In newly released research, Charles Courtemanche and Daniela Zapata ask perhaps the most important question about the Massachusetts health-care reforms: Did they improve health outcomes in Massachusetts?
The answer, which relies on self-reported health data, suggests they did. The authors document improvements in “physical health, mental health, functional limitations, joint disorders, body mass index, and moderate physical activity.” The gains were greatest for “women, minorities, near-elderly adults, and those with incomes low enough to qualify for the law’s subsidies.”
Some of those results are a bit odd. Although it’s possible to tell yourself a story about how the Massachusetts health reforms affected the body mass indexes of the newly insured, you have to stretch a bit.
But most of them make perfect sense. The reforms led to more people having insurance, which is to say more people having more opportunities to see a doctor and get early and/or regular treatment for ailments. That led to improvements in health. If that hadn’t led to improvements in health, it would be the worth of going to the doctor and getting timely medical care that would be called into question. And if going to the doctor and getting timely medical care isn’t worth doing, the Massachusetts reforms are pretty far down the list of practices and policies we need to rethink.
The researchers end by asking whether the Massachusetts reforms provide a good guide to what will happen under the Affordable Care Act. “The general strategies for obtaining nearly universal coverage in both the Massachusetts and federal laws involved the same three-pronged approach of non-group insurance market reforms, subsidies, and mandates, suggesting that the health effects should be broadly similar,” they write. “However, the federal legislation included additional costcutting measures such as Medicare cuts that could potentially mitigate the gains in health from the coverage expansions. On the other hand, baseline uninsured rates were unusually low in Massachusetts, so the coverage expansions — and corresponding health improvements — from the Affordable Care Act could potentially be greater.”
I’d add one point to their discussion: The national reforms, unlike the Massachusetts reforms, included major investments in comparative-effectiveness research, electronic health records, accountable care organizations and pay-for-quality pilots. If any or all of those initiatives pay off, they could dramatically improve our understanding of which treatments work and force the health-care system to integrate that new knowledge into everyday treatment decisions very quickly.
If that happens, medical care could become substantially more effective than it is now, which should also improve health outcomes. Quality improvements like that could, for the already insured, be the largest payoff from the Affordable Care Act.
By: Ezra Klein, The Washington Post, March 12, 2012
This morning’s Washington Post-ABC poll shows that President Obama’s poll numbers are falling in tandem with rising gas prices. Nearly two-thirds of Americans say they disapprove of how he’s handling the situation at the pump. Could gas prices end up swaying the 2012 election after all?
It’s hard to rule anything out, but evidence remains thin that gasoline will be a determining factor in November. While Americans love to grumble about expensive gasoline — and with good reason — political science research suggests that it’s not the main thing that shifts votes. Nate Silver, for one, has found that “there’s not a lot of evidence that oil prices are all that important” a factor in presidential elections. Nor do gasoline prices necessarily dictate the public’s view of the White House: Back during George W. Bush’s presidency, there was a much-linked graph showing his approval ratings climbing and dipping in lockstep with gas prices. But subsequent analysis by political scientist Brendan Nyhan showed that the correlation was just a “statistical artifact.”
The more severe worry for Obama, at this point, is that soaring gas prices could stomp on the nascent economic recovery. The way this typically happens is that pricey gasoline starts crimping the checkbooks of U.S. consumers, who then have less money to spend on other things. (In the Post-ABC poll, most respondents said they were already feeling the pinch.) That leads to slower growth. And slower growth, political scientists agree, really can sink a presidency. As Silver puts it, “higher gas prices are important to the extent that they affect things like G.D.P., inflation and unemployment. But there isn’t evidence that they matter above and beyond that.”
That said, it’s not yet clear whether oil prices actually will crush the current recovery. There’s certainly reason for concern: James Hamilton, an economist at UC San Diego, has found that most U.S. recessions since World War II have been preceded by a sharp run-up in oil prices. But, oddly enough, one person who isn’t gloomy about our current predicament is Hamilton himself. “I find myself in the unusual position,” he recently wrote, “of being less concerned about the impact of oil prices on the U.S. economy than many other analysts.” Hamilton notes that, for now, oil prices are simply moving back to 2011 levels. And price increases that simply reverse earlier declines are less harmful than historic new highs.
For instance, high oil prices have historically inflicted disproportionate harm on the U.S. economy by leading to a cut-back in sales of SUVs and other inefficient vehicles that Detroit has long specialized in. But this time around, he notes, sales are holding steady — perhaps because U.S. automakers have shifted to selling fuel-efficient models. Moreover, low natural gas prices, a warm winter, and improved fuel efficiency have helped insulate U.S. consumers from pricey oil to date. Overall energy expenditures are actually down this year. Americans have been grappling with expensive oil for several years now, and they appear to be adapting.
That should come as a quiet relief to most incumbent politicians. Because the unsatisfying reality is that there’s not a whole lot the White House or Congress can actually do to lower gasoline prices. Oil prices are skyrocketing because global crude supplies remain tight and tensions with Iran are making traders skittish about a possible conflict in a crucial oil-producing region. If Obama could figure out a way to calm down the situation with Iran, that might cause crude prices to settle back down.
But apart from that, options are limited. More domestic drilling won’t bring back $2.50-per-gallon gas, as Newt Gingrich has suggested — oil prices are dictated by the vast world market, of which U.S. production is just a small fraction. The still-in-limbo Keystone XL pipeline is just as likely to raise gasoline prices in the Midwest as anything else. Cracking down on “financial speculators,” as many Democrats have called for, isn’t particularly promising, as many oil traders simply appear to be following fundamentals. And, judging by past experience, releasing oil from the Strategic Petroleum Reserve won’t offer much more than very short-lived relief. Meanwhile, Americans are becoming significantly more oil efficient, but that’s a slow, painstaking process.
That won’t stop politicians from talking about the issue. And it won’t stop Americans from expressing their disapproval. But those are two very different things from swaying an election.
Update: Here’s another notable aspect of the Post-ABC poll to consider, pointed out to me by Third Way’s Josh Freed. At the moment, 63 percent of Americans say that gas prices are causing them financial hardship, with 36 percent saying the gas squeeze is causing “serious” financial hardship. (See Question 11.) But those are actually the lowest hardship numbers since May of 2008 — and, in fact, it’s virtually identical to what Americans were saying in May of 2004, six months before George W. Bush won re-election.
By: Brad Plumer, The Washington Post, March 12, 2012
The other day, David Bernstein argued that there’s been an “important tipping point” where many national media figures have come to understand that “in the Romney campaign, they are dealing with something unlike the normal spin and hyperbole.” Bernstein suggested they are realizing Romney has crossed into groundbreaking levels of dishonesty.
I wish I were as optimistic. I’d argue that much of the national media is still treating Romney’s nonstop distortions, dissembling, and outright lying as par for the course, as business as usual.
Here’s a test case: The debate over Medicare — and Romney’s embrace of the Paul Ryan plan — is about to dominate the conversation. Romney is moving to get ahead of the story by accusing Obama of being the one who would “end Medicare as we know it.” Here’s the Romney campaign’s statement this morning:
“There are two proposals on the table for addressing the nation’s entitlement crisis. Mitt Romney — along with a bipartisan group of leaders — has offered a solution that would introduce competition and choice into Medicare, control costs, and strengthen the program for future generations. President Obama has cut $500 billion from Medicare to fund Obamacare and created an unaccountable board with rationing power — all while America’s debt is spiraling out of control and we continue to run trillion-dollar deficits.
“If President Obama’s plan is to end Medicare as we know it, he should say so. If he has another plan, he should have the courage to put it forward.”
The claim that Romney supports a solution favored by a “bipartisan group of leaders” is a reference to the plan authored by Ryan and Dem Senator Ron Wyden. The idea that this represents “bipartisan” suppport is laughable. But this type of claim is made on both sides, so put it aside.
More interesting is the assertion that Obama has “cut $500 billion from Medicare” and created an “unaccountable board with rationing power” even as the deficit is “spiraling out of control.” That’s a reference to Obamacare’s efforts to curb spending with $500 billion in savings that are actually wrung from health care providers, not Medicare beneficiaries. That “unaccountable board,” meanwhile, is a reference to the Independent Payment Advisory Board, which is designed to make recommendations for reducing Medicare costs, and explicitly cannot recommend rationing.
Get the trick here? The Romney campaign is accusing Obama of slashing Medicare, and hence “ending Medicare as we know it,” while simultaneously accusing him of failing to curb entitlement spending in ways that pose grave danger to the nation’s finances. This, even as Romney has endorsed a plan that would quasi-voucherize Medicare and end the program as we know it.
This is all about muddying the waters in advance of a debate that could cut badly against Romney. The GOP primary forced him to embrace Ryancare; Dems are going to hammer him over it. So the Romney camp is trying to get out front by blurring lines and sowing confusion over who actually is defending traditional Medicare and who would end the program’s fundamental mission as we know it. The question is whether this, too, will be treated as just part of the game.
By: Greg Sargent, The Washington Post, The Plum Line, March 12, 2012
Texas Republicans have been trying for years to pass a law that would require state voters to show identification before hitting the polls—and state Democrats have been equally determined to stop such a measure. The Rs came close in 2009, but the House Democrats, only two seats away from a majority, blew up the legislative session rather than see the measure pass. By 2011, however, fresh from Tea Party victories, the GOP had overwhelming majorities in both Houses. The bill was almost undoubtedly going to pass, and rather than go for a more moderate version of voter ID with non-photo options, the conservatives went for the gold, introducing one of the most stringent versions of a voter ID requirement. The only option left for the Democrats was to set up the grounds for the legal battles sure to come.
Monday, it looks like those efforts paid off. The Department of Justice has blocked the law, meaning that while the measure goes to the United States District Court for the District of Columbia, the Lone Star State won’t be allowed to enforce the measure. Not every state must seek permission before changing election law, a process known as preclearance. The entire reason Texas must preclear changes to its election law stems from the state’s history of civil rights abuses. 50 years after the Voting Rights Act was passed, it seems the feds are right to keep their guard up.
Of the many problems the DOJ outlines in its letter to the state, one major point came up repeatedly during the legislative debate on the subject: the plight of rural voters. Democratic senators hit hard on the problem of access to state drivers’ license offices; in the letter, the DOJ notes 81 of the state’s 254 counties lack operational drivers’ license offices. The DOJ also notes that in rural areas the gap between Hispanics and non-Hispanics who have the necessary ID is “particularly stark in counties without driver’s license offices.” The senators were also vehement in discussing the hardships low-income voters would face both in terms of logistics and in terms of monetary costs. The DOJ finds that someone lacking the necessary documents to get an ID would have to start by obtaining a birth certificate—at minimum $22.
The question, not surprisingly, stems from whether Hispanic voters will be disproportionately affected by the new hurdles. The DOJ is fairly damning here, looking separately at two data sets provided by the state, one from September 2011 and one from January 2012. The state failed to explain discrepancies between the two sets of data, but more importantly, the two sets both show similar trends. Latino residents are significantly less likely to have the identification necessary for voting. Furthermore, the letter notes that the state has done almost nothing to educate voters about the coming change: “The state has indicated that it will implement a new educational program;” the letter reads, “but as of this date, our information indicates that the currently proposed plan will incorporate the new identification requirement into a general voter-education program.”
The state attorney general has already filed a preemptive lawsuit, so the next step is the D.C. Courts. But in the meantime, the law can’t go into effect—a legal win for the minority rights groups and Democrats fighting against the state. It’s not the only victory. As the DOJ issued its letter, a second judge in Wisconsin has blocked the state’s measure to require idenfication. Back in December, the Obama administration nixed a similar proposal from South Carolina.
To me, the partisan quality of the debate stains almost everything. Last week, I wrote about Connecticut’s efforts to increase voter turnout—a rare example in the midst of efforts to make voter more difficult. I’ll say now what I said then. These measures have obvious partisan consequences—and voter ID would help Republicans and hurt Democrats in political races. It’s obvious that concern for power is motivating many of the actors in the debate.
But voting is a holy act in democratic governments. It’s a powerful right, one people have struggled and died to exercise, and only relatively recently have minority communities had the necessary legal protections to get to the ballot box. The fact that the DOJ’s decision may benefit one political party is hardly worth mentioning when one considers that it also benefits basic rights of citizens.
By: Abby Rapoport, The American Prospect, March 12, 2012
To go back to The Washington Post poll for a moment, there is a little good news if the Obama administration is still fretting over its handling of the contraception mandate.
By a margin of 61 percent to 35 percent, Americans believe that health insurers should be required to cover the full cost of birth control for women. This even extends to religious-affiliated employers—like hospitals—which were the focal point of the controversy. According to the poll, 79 percent of those who support the birth-control mandate also support it for religious-affiliated employers.
Now that the controversy is over, for the most part, it’s obvious that this is good territory for the administration, and they should continue to press their advantage. Already, as The New York Times reports, Republican missteps have created an opening for Obama to improve his standing with moderate and Republican-leaning women. Indeed, as the year goes on, I expect that this view will become a little more prevalent:
“We all agreed that this seemed like a throwback to 40 years ago,” said Ms. Russell, 57, a retired teacher from Iowa City who describes herself as an evangelical Christian and “old school” Republican of the moderate mold. Until the baby shower, just two weeks ago, she had favored Mitt Romney for president.
Not anymore. She said she might vote for President Obama now. “I didn’t realize I had a strong viewpoint on this until these conversations,” Ms. Russell said. As for the Republican presidential candidates, she added: “If they’re going to decide on women’s reproductive issues, I’m not going to vote for any of them. Women’s reproduction is our own business.”
In the same way that Democrats should avoid preemptive celebration, Republicans should proceed with caution. It’s one thing to alienate single women, who lean Democratic anyway. It’s something else entirely to scare suburban white women from the GOP coalition. In a world where that happens, it’s hard to imagine Republican control of anything, much less the White House.
By: Jamelle Bouie, The American Prospect, March 12, 2012