Which States Are Ahead at Reducing Their Uninsured?

Gallup: “Arkansas and Kentucky have had the sharpest net reductions in their uninsured rates since the healthcare law took effect at the beginning of 2014, followed closely by Oregon. West Virginia and California round out the top five states with the greatest declines in the percentage of adult residents without health insurance.”

States With the Largest Reductions in the Percentage of Uninsured, 2013 vs. 2015

“For the eighth year in a row, Massachusetts had the lowest uninsured rate nationally, and Texas had the highest. In general, Southern, Southwestern and Mountain West states have the highest uninsured rates in the U.S.”

Uninsured by State, 2015

Lead Poisoning Is Still a National Issue

Vox: “The problem of lead exposure among children is not a local Flint story … The data that is available shows that lead exposure is a pervasive issue in the United States. In some places outside of Flint, more than half of children test positive for lead poisoning.”

“Nine counties nationwide told the CDC that 10 percent or more of their lead poisoning tests came back positive. Four of them are in Louisiana, two in Alabama, and the rest scattered across West Virginia, Kentucky, Indiana, and Oklahoma.”

“These are places that have told the federal government they actually have higher rates of lead poisoning than Flint, where officials say the number hovers around 4 percent. But these aren’t places we talk about that much.”

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“The map above uses CDC data to show lead poisoning rates across the country. The reason so many of the counties are light gray is that most counties simply don’t report this information — nor are they required to.”

Average Obamacare Premium Increase is Under 10%

The Hill: “The average ObamaCare premium rose to $408 per month for 2016 plans, about a 9 percent increase from this time last year, according to a new report from the Department of Health and Human Services.”

“However, 83 percent of ObamaCare enrollees pay far less than $408 because they get tax credits under the healthcare law. The average tax credit for 2016 is $294, meaning that the average share of the premiums that enrollees have to pay is $113. That is up $8 from the $105 people paid on average last year.”

“As Republicans highlighted, premium increases for certain plans in some states were far higher, as much as 40 percent. But the report released Thursday shows that on average premium increases were less than that, and tax credits helped reduce the burden even more.”

“The administration touted the tax credits as showing that plans are affordable, as the Jan. 31 deadline to sign up for 2016 coverage nears. Officials also emphasize that people can save money by actively shopping around for the best plan.”

Bernie Sanders’ Health-Care Plan and Its Magic Asterisk

Megan McArdle in Bloomberg asks how Sanders proposes to pay for his health-care plan.

“National Health Expenditure data … says we spent about $3 trillion on health care in 2014 from all sources … Now the government already spends $1.3 trillion, or thereabouts, so … that leaves us with about $1.7 trillion to go. Yet Sanders claims that his plan, despite providing vastly more generous health benefits than basically any plan in existence, will cost only $1.35 trillion a year. That’s a pretty big gap. How does he get there? ‘Reforming our health-care system, simplifying our payment structure and incentivizing new ways to make sure patients are actually getting better health care will generate massive savings.’”

Sanders “has proposed a Magic Asterisk worth a third of a trillion dollars a year … But of course, it would be DOA anyway … Sanders won’t easily persuade congressional Democrats to embark upon another such bruising, vote-losing political battle.”

“The very fact that Sanders relies on the Magic Asterisk shows us just how impossible single payer is in this country. Even Sanders — its fondest supporter, who never met a high-income tax he didn’t like — knows he can’t be upfront about the cost and raise taxes accordingly. If Sanders won’t do it, then no one else will either.”

“Single payer’s off the table, for now and for the foreseeable future. The only place you’re going to see it is on Bernie Sanders’s website.”

Has Obamacare Increased Abortion Restrictions in the U.S.?

The Kaiser Family Foundation 1/21/16 newsletter reports that “on the eve of the anniversary of the Roe v. Wade decision, a new Kaiser Family Foundation analysis finds 25 states either bar abortion coverage in Affordable Care Act (ACA) marketplace plans or limit it to cases of rape or incest or when the woman’s life is endangered. In an additional six states, no 2016 ACA plans offer abortion coverage despite the absence of state legislative restrictions (Delaware, Iowa, Minnesota, Nevada, West Virginia and Wyoming). In three states without bans, plans that include abortion coverage are unavailable in at least one county (Colorado, Illinois and Texas).”

Availability of Abortion Coverage through Marketplace Plans, 2016

“Although the number women gaining access to health insurance coverage is rising, an increasing share of women are facing limitations in the scope of that coverage when it comes to abortion services.  The impact of the abortion coverage restrictions disproportionately affects poor and low-income women who have limited ability to pay for abortion services with out-of-pocket funds … While millions of women have gained health insurance coverage as a result of the ACA insurance expansions, many are enrolled in plans that restrict the circumstances in which abortion services will be covered.”

Is Drug Addiction the Biggest Health Epidemic in the U.S.?

New York Times: “Deaths from drug overdoses have jumped in nearly every county across the United States, driven largely by an explosion in addiction to prescription painkillers and heroin. Some of the largest concentrations of overdose deaths were in Appalachia and the Southwest, according to new county-level estimates released by the Centers for Disease Control and Prevention.”

“The death rate from drug overdoses is climbing at a much faster pace than other causes of death, jumping to an average of 15 per 100,000 in 2014 from nine per 100,000 in 2003.”

“The trend is now similar to that of the H.I.V. epidemic in the late 1980s and early 1990s, said Robert Anderson, the C.D.C.’s chief of mortality statistics.”

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“Drug overdoses cut across rural-urban boundaries. In fact, death rates from overdoses in rural areas now outpace the rate in large metropolitan areas, which historically had higher rates.”

GOP Has Perfected Obamacare Repeal, But Replace With What?

Des Moine Register‘s Editorial: “Every remaining Republican presidential candidate supports repealing the Affordable Care Act. Yet their ideas for replacing the law are ‘still works in progress,’ according to a headline last week in the Wall Street Journal.”

“There is a reason a Republican-controlled Congress for years failed to reduce the number of uninsured Americans and it took a Democratic-controlled Congress more than a year to agree on the reform law: This is complicated stuff … Sound bites and half-baked ideas offered by candidates do not even begin to substitute for the existing law.”

“Perhaps this crop of presidential candidates doesn’t understand just how expensive health care is in this country. Those who hold public office enjoy coverage subsidized by taxpayers. Those who are wealthy can pay for health expenses themselves. The majority of Americans are not so fortunate.”

“Dismantling a law that has been implemented in every state would be disastrous for local governments, health providers, insurance companies, businesses and average Americans. Instead of talking more nonsense about abolishing a 6-year-old law, candidates should share their ideas for how they’d improve it.”

What’s the Most Likely Way You’ll Die?

Washington Post: “Not to be morbid, but what are you likely to die from? Nathan Yau of Flowing Data has created a fascinating interactive chart that shows the answer, according to statistics. Drawing on data from the Centers for Disease Control and Prevention’s Underlying Cause of Death database, Yau charted the cause of death for Americans by age.”

Here’s what the chart looks like for women overall:

Note that this chart shows percentages by age group, not absolute numbers. There are far more people dying in 70s and 80s than there are in their 20s, but this kind of chart gives them all equal space, to show you how deaths break down by percentages. And here is the chart for men overall:

“You can see that death by disease is far more common for children and for older people. Roughly a third of people die from diseases of the respiratory system, including the flu. Cancer is mainly an issue for older people, and infectious diseases are much more rare. External causes — drugs, guns, homicides — are a much bigger cause of death for those in their teens and 20’s.”

GOP Obamacare Alternatives: Repeal, Then What?

Wall Street Journal: “Every GOP presidential candidate’s health-policy platform begins with repealing the law, but for most, that’s also where it ends, at least for now.

“Questions about how they would pull back a law that’s largely been implemented—and what, if anything, they would enact in its place—have gone largely unanswered in a primary contest dominated by national-security issues.”

“Among the 12 candidates still in the GOP race, only two, ex-Florida Gov. Jeb Bush and retired neurosurgeon Ben Carson, have posted health plans, and both use broad brush-strokes.”

“Florida Sen. Marco Rubio has described his health-policy ideas in a few paragraphs in an op-ed piece that also indicates support for such measures … The current front-runners, businessman Donald Trump and Texas Sen. Ted Cruz, have said little concrete.”

“Chris Jacobs, a writer for Conservative Review who had previously helped Mr. Jindal write his plan, said he was worried that delaying the debate over specifics could harm a Republican nominee once elected because voters might revolt over the kind of ‘trade-offs’ that are inevitable in health policy, such as the price-tag that comes with government efforts to extend insurance coverage.”

Proof That Obamacare is Here to Stay: Kentucky

Sarah Kliff in Vox: “Kentucky was the first state in the country where a Republican governor won on a platform of undoing his Democratic predecessor’s Medicaid expansion. The fact that Kentucky Gov. Matt Bevin has decided to drop the issue suggests something important about the politics of Obamacare: Once a state uses the health law to expand its Medicaid coverage, it’s incredibly difficult to shrink the benefit back down.”

“The Bevin situation shows that reversing course on Medicaid expansion has a completely different dynamic: There are half a million Kentuckians who rely on the program, who have an easier time paying their health care bills, and who would face difficulty accessing doctors if the expansion disappeared. Those people don’t exist in Texas, which never expanded the program. But they exist in Kentucky, and that matters.”

“This underscores how crucial the first decision to expand Medicaid becomes and the legacy it creates. That’s powerful for Obamacare supporters, who are pushing more states to expand. They most likely won’t have to lobby, over and over again, for states to continue their Medicaid expansion.”

Alcohol: The True Gateway Drug

Christopher Ingraham: “You may have heard that marijuana is a gateway drug … “New research out this month in the Journal of School Health could shed some light on this question. A team of researchers from Texas A&M and the University of Florida examined data from from 2,800 U.S. 12th graders interviewed for the Monitoring the Future study, an annual federal survey of teen drug use. They wanted to establish which substances teens typically used first.”

“They found that ‘the vast majority of respondents reported using alcohol prior to either tobacco or marijuana initiation.'”

“Not only that, but of those three main substances — alcohol, tobacco and marijuana — kids were the least likely to start using pot before the others.”

Uninsured Rate of 11.9% at End of 2015

Gallup: “In the fourth quarter of 2015, 11.9% of U.S. adults were without health insurance, up slightly from 11.6% in the third quarter and back to where it was in the first quarter of 2015. Still, the uninsured rate declined 5.2 percentage points since the fourth quarter of 2013, right before the key provision of the health law requiring Americans to carry health insurance took effect in early 2014.”


“”The sharp drop in the uninsured rate seen in the first year after the insurance exchanges opened has leveled off in the second year, with smaller declines seen in 2015 compared with 2014. This validates concerns that similarly large reductions may not be possible in the future because the remaining uninsured are harder to reach or less inclined to become insured more generally. Future reductions will likely require significant outreach and expanded programs targeting those who have not yet taken advantage of the health insurance marketplace.”

How Much Obamacare has Reduced the Uninsured Rate in Each State

Sarah Kliff in Vox has constructed a map that “shows how much the uninsured rate has dropped in each state since the health reform law’s insurance expansion went into effect.”

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“One of the biggest things that divides states with faster declines from those with slower changes — the difference between the light and dark purple states — is whether they decided to expand Medicaid.”

“Twelve of the 13 states in the two darkest shades of purple above are those that decided to use the health law to expand Medicaid to cover all residents below 133 percent of the federal poverty line (about $15,300 for an individual or $31,500 for a family of four).”

“The 10 states with the fastest declines in their uninsured rates all expanded Medicaid. The fastest drop happened in Rhode Island, where uninsured rates fell 79.9 percent between 2013 and 2015.”

“At the other end of the spectrum, nine of the 10 states that had the smallest decline in their uninsured rate (or, in Wyoming’s case, the rate increase) did not expand Medicaid.”

An Obamacare Fear That Didn’t Happen

Washington Post: “During the debate over President Obama’s signature health care law, opponents warned that the law would discourage large numbers of Americans from working, force millions into part-time jobs and make it more difficult to find work. Three new studies released this week suggest that, so far, it hasn’t happened.”

“They found that overall, the Affordable Care Act had little impact on employment patterns.”

One study, published in the journal Health Affairs, “is the latest in a series to conclude that Obamacare did not, in fact, widely result in more firms asking employees to to work part time.”

“The authors examined Census data, and found no increase in the likelihood of working part time, except for a 0.18 percentage point increase in the likelihood of working 25 to 29 hours per week between 2013 and 2014 — a trend that the authors say predated the ACA.”

“The study included another piece of evidence that appears to contradict the notion that the law would cause an increase in part-time work: the number of people working 25 to 29 hours a week in firms not subject to the mandate increased between 2012 and 2015, while the number of people at firms subject to the mandate slightly decreased.”