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Obamacare Enrollment 2015: How Many People Will Sign Up Next Year? (Public Support for Obamacare Is About to Turn a Corner) Part 1

Thanks to the Affordable Care Act, some 10 million previously uninsured adults gained coverage during the open enrollment period that began on October 1, 2013. Last month, the New England Journal of Medicine reported that the share of Americans who are “going naked” has plummeted from 21 percent in September of 2013 to 16.3 percent in April of this year.

Even though open enrollment officially ended on March 31, 2014, people are continuing to sign up. Anyone who experiences a major life change (getting divorced, losing a job, having a baby) can still purchase insurance on the Exchanges this summer. Others are dropping out because they landed a job, married someone with insurance, or turned 65.

Earlier this month, Aetna told Investor’s Business Daily “the degree of attrition was “scary” and “unexpected,” and as a result, enrollment is “shrinking.” But enrollment expert Charles Gaba soon put that rumor to rest. Perhaps Aetna is losing customers, but overall, enrollment is holding up. Indeed, ultimately, the Congressional Budget Office (CBO) projects that by the end of 2014, 12 million formerly uninsured Americans will be covered either by the Obamacare insurance they purchased on the Exchanges or by newly expanded Medicaid programs.

On November 15, a new open enrollment period begins. Now the big question is this:

Will the ACA Be As Popular In 2015 As It Was In 2014?

Over at the Huffington Post, Jeffrey Young is pessimistic. In a post headlined “Why Obamacare May Have Trouble Signing Up As Many Uninsured Next Year,” he quotes Richard Onizuka, the CEO of the Washington Health Benefit Exchange saying “we got the low-hanging fruit” last year. The people who most needed healthcare signed up right away. These include folks with pre-existing conditions, who had been shut out of the market under pre-Obamacare rules.

By contrast, in this second round of enrollment, Young points out that reformers will be trying to sign up people who are not desperate for insurance, and who may be harder to reach, including: “Hispanics . . . people who have less education, live in remote rural areas . . . don’t have Internet access or don’t consume news.”

Moreover, Young notes: “public opinion about the law itself is negative.” Indeed, nationwide polls show that approval ratings for Obamcare have been sinking in recent months. Reform appears less popular than it was when enrollment began in October of 2013. As a result, Young believes that enrollments will tumble: The CBO now predicts that just 7 million Americans will gain insurance in 2015.

But as I will point out in my next post, there are indications that in states where Obamacare enrollments have been most successful–including Red states – the Affordable Care Act (ACA) may be about to turn a corner, even among Republicans.

This explains why Republican Party leaders who decide how to spend campaign dollars have begun backing away from ads attacking Obamacare. The GOP senses that, going forward, bashing Obamacare will no longer be the best way to bash Obama. Too many people are finding out why reform is a good deal.

Ten Reasons Why Obamacare Will Cover Another 10 Million in 2015

Usually, I agree with Young—his analysis of health care reform is both fact-based and shrewd. But in this case, I’m not persuaded. I can think of at least ten good reasons to expect that another 10 million will either purchase Exchange insurance or join Medicaid’s rolls next year.

The millions who have already signed up are now telling friends and neighbors about the benefits of Obamacare — including the fact that 87% of them received government subsidies that helped cover premiums. Polls show that while many Americans don’t trust the media’s conflicting reports about Obamacare, they do believe the information they receive from friends and relatives.

Word-of-mouth will dispel rumors that continue to confuse potential customers. For example, In July a Kaiser Foundation poll revealed that 37% of those polled thought that under the Affordable Care Act, people had no choice of policies. They believed that anyone who bought coverage in an Exchange was shoved into one government-run plan.

Amazing, when Enroll America conducted a survey in April, just after the first enrollment period ended, it discovered that 26% of those who had not signed up still had not heard that the government was offering financial assistance to low-income and middle-income people who bought coverage in the Exchanges. Those who did enroll were twice as likely to know about the subsidies (56% vs. 26%). In the months ahead, millions will learn more about true cost Obamacare as friends talk about what they are paying for their policies.

Many will find that premiums are lower than they were in 2013, in part because more insurers will be selling policies on the Exchange, increasing competition. I recently received a letter from my insurer telling me that, next year the premium on my zero-deductible Exchange plan will be falling by 10%. As state regulators make final decisions about which increases they will and won’t approve, I will be writing more about how many insurers are dropping rates.

In 2015, the Refuseniks will have to pay a fine that rises from 1 percent of yearly household income or $95 per person (whichever is greater) to 2 percent of household income or $325 per person. A family of four earning $70,000 would have to fork over $1,400—and receive nothing in return.Or that same family can sign up for a subsidy, pay part of the premium and wind up with comprehensive insurance that includes free preventive care, and caps out-of-pocket costs.

This fall, it will be far easier to use the online websites than it was in the fall of 2013. By the end of the first enrollment period, most sites were working smoothly (though by then many would-be customers had given up). This year, there should be many fewer glitches because the administration has persuaded Mikey Dickerson, the Google engineer credited with fixing bottlenecks on the website last spring, to become the government’s full-time IT czar.

The “navigators” charged with helping customers find plans that meet their needs, either in person, or on the phone, will be that much more experienced, and many will have received more training. There will also be more bi-lingual navigators available.

Over the next year, more states will expand Medicaid. Political pressure is mounting: states that refuse to take the federal dollars that Washington is offering are leaving too much money on the table, and voters are hearing about it. In North Carolina, for instance, local newspapers are reporting that, over the next decade the state risks missing $51 billion in federal payments. Hospitals would get $11.3 billion of that amount. At present, North Carolina hospitals are threatening to lay off workers. If North Carolina expands Medicaid, another 400,000 Americans would be insured under the ACA. And that’s just one state.

As low-income people who have joined Medicaid talk to their neighbors, more will become aware that the rules for eligibility are changing. We’re likely to see a major impact in the Latino community where language barriers have blocked government efforts to spread the word.

More young adults will find out that they can sign up for a parent’s employer-based insurance and stay on it until they turn 27. A Deloitte survey of young adults reveals that in April, 45% still had not heard about this Obamacare benefit.

The Kaiser Foundation’s July poll reveals that most people who actually signed up for Obamacare rate their policies as “excellent” or “good.” This, along with what I know about how the ACA is helping millions, is the major reason why I am convinced that as the newly insured share their experience with others, public support for health care reform will climb—especially among those who most need it.

As I will explain in part 2 of this post, some affluent Americans who don’t need the ACA or its subsidies (because they already are covered by employers) may be inclined to remain nervous about Obamacare. But Americans who are wealthy enough to feel that they and their adult children are economically secure are a shrinking minority. This is the one good thing that can be said about growing economic inequality.

Originated at Health Beat Blog

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Widening wealth gap

Recent census date points to a Widening wealth gap:

The Census Bureau released updated data this week on the net worth of American households, drawn from the Survey of Income and Program Participation. These totals reflect all assets including money in checking accounts, owned homes, rental properties, 401ks, stocks and vehicles, offset by liabilities like mortgages, student loans, and medical and credit card debt. Below, I’ve charted the distribution of net worth by income quintiles for several groups: non-Hispanic whites, blacks, Hispanics and Asians, as well as households headed by workers with a high school degree or more.

The Census data suggest that the wealth gap in America has widened over the past decade, regardless of how you slice it. The gap between the bottom and top quintiles in America has widened, as has the gap between blacks and whites, and between workers with only a high school degree and those with much more.

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Government dependence

I remember in the late sixties and early seventies in the little suburb town where I lived in Ohio, the police chief had files on ‘potential threats’, including candle light vigil participants such as my parents.  Feelings of fear were common, and some quick to judge:

Mike Konczal takes a look back at some of the attitudes currently acted upon and displayed in the news:

Before it was anything else, the neoconservative movement was a theory of the urban crisis. As a reaction to the urban riots of the 1960s, it put an ideological and social-scientific veneer on a doctrine that called for overwhelming force against minor infractions — a doctrine that is still with us today, as people are killed for walking down the street in Ferguson and allegedly selling single cigarettes in New York. But neoconservatives also sought, rather successfully, to position liberalism itself as the cause of the urban crisis, solvable only through the reassertion of order through the market and the police.

The Unheavenly City’s most infamous chapter is “Rioting Mainly for Fun and Profit.” Fresh off televised riots in Watts, Detroit, and Newark, Banfield argued that it was “naive to think that efforts to end racial injustice and to eliminate poverty, slums, and unemployment will have an appreciable effect upon the amount of rioting that will be done in the next decade or two.” Absolute living standards had been rising rapidly. For Banfield, this was entirely the result of market and social forces rather than the state, and the poor, with their short time-horizons and desire for immediate gratification, would largely be left behind and always be prone to rioting. Today’s classic, if often implicit, repudiations of poor people’s humanity were clearly expressed here.

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“Have It Your Way”

Remember that old jingle Burger King used in it’s advertisements? Well it looks like Burger King is determined to have it “their” way by merging with Canada’s Tim Hortons in a take over of the company. Not that Canadians will be happy with this merger as they were not according to rumor the last time Tim Hortons was taken over by Wendys.

MSN Money News Center Euan Rocha writes: “The companies, whose market values are comparable in size, confirmed late on Sunday that they were discussing a takeover of Tim Hortons by Burger King. They said the new entity would be based in Canada, which has a lower corporate tax rate than the United States, especially for entities with large amounts of earnings from overseas.”

There is a question as to whether it is for lower corporate taxes or other reasons corporations are attempting to avoid the US corporate income tax. As DealBook Blog founder Andrew Sorkin questions the takeover and quotes Southern California Gould School of Law Prof. and former JCT chief of staff Edward D. Kleinbard in his paper ‘Competitiveness’ Has Nothing To Do With It.

“‘Despite the claims of corporate apologists, international business ‘competitiveness’ has nothing to do with the reasons for these deals,’” Edward D. Kleinbard writes. ‘Whether one measures effective marginal or overall tax rates, sophisticated U.S. multinational firms are burdened by tax rates that are the envy of their international peers.’”

Sorkin counters; “What? We’ve been told repeatedly that the United States has the highest corporate tax rate in the developed world — 35 percent — which is higher than the nominal tax rates in places like Ireland (12.5 percent), Britain (21 percent) and the Netherlands (25 percent) and the 24.1 percent average rate of all countries that are part of the Organization for Economic Cooperation and Development.”

Sorkin goes on with Kleinbard’s points. “All that is true,” contends Professor Kleinbard; however, “most United States multinational companies do not pay anywhere near 35 percent. Companies paid an average 12.6 percent, according to the Government Accountability Office, which last measured it in 2010 and avoid taxes by deliberately stashing piles of cash abroad.”

So what is the deal? Are corporations being taxed too high and deliberately keep money out of the US to avoid taxes? The argument by Kleinbard is “lower tax rates are not driving companies to inversions; instead, he contends it is all the money that companies have overseas — some $2 trillion — and don’t want to bring back to the United States despite protestations by many chief executives that they wish they could.”

Companies have become adept at avoiding corporate taxes and take advantage of the US tax code, are more competitive than their foreign counterparts, and do not face the same “anti-abuse” rules which non-US companies face in stricter territorial tax systems. Inside of accepted accounting rules, US firms take full advantage in operations in lower tax jurisdictions in a cash tax matter and also through the U.S GAAP measurement of a company’s performance.

Is the excess $2 trillion in profits trapped overseas due to high US corporate taxes? Kleinbard thinks not and points to one company in particular which has used it to their advantage. In 2013, Apple was borrowing in the US and using its offshore foreign earnings to pay the incurred interest. The burdensome US tax code allows interest earned on offshore cash to be included in the US company’s income offsetting the tax deduction on interest expense from US borrowing. In effect, no harm is done to company’s economic stance from borrowing.

While there is agreement the US tax code is inefficient; Kleinbard states, “one of the few deficiencies it has avoided is imposing an unfair international business tax competitive burden on sophisticated U.S. multinationals.”

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Lengthy Island [Updated]


— Title of this post of mine from Friday as translated by … a computer that lives elsewhere.

Sorry.  I couldn’t resist. I don’t live on Lengthy Island, but still thought it was hilarious.

Seriously, though: I’m grateful for the repost by, and to the others who have reposted or linked to my Blackie posts.


UPDATE:  Oookay, I’m gonna indulge myself here and repost the entire Comments thread to this post:

Comments (4)


August 25, 2014 4:17 pm

and Bill H became Invoice H…who are those people?



August 25, 2014 4:39 pm

Hi Bill- unfortunately I can’t access that link here at work (I think it’s our firewall here). I’m happy to report that Blackie was adopted yesterday!

Thank you for sharing him!



Town of Hempstead Animal Shelter

3320 Beltagh Avenue

Wantagh, New York 11793

Tel: 516-785-5220

Fax: 516-785-0129


Beverly Mann

August 25, 2014 4:42 pm

As someone who knows Bill H personally, Rjs, I can say with certainty that “Bill H” is just a pseudonym he uses to try to throw off the NSA. His real name is Invoice H.

As for who these people are, I’m not sure. But they may well be corporate persons, since they obviously have First Amendment free-speech rights. They probably exercise their religion, too, since I suspect that these corporate persons (or this corporate person) operate as a closely held computer.


Beverly Mann

August 25, 2014 4:48 pm

Hey, thanks for passing that along, Invoice!

This is terrific. Let’s hear it for some wonderful dog lover on or near Lengthy Island!

I’d forgotten how much fun it is to laugh at your own dumb jokes. I should do this more often!

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Understanding Piketty, part 2

In my last post, I gave an introduction to the massive data work underlying Capital in the Twenty-First Century, as well as two clear results from Piketty’s work. First, he showed that the optimistic Kuznets view after World War II that inequality was well on its way to being conquered was wrong, based on putting too much stock into a short-term trend. Inequality in fact has been increasing in the industrialized world since about 1980. Second, Piketty showed that a slow-growth economy is ripe for an increasing concentration of wealth in society, absent government action to counter that trend. He introduced the relationship r>g, which says the private return on capital is greater than the economic growth rate. When this holds true, as it has for most of history, inequality is likely to increase.

In this post, I address Part Two, “The Dynamics of the Capital/Income Ratio. The next two posts will address parts Three and Four, followed by a summation and critique of certain aspects of the book.

One important observation that Piketty makes is that in Europe, capital in the form of agricultural land accounted for 300-400% of gross national income (GNI), and total capital reached about 700% of GNI in the early 1700s. In Britain (Figure 3.1), France (Figure 3.2), and Germany (Figure 4.1), total capital fell below 300% of GNI in the period encompassing World War I and World War II. By 2010, total capital was back up to about 600% of GNI, but its composition had changed, with agricultural land falling to vanishingly low levels, replaced by housing and other domestic capital. In the United States (Figure 4.2), by contrast, farmland in 1770 was plentiful and cheap, making up about just 150% of GNI. Total capital also was much lower than in Europe, only about 300% of GNI. In the twentieth century, however, the U.S. did not suffer the devastation of the World Wars, so it had fewer and smaller dips in the value of total capital, which had risen to about 450% of national income in 2010; like in Europe, however, the value of U.S. agricultural land had also fallen to a tiny fraction of national income. Piketty points out if one includes the value of slaves, total U.S. capital in 1770-1810 rises by another 150% of national income (Figure 4.10), meaning that the capital/income ratio in the United States has been even more stable than it appears at first blush.

For Piketty, the resurgence of the capital/income ratio in the late 20th century is a consequence of slow growth. One important result of this is that capital’s share of national income has increased since 1975, and labor’s share has consequently fallen. According to his data for eight rich countries (the United States, the United Kingdom, Germany, Japan, France, Canada, Italy [the G-7, as they are usually called] and Australia.), “Capital income absorbs between 15 percent and 25 percent of national income in rich countries in 1970, and between 25 percent and 30 percent in 2000-2010” (Figure 6.5, p. 222). Notably, he raises the important point, central to my own academic work, that the increasing mobility of capital increases capital’s bargaining power vis-a-vis both labor and governments (p. 221). He considers it likely that this factor has been mutually reinforcing with  the ability to substitute capital for labor. I would consider it not merely likely, but close to self-evident. Moreover, he omits (though I am sure he is aware) that one use capital mobility has been put to is to substitute less expensive for more expensive labor.

This increase in capital’s share of national income shatters another comforting standard economic view, that the relative share of capital and labor is fixed. This assumption is built into a workhorse of neoclassical macroeconomic analysis, the Cobb-Davis production function. Piketty shows that, as with Kuznets work, the results of Cobb and Douglas generalize from a data sample that is far too short in term (p. 219).

My next post will analyze Part Three, “The Structure of Inequality.” See you soon.

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Monkey Cage Match

by Robert Waldmann

Lifted from Robert’s Stochastic Thoughts

Monkey Cage Match

A real smack down in the Monkey Cage via Jonathan Bernstein (who summarized better than I can)

A catch to Andrew Gelman for correcting an attempted but inaccurate catch by Alfred Moore, Joseph Parent and Joseph Uscinski, who thought they had caught Paul Krugman in an error on the always-fun topic of conspiracy theories. Not so!

I cut and paste from Gelman

More particularly, Moore et al. criticize liberal pundit Paul Krugman for writing, “Unlike the crazy conspiracy theories of the left — which do exist, but are supported only by a tiny fringe — the crazy conspiracy theories of the right are supported by important people: powerful politicians, television personalities with large audiences.” They respond, “Krugman is mostly wrong that nuttiness is found mainly among conservatives.” But that’s not what Krugman wrote!

This shows, among other things, the power of Krugman derangement syndrome — people often right that his claim is refuted because of a fact noted in the criticized post. I think there is a simple solution to the Moore et al etc problem. I think there should be an editorial rule that if one criticizes another for exaggerating (say Al Gore inventing the internet) oversimplifying or omitting inconvenient facts, then one is not allowed to paraphrase. If Moore et al had been required to use only direct quotes of Krugman, their elision of his statement of exactly the fact which they claim contradicted his statement would have been obvious.

What’s the problem even with the stronger rule that one must quote directly and only quote directly when one criticizes ?

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Santa Cruz CA and water policy

Drought in Santa Cruz, CA is especially relevant because the city relies on precipitation for sources rather than the extensive systems in place for the state. There are other towns in the same dilemma, but watching policy develop to change behavior is interesting. Like bottled water in Head scratching use of water in a previous post the volume of this municipal water compared to agricultural use is minor, but useful in that so many of us live in closed system pipe systems and dense populations. I get the impression that the ‘low hanging fruit’ of watering lawns, cars, and cleaning sidewalks is key.

The city primarily draws water from the drought-vulnerable San Lorenzo River, North Coast streams and Loch Lomond Reservoir. The city’s goal under the rationing program is to cut overall use by 25 percent through the summer months when demand is highest.

The system’s water production for June has averaged 8.4 million gallons per day, which is lower than the 8.7 million goal set by the city. Last June, the system produced between 10 million and 11 million gallons of water per day.

May’s production also was on target at 8.3 million gallons per day. The reservoir level is holding steady at the city’s desired two-thirds of capacity.

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Sugar coated truths

Dr. Mark Harmon points us to a number of studies concerning the role of sugars in our public health arena and stunning changes over the last fifty years:

This study of more than 40,000 people, published in JAMA Internal Medicine, accounted for all other potential risk factors including total calories, overall diet quality, smoking, cholesterol, high blood pressure, obesity and alcohol.

U.S. Dietary Guidelines provide no limit for added sugar, and the U.S. Food and Drug Administration (FDA) still lists sugar as a “generally regarded as safe” (GRAS) substance. That classification lets the food industry add unlimited amounts of sugar to our food. At least the American Heart Association recommends that our daily diet contain no more than 5 percent to 7.5 percent added sugar.

Here’s the simple fact: Sugar calories are worse than other calories. All calories are not created equal. A recent study of more than 175 countries found that increasing overall calories didn’t increase the risk of Type 2 diabetes, but increasing sugar calories did — dramatically.


And fats, including saturated fats, have been unfairly blamed. With the exception of trans fats, fats are actually protective. This includes omega-3 fats, nuts and olive oil, which was proven to reduce heart attack risk by more than 30 percent in a recent large randomized controlled study.


Recent and mounting scientific evidence clearly proves that sugar — and flour, which raises blood sugar even more than table sugar — is biologically addictive. In fact, it’s as much as eight times more addictive than cocaine.

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