantar
@MomSense:
In my fantasies, I sometimes imagine FactCheck.org turning its sights on pundits and journalists instead of politicians. Of course, the problem there is some spew out so many objectively false claims that no amount of paid staff would be able to keep up with it all. Also, FactCheck.org would probably start making some offhand statement by Rachel Maddow into the Lie of the Year in order to appear balanced.
ruemara
The whole situation in this country is terrifying to someone like me, with chronic illness. Between age, future prospects and this, I am not sure how much more of the bullshit that this existence is I can take.
Steeplejack (phone)
Is the site messed up? Crickets.
C’mon, people. I’m waiting to pick up someone at the Metro, and I need reading fodder. Rumor, invective, anything.
PurpleGirl
@Steeplejack (phone): Lol. It’s humid and hot and I guess everyone is tired. Maybe even bored. But I know what you mean, I’m going back and forth between here, a kitten cam and a jigsaw puzzle site. (I also just turned on the AC.)
kc
@greennotGreen:
SC? That’s where I live. I’m livid at the dumb-assery at work here.
Steeplejack (phone)
@PurpleGirl:
I’m so hooked that I don’t even want to read other sites. It’s the Juice or nothing!
Guess I’ll see if I can find a tutorial on “track changes” in Word. Got an editing gig coming up with the Anal Retentive Writer.
piratedan
the other shoe is the economic repercussions as people migrate when and where they can if there continues to be a stark contrast between what kind of healthcare benefits you can receive. If there are some people who have any means at all, they’ll start relocating to bluer states (and I can understand that) but the reaction of just making red states, redder and more inclined to be noseless after all of the budgetary cuts that require their smelling organs to be sacrificed. I’m with cervantes, while there’s some schadenfreude to be had, we’re still talking about millions of our fellow citizens that need/deserve healthcare, left behind and the GOP essentially cares fuckall about them as long as they can continue to count these hypothetical political coup.
JPL
@PurpleGirl: The New Yorker has jigsaw puzzles of their covers.
Iowa Old Lady
@JGabriel: Yeah, karma is a better word.
@Cervantes: True that.
MomSense
@the Conster: @Cervantes:
It is clear to me that the corporate media do not see their function as providing accurate information to the public so that we can make informed decisions. Their mission is definitely not to serve the public good. I think Cervantes is right and they are just serving the agenda of the corporations that (not people dammit!) own them.
MomSense
@Xantar:
Maybe we could ask Steve to approve running a daily point and mock at shitty media thread so we can report on all the lies we are hearing from journalists and pundits.
John M. Burt
@ruemara: I’m so sorry that your health care situation is so difficult. My own life sometimes feels like a perfect disaster, but I really have a lot to be thankful for, and one of them is being married to a retired mail carrier, and thus being able to say to any insurance salesperson who offers to provide me with much better coverage, “We-ell, my wife’s a Fed….”
gene108
@JGabriel:
The one thing I learned, from the 1988 Presidential election, when I was young teenager was that if you can’t fit your pitch on a bumper sticker no one is going to remember it.
“It’s the economy, stupid”
“Hope and Change”
“Morning in America”
The one exception is “Are you better off now, than you were four years ago?” connected with voters, though a bit wordy.
People are not going to understand “import-export” whatever-it-is, so it does not help Democrats.
currants
@Richard Mayhew: @Cervantes:
I saw one yesterday, and cannot locate it right now. Could have been LGM (Scott Lemieux I think) or Digby? Someone also linked to Balkinization but I don’t think that was the piece I read (that’s mostly about the decision, and what I read was specifically about the errors in Adler’s amicus, which were substantive and which he knew about in advance–and which makes his failure to withdraw the brief even more egregious (or telling, depending on your POV).
gene108
@the Conster:
Seems like the role of the MSM, since the Clinton years, has been to cheer on Republican abuses of information (i.e. lies) and laugh, when a Democrat cannot counter them.
It’s sort of like a bully who grabs your arm, twists it around and says “why don’t you stop hitting yourself” and everyone around views it as your fault for not being able break out of the hold.
The MSM are the crowd laughing at the kid getting beat up.
currants
@currants: Hah. Gee, wonder where I read that. https://balloon-juice.com/2014/07/22/en-bancing-on-halbig-and-general-assholery/
GAH. Apologies, Richard.
jayjaybear
@piratedan: It’s more evidence that the GOP has become the party for sociopaths. “If it’s not happening to me, it’s not happening.” Millions of people without healthcare doesn’t matter to the GOP folks at the top, and it doesn’t matter to the GOP base because “We don’t have healthcare…why should anyone else?!” Never underestimate the sheer bloody-mindedness of a crab in a barrel who sees fellow crabs somehow escaping.
Cervantes
@gene108: Speaking of the 1988 election, “Read my lips: No new taxes” should be on your list.
Unluckily for Bush, people “understood” his bumper-sticker pitch only too well.
(PS: I did not ever criticize him for breaking that “pledge,” only for making such an irresponsible statement in the first place. The Right skewered him for doing the responsible thing re taxes and he bloody well deserved it.)
Richard Mayhew
@currants: Linked in previous thread :) Via Balkinization
Richard Mayhew
@gene108: I agree, import export modeling with REMI multipliers won’t fit on a bumper sticker, this is high wonkery to mid-wankery as I fell asleep last night to thunderstorms and memories of being a young grad student learning about import-export local economic modeling for the first time…
JustRuss
While I agree with all Mayhew’s points, I doubt if it will matter, in the short term at least. Conservatives’ one true superpower is to ignore any fact that contradicts their world view. Just look at the original ACA “debate”, when they (and I include most our media) studiously ignored the fact that most civilized countries have already dealt with healthcare, and quite successfully in most cases.
Sure, this will make fascinating material for studies and academia. Fox viewers will never see any of it, except cherry-picked horror stories about soshalized helth care.
Cervantes
@currants: Thanks. Yes, I saw Richard’s previous article. It was good. What I am looking for is exactly that sort of analysis but more comprehensive, tackling most or all of their productions on this subject. Or a compendium of such analyses.
It is true that they — I mean Adler and Cannon, of course — are both secure at Case Western and Cato, respectively — and that they have collaborators in some precincts of the judiciary — and that, in the current media environment, they will not be embarrassed into oblivion.
(Eppur si muove.)
Barry
@Steeplejack (phone): “Guess I’ll see if I can find a tutorial on “track changes” in Word. Got an editing gig coming up with the Anal Retentive Writer. ”
Some things I’ve learned:
1) Sometimes ‘track changes’ doesn’t stay turned off and when you send somebody a document they see all of the crud and comments. Send it in PDF.
2) It’s only good for two or three people. After that, it’s a nightmare and you can’t read anything.
3) When you’re updating tables, it’s a visual nightmare.
piratedan
@jayjaybear: bloody mindedness is right, it’s simply strange that their ideas and concepts only pertain to what is inside their box, you try and extrapolate that into a scenario that isn’t of their own making or definition, well then you get a whole different set of labels and designations thrown at you.
Cervantes
The Bureau of Labor Statistics released a report last week: “REGIONAL AND STATE EMPLOYMENT AND UNEMPLOYMENT — JUNE 2014.”
Christopher Rugaber (and colleagues at the Associated Press) took a look:
A good indication — but by itself it proves nothing, of course, except that our right-wing propaganda-mills must be grinding away again to come up with “new” critiques.
Emma
@JustRuss: We have to simply write off Fox viewers. They can’t be convinced or even reached. Those who walk out of the thickets will only do it like John did, on their own and using their own brains.
burnspbesq
I don’t know whether it’s fair to tar Adler and Cannon with the same brush. I still think that the difference between “smart but misguided” and “a fucking sociopath” is meaningful.
scav
@Richard Mayhew: Ahhhhhhhhhhhhhh you reveal your Zozialist Marx-influenced dreams with your Leontief musings, with a apéritif of French tableax, comerade! and that was some entirely fortuitous pulling of distant grad student memories in itself — the first introduction made us invert a matrix by hand for some neferious reason. REMI is ringing no bells, how are they different from those basic multipliers of long ago?
piratedan
@burnspbesq: that may be true, but these guys even admitted that they made a mistake in their own brief, allegedly invalidating it and essentially said “fuck it” and submitted it anyway, so I can understand the sociopathic allegations….
Cervantes
@piratedan: One of them admitted making that mistake. He apologized to the other. And they both proceeded, anyway, because, according to them, the mistake was not significant (i. e., they said it did not affect the strength of their argument).
scav
@scav: PS tracked down the basic REMI thing, mostly learned theory and longish ago at that. Now in post LQ delayed shock for some reason.
Roger Moore
@gene108:
Turning it into a slogan shouldn’t be that hard. “Everyone deserves affordable healthcare” seems like a decent start.
burnspbesq
@piratedan:
That was pretty (to use a technical legal term) skeevy. At a minimum, letters should have been written to both Courts of Appeal, fessing up to the “mistake” (if indeed that’s what it was, a point on which I am rather skeptical).
piratedan
@Cervantes: so a non-apology apology?
burnspbesq
The Internets are being packed for shipment to Northwestern law school, courtesy of Drew Koppelman.
http://balkin.blogspot.com/2014/07/halbig-and-hurting-innocent-as.html
Roger Moore
@gene108:
No, they’re the sidekicks who hold the guy’s other arm behind his back.
Barry
@burnspbesq: “I don’t know whether it’s fair to tar Adler and Cannon with the same brush. I still think that the difference between “smart but misguided” and “a fucking sociopath” is meaningful. ”
Except you have to say ‘smart, but misguided, and ignoring reality again and again and again and again…..’
Which, in the end, boils down to ‘a ‘fucking sociopath’.
burnspbesq
@Barry:
My sense of Adler is that when his position loses, he will (grudgingly) accept that he was wrong, because that’s what smart lawyers do when they lose. Cannon will immediately look for a new way to fuck millions of low and moderate income Americans, because that’s his mission.
Cervantes
@burnspbesq:
Well, leaving aside for now the trivial question of who is which, would you agree that someone who is “smart but misguided” can be corrected?
burnspbesq
@Cervantes:
One would hope. See comment 57.
Richard Mayhew
@scav: They are just a particular brand of multipliers that one of my professors loved, so they were the ones I got to play with for eighteen months on a couple of cool questions.
Cervantes
@burnspbesq: Yet if he is “smart but misguided,” why should it take a defeat to correct him? Verb. sap. and all that, no?
burnspbesq
@Cervantes:
Rule 78 of the Ferengi Rules of Professional Conduct:
“A creative argument isn’t wrong until an appellate court says it’s wrong.”
And don’t forget the Commentary to Rule 66:
“We have appellate courts for a reason, and the reason is that trial courts fuck up.”
Cervantes
@burnspbesq: To me, “Ferengi” sounds a lot more like “sociopath” than “smart but misguided.”
Sister Machine Gun of Quiet Harmony
No no no. You are failing Basic Wingnut. They will counter this by talking about terrible people who don’t take care of themselves and expect the tax payer to pick up the tab. You need something more like, “Everyone needs affordable healthcare.” That is slightly harder to counter.
rikyrah
You can always count on Working Whites to go against their own economic self-interest.
…………………………
The Ruling That Would Gut Obamacare Is an Amazing Advertisement for Obamacare
By Jordan Weissmann
Much of the case rests on the complaints of one David Klemencic, a West Virginia man who says he doesn’t want to buy health insurance, and that were it not for the government’s generous subsidies, he wouldn’t have to. Below is how the court describes his predicament:
The district court determined that at least one of the appellants, David Klemencic, has standing. Klemencic resides in West Virginia, a state that did not establish its own Exchange, and expects to earn approximately $20,000 this year. He avers that he does not wish to purchase health insurance and that, but for federal credits, he would be exempt from the individual mandate because the unsubsidized cost of coverage would exceed eight percent of his income. The availability of credits on West Virginia’s federal Exchange therefore confronts Klemencic with a choice he’d rather avoid: purchase health insurance at a subsidized cost of less than $21 per year or pay a somewhat greater tax penalty.
Let’s spell that out: This lawsuit has been brought by a man who, thanks to Obamacare’s subsidies, could purchase health insurance for $21 per year. That’s about the cost of a 750 of Jack Daniel’s or a hardcover novel. I guess you can’t accuse Klemencic of putting self-interest ahead of his principles.
http://www.slate.com/blogs/moneybox/2014/07/22/obamacare_subsidies_struck_down_ironically_the_ruling_is_a_great_advertisement.html
burnspbesq
@Cervantes:
Outsourcing this reply to Foghorn Leghorn:
“Thassa joke, son.”
Mnemosyne
@rikyrah:
Conservative white dudes are always convinced that they did everything themselves and it’s only the government propping up black and brown folks that are the reason for their lack of success. It’s a disease.
Cervantes
@burnspbesq: I know, and so was my response, even if it was barbed.
Anyway, to me, “misguided” implies a certain innocence, which I am at this point unable to see in Adler.
JustRuss
@rikyrah: “If I get sick I deserve to die because my crappy job doesn’t pay me enough to afford health insurance in a free market” is an ethos, I guess.
Gex
Halbig and hurting the innocent as a political tactic – Andrew Koppelman
His closing graph includes facts not yet in evidence I think. (Emphasis mine)
“The Republicans increasingly are officially committed to the view that, if you get sick and you can’t pay for it, that’s your tough luck. They are, for the most part, decent people who don’t really mean that. They should stop saying it.”
People on the right have said this same thing over and over for years and years on issue after issue. I think he’s wrong to assume that they don’t mean it when they will go to such ridiculous ends to make sure that what they say should happen actually happens. I mean, we saw them CHEER at the idea that that one man should die for lack of health care in a primary debate. They couldn’t be any clearer than that.
gene108
@Roger Moore:
“Everyone deserves affordable healthcare”, has been tried as a slogan since Harry Truman.
It gets met with “socialized medicine” and that line Reagan had in his anti-Medicare rant, back in the 1960’s, about grandparents telling their grandkids about being free in America, because Medicare had been made into law.
The best explanation I’ve heard in the difference between the U.S. and Europe is our racial / ethnic divisions that are not as stark in Western Europe.
A western European sees a countryman on hard times and thinks, “but there for the grace of God go I”.
An American a countryman on hard times and thinks the [fill in blank] is from a lazy no good people and would squander whatever help I give him.
Cervantes
@efgoldman: But is it your impression that there are no progressives who vote in, say, Georgia? If you acknowledge their existence, you have to acknowledge that they get punished when other people out-vote them. What credit or blame do you think they should take?
Steeplejack
@Barry:
Thanks for the advice. I think I’ll be okay. It’s just one person, the writer, who is doing a family history for a businessman client, with maybe a little kibitzing from the book designer/typographer. The writer wants the copy edited and spruced up, but he is such a control freak that he wants to track every specific thing that I change. But there won’t be a lot of backing and forthing. I’m planning to do only the one pass. If the writer disagrees with a change of mine, that’s fine. It’s his baby, and he’s the one who has to get it approved by the client, so he can have it however he wants it. I won’t be hitting him over the head with the Chicago Manual of Style or any other stylebook, but I’m sure I’ll be gritting my teeth at times.
Although I am a Word meister, I’ve never had occasion to use “track changes” for longer than just to see roughly how it worked years ago—and it worked very roughly—so I’m looking forward to giving it a real workout, secure in the knowledge that it will no doubt exhibit the good design and friendly user interface that have been Word’s hallmark since about Office 2003. (We’re using 2010 for this project.)
ETA: And no tables that I know of!
Steeplejack
@burnspbesq:
Which is which?
ETA: Okay, I think I get it from the further comments.
BubbaDave
@gene108:
“Blue states are richer. Red states are poorer. Let’s keep America blue.”
Fred Fnord
@Richard Mayhew: Criminal psychology.
Forensics.
Oh, and it will help a lot to improve the flow of cadavers into our med schools.
JM
@MomSense: My mother is like this, and what makes it especially tragic is that she refused to even look at Marketplace plans not out of blind visceral hatred of Obama, but rather because she’s afraid of change and let her insurance company tell her that, despite how she’s been living off of the savings of her deceased husband (my father…died in 2003) and only sporadic work as an adjunct professor, she “makes too much money” to qualify for a Marketplace plan and she should stick with the company that’s gouging her instead.
cosima
I just got off the phone with my cousin in New York and needed some BJ-Richard fix bad!
My cousin lost his job a year ago — he lives in a rural area of NY that might as well be in Mississippi or something. Anyway, since then they’ve been stringing him along, telling him “just another month we can take you back” so he’s not committed to any other job and is doing part-time stuff with no benefits. Well, tonight he told me that his friend who still works at Company Jerksaround says they can’t hire him or anyone else because all of the jobs are being moved to Texas and Obamacare! That was after he read me the letter from the doc’s office saying he really needs to have some tests done because the doc wants to rule out cancer. He says he can’t get Medicaid (historical issues with them that I think can’t be legally valid, but who knows maybe they can), and he said “I’m sure as $%#@ not getting Obamacare!”
I said “what, no AetnaCare, BlueCrossCare, WhoeverCare? What’s this Obamacare thing you’re talking about? You mean the Affordable Care Act?” I don’t want to re-hash the name issue here – it started a huge row back a while ago, but I will say that I’m not surprised that it remains pervasive and a point of contention.
What I would appreciate from BJers, though, is any info you may have about the ACA experience in NY. I sent my aunt a link to the website with phone numbers and asked her to phone them to get info because my cousin surely won’t do it. I sent my cousin the irs.gov page that talks about large vs. small employers (Company Jerkaround has about 12 full-time employees) to debunk that whole “we’re being taxed by Obamacare so we have to raise your insurance rates/lay you off/shut down/etc.”
What else can I give my cousin — who may or may not have cancer, for eff’s sake — that can tip the scales?
Oh yes, I did tell him to stop watching so damned much Fox and listening to the idiots in that crazy corner of NY. Not that that will do much good.