Thursday, June 25, 2015

Thursday, June 25, 2015

Supreme Court upholds ACA subsidies; Jindal’s presidential bid hindered by bad policy; Medicaid coverage on par with private coverage and; After the flag comes down

Supreme Court upholds ACA subsidies

The U.S. Supreme Court upheld a key tenet of the Affordable Care Act this morning, ruling in a 6-3 decision that the federal government can continue to subsidize health policies in states such as Louisiana that refused to set up their own insurance marketplaces. The New York Times has the story:


The case concerned a central part of the Affordable Care Act, Mr. Obama’s signature legislative achievement. The law created marketplaces, known as exchanges, to allow people who lack insurance to shop for individual health plans.Some states set up their own exchanges, but about three dozen allowed the federal government to step in to run them. Across the nation, about 85 percent of customers using the exchanges qualify for subsidies to help pay for coverage, based on their income.The question in the case, King v. Burwell, No. 14-114, was what to make of a phrase in the law that seems to say the subsidies are available only to people buying insurance on “an exchange established by the state.”


Jindal’s presidential bid hindered by bad policy
Gov. Bobby Jindal formally kicked off his presidential campaign on Wednesday with a rally in Kenner and numerous polls that show him in the back of the presidential pack. The Washington Post’s editorial board says there’s a good reason why Jindal’s political star has fallen in recent years: bad policy choices.


To a party seen as too white and too reactionary, Mr. Jindal seemed to promise policy expertise and serious intellectual power. The result, however, has been a shambolic state budget. Louisiana’s leaders have had to scramble to fill a $1.6 billion shortfall. Lower oil prices haven’t helped the energy-producing state keep its accounts in order. But a major underlying driver has been Mr. Jindal’s deep tax cuts and unwillingness to raise enough revenue to pay for state spending needs. He has raided various parts of the budget — hospitals, universities, rainy-day funds — to shore things up, but that’s neither sustainable nor prudent.


Medicaid coverage on par with private coverage
A new study by the Commonwealth Fund finds that being covered by Medicaid health insurance is far preferable to having no coverage at all – and says the experience of those on the government-financed program for the poor is often comparable to those who have private insurance or Medicare. The findings refute critics’ charges that Medicaid is a “broken” program that shouldn’t be expanded.


The survey asked respondents about their access to preventive health services, perceived quality of care, the responsiveness of their providers, and whether their care was coordinated among providers. Medicaid enrollees were as likely as those with private insurance, and significantly more likely than uninsured adults, to report having a regular source of care (Exhibit 1).2 Medicaid enrollees rated the quality of their care as highly as privately insured adults, and significantly better than uninsured adults. When they were last sick and needed an appointment with a doctor or nurse, Medicaid enrollees were significantly more likely than those who were uninsured during the year to say they had been seen by a doctor or nurse the same or the next day, and nearly as likely as privately insured adults.3 The same pattern held for reports about how often medical staff were familiar with patients’ medical history and coordinated their care with other doctors; those with Medicaid reported better experiences than those who had lacked coverage during the year and statistically equivalent experiences to privately insured patients (Exhibit 2).


After the flag comes down

The New York Times’ Nicholas Kristof is glad that several Southern states, spurred by the racially-motivated slaughter of nine black churchgoers in Charleston last week, are finally removing the Confederate battle flag from public spaces.  But he writes that it’s only a symbolic start of what should be a larger effort to address systemic racial inequities that continue to plague America half a century after the Civil Rights era.


America’s greatest shame in 2015 is not a piece of cloth. It’s that a black boy has a life expectancy five years shorter than a white boy. It’s that the net worth of the average black household in 2011 was $6,314, compared with $110,500 for the average white household, according to census data. It’s that almost two-thirds of black children grow up in low-income families. It’s that more than one-third of inner-city black kids suffer lead poisoning (and thus often lifelong brain impairment), mostly from old lead paint in substandard housing. More consequential than that flag is our flawed system of school finance that perpetuates inequity. Black students in America are much less likely than whites to attend schools offering advanced science and math courses.


Number of the Day

$44,554,620 – Total monthly tax credit dollars that flow to Louisianans who buy health coverage through a federal health insurance exchange. The subsidies were upheld Thursday by the U.S. Supreme Court. (Source: Kaiser Family Foundation)