Wednesday, September 9, 2015

Wednesday, September 9, 2015

Obamacare is still working; The value of health insurance; College aid is upside-down; and No Easy Street


Obamacare is still working

It has been more than 2 ½ years since the Affordable Care Act took full effect. And to the chagrin of its critics, the sky has not fallen. What has fallen, dramatically, is the number of parents in America who are uninsured, according to a new report from the Urban Institute:


We find that the uninsurance rate for parents fell 5.8 percentage points…from 16.2 percent in September 2013 to 10.4 percent in March 2015…a decline of 35.6 percent. The trend of declining uninsurance among parents that we found in our earlier analysis continued during the ACA’s second open enrollment period … Particularly large percentage-point declines were found in the uninsurance rates for low-income parents and Hispanic parents, groups that have historically had higher rates of uninsurance… Between September 2013 and March 2015, the share of parents without insurance decreased 14.2 percentage points…among those targeted by the ACA’s Medicaid expansion (i.e., those with incomes at or below 138 percent of FPL) and 3.8 percentage points…among those targeted by the new subsidies for Marketplace coverage (i.e., those with incomes between 139 and 399 percent of FPL).


Unfortunately, many Louisianans are being left out because of the state’s refusal to expand Medicaid coverage. On a brighter note, new data from the U.S. Department of Health and Human Services confirms that moderate-income Louisianans are benefiting from Obamacare’s tax credit and insurance market reforms. Bruce Alpert with reports:


Nearly 142,000 Louisiana residents enrolled and paid for health care coverage under the Affordable Care Act, an increase of nearly 40 percent from 2014…Nationally, enrollment topped 9.9 million, which HHS said bested its goal of 9.1 million. The data reflects enrollments and paid premiums through June 30, 2015. In Louisiana, of the 141,740 who enrolled and paid for coverage, 90.7 percent qualified for income-based tax subsidies to lower their premiums. Nationally, 84 percent qualified for subsidies, with the higher percentage in Louisiana reflecting   larger percentages of low-wage families.


For more on who would benefit from Medicaid expansion in Louisiana, see LBP’s recent report celebrating Medicaid’s 50th anniversary.


The value of health insurance

What exactly are families getting when they gain health insurance? A lot, it turns out. Having health coverage doesn’t just protect against bankruptcy due to medical bills, but really does improve health outcomes–even if some coverage opponents are misreading studies to conclude the opposite. Carolyn Johnson with the Washington Post sums up the research:


A study published Tuesday in Health Affairs reports new evidence of health insurance’s salutary effects on chronic disease, quantifying those effects down to changes in blood sugar control, blood pressure and a slight drop in cholesterol. Expanding coverage to half the number of non-elderly uninsured people, the authors estimate, will mean 1.5 million additional people will be diagnosed with chronic diseases and 659,000 will gain control of their illness…A study of the aftermath of insurance expansion due to health care reform in Massachusetts found that among people between 20 and 64 years of age, there was a significant drop in mortality: 8 fewer deaths per 100,000 adults…Research examining the expansion of Medicaid to pregnant women in the 1980s and 90s found that insurance coverage was associated with less infant and child mortality.


It also turns out that the type of health coverage matters less than having it at all:


“Being on Medicaid is better than being uninsured,” said Katherine Baicker, a professor of health economics at the Harvard Chan School of Public Health.

College aid is upside-down

Writing in the New York Times magazine, Adam Davidson of NPR’s Planet Money tackles what’s really behind rising college tuition. Davidson explains how rising tuition at elite universities paired with more generous financial aid may counter-intuitively increase access for lower-income students and details how cuts to public colleges have increased financial burdens on families. His conclusion –  condemning our misallocation of resources – is spot on:  


Considered as a whole, it is a bizarre system. Students who go to private nonprofit schools, disproportionately children of middle-class and wealthy parents with college educations, receive an average of $25,000 a year in aid. Those who go to less-selective public schools receive an average of $13,500 a year. And students who attend public community colleges, who are most likely to come from disadvantaged backgrounds and parents without college degrees, receive an average of $8,000 a year. In other words, our system gives three times as much aid to the least needy as it gives to the most. This makes no economic sense: Once students drop out of community college, taxpayers will continue to pay their bills. That’s not called education funding; it’s called welfare or criminal-justice or health care expenditures. The difference is significant. In the language of economics, education funding is an investment; it more than pays back its initial costs over time. The other expenses are known as transfer payments; which means they make society poorer. In an economy that demands and rewards education, those who have it will pay the bills for those who don’t.


No Easy Street

Business interests in the Baton Rouge region have recently come together under the nom de guerre CRISIS (Capital Region Industry for Sustainable Infrastructure Solutions) to push for better transportation policy.  But words of encouragement won’t fix our broken roads, bridges and highways, writes The Advocate’s Lanny Keller. Improving Louisiana’s infrastructure is going to take money, and that means taxes:


CRISIS’ manifesto for the fall elections does not flinch from the money issue: “Just as a regional mobility plan requires a comprehensive approach, funding its components will require multiple strategies — including, if necessary, increased gas, sales or severance taxes dedicated to specific projects — to achieve a level of investment sufficient to meet the region’s backlog and capacity needs, improve safety and quality of life, and sustain economic growth.” Leaving aside the demand for dedications — isn’t the Baton Rouge Area Chamber against that policy in the state budget? — the main obstacle to highway progress is politicians’ refusal this year, as in years before, to raise the state gasoline tax for DOTD’s budget. Nor does it help that Congress, as [Rep. Garrett] Graves recognizes, hasn’t raised the federal gasoline tax since 1993. Until lawmakers make that ante, there is mostly a blame game around the transportation poker table in the capital region.


Number of the Day


17,200 – Number of college students in Louisiana who are uninsured and stuck in the “coverage gap” because of policymakers’ failure to expand Medicaid (Source: Louisiana Budget Project)