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Ezra Klein assures us the individual mandate in Massachusetts is the cat's pajamas

Of course, he's been saying so for quite some time now, but recently he cites these figures to make his point:

• Over 96% of tax-filing adults who completed the Schedule HC had coverage at some point during calendar year 2008; almost 96% had coverage for the full year.

• 45,000 filers, uninsured and deemed able to afford insurance, were subject to a penalty—down 25% from last year’s 60,000 penalized.

• Insurance was unaffordable for about 21,000 (plus 88,000 under 150% fpl) individuals for the full year of 2008 and 24,000 individuals (plus 47,000 under 150% fpl) for part of the year.

That's all fine and dandy, but it's worth noting that being a blogger instead of a journalist, he can get away with citing another blog, instead of looking up primary sources. Cuz that's what bloggers do, doncha know, just cite and re-cite each other. None of that boring time-consuming research for us!

Dept of Revenue 2007 Tax Year Report
Dept of Revenue 2008 Tax Year Report

Out of laziness [and a lack of data, since the 2007 report only counts the number of uninsured on Dec 31 2007 and the 2008 report counts the number of uninsured all year or any part of the year] I'm not going to address all 3 points [yeah, the coverage numbers look good], but I found the affordability numbers to be interesting, in a train-wreck sort of way.

On the last day of 2007, 168,000 people were uninsured. Of these 168,000 people, 97,000 [58%] were deemed by the state "able to afford insurance" and 62,000 [37%] were deemed by the state "unable to afford insurance". But wait, out of those 97,000 who could afford insurance, 11,000 of them appealed. That means about 7% of the uninsured felt like they couldn't afford insurance even though the state thought they could. If we shift those to the "can't afford it" column, we end up with 51% of the uninsured could afford it but were freeloaders, and 43% [rounding error] of the uninsured just plain unable to afford insurance. On the grand scale of things this means that only 2% of the entire population couldn't afford insurance, but I'm not finished yet.

In 2008, 140,208 people were uninsured all year. Of these:

o Roughly 19%, or 25,994 filers, were deemed able to afford health insurance. 22,289 filers were assessed a penalty, and 3,705 filers requested an appeal.

o 63%, or 88,396 filers, reported that their income in 2008 was at or below 150% of the federal poverty level and were thus exempt from a penalty.

o 15%, or 21,012 filers, were deemed unable to afford health insurance and were thus exempt from a penalty.

Of the all-year uninsured, the state decided that 78% of them could not afford insurance, and 3% more felt like they could not afford insurance. Compare this ~80% in 2008 with the ~43% in 2007 who could not afford insurance. Or in raw numbers: 113,000 in 2008 and 73,000 in 2007 could not afford insurance.

There's more. In 2008, 155,390 people were uninsured for at least part of the year. Of these:

o Roughly 17%, or 26,962 filers, were deemed able to afford health insurance for the period they were uninsured. 22,646 of these filers were assessed a penalty, and 4,316 filers sought relief from the penalty by filing an appeal through the Health Connector.

o 32%, or 50,230 filers, reported a lapse in coverage of three months or less and were thus exempt from a penalty.

o 30%, or 46,733 filers, reported that their income in 2008 was at or below 150% of the federal poverty level and were thus exempt from a penalty.

o 15%, or 23,908 filers, were deemed unable to afford health insurance and were thus exempt from a penalty.

The 32% who went without insurance for less than 3 months, how many of them did so because they could not afford it? Don't know. Of course, this implies that the remaining 68% went without insurance for longer than 3 months. Not good.

Definitely 45% of them [30% + 15%] were unable to afford insurance, the state said so. Another 3% of them appealed, so they probably felt like they couldn't afford insurance. So, somewhere between 45% and 80% of the partially uninsured in 2008 could not afford insurance.

Looks to me like the drop in assessed penalties that Ezra points to as a good thing had something to do with the apparent rise in unaffordability, which clearly ought to be considered a bad thing instead. Sure, the overall percentages may look "not too shabby" [Ezra's choice of words] but this particular trend is not a good sign.

Oh but wait! They're eventually going to get around to controlling costs! If they do actually succeed in controlling costs, then yes, the unaffordability trend should reverse itself.

Until then, there's always the unity pony.

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basement angel's picture
Submitted by basement angel on

is shoving vulnerable people out of health care entirely. Scared of being penalized, they'll be even less likely to go the doctor. I'm afraid I'm one of those people.

Submitted by hipparchia on

i've long argued that, while they don't anyone's death on their consciences, the elites really would be happier if we the little people would just disappear from their immediate orbit. if some of us have to die because we're too lazy to work and earn enough to afford high-end [or even ordinary] health care, that's a feature not a bug. that way it becomes our fault, not theirs.

but no, actually shoving us out of the system would hurt their consciences, for a little while anyway.

i can relate. i've got enough money to go to the doctor for relatively minor stuff -- yearly checkup, if i were to feel the flu coming on, stuff like that -- but even though i can afford all the various recommended screening tests, no way could i ever afford anything like cancer treatment if they found something major.

Submitted by gmanedit on

I stay away from doctors unless something is wrong. I don't want to be screened; if they look hard enough, they'll find something. I hate that they charge multiples more for procedures if you don't have insurance; that's piling on. Like you, I worry about cancer or another disaster.

Submitted by lambert on

There's no upside to getting a diagnosis if you can't do anything about it. So, better to be happy than unhappy, given that the outcome is the same in either case.

Submitted by gmanedit on

I don't want, for example, to be prescribed statins because my cholesterol is a little high. I don't want to be forced to become a patient in the name of "wellness."

I've had pushback, on this site and others, for recommending that people read Junkfood Science (because they don't like her politics), but she repeatedly emphasizes (with links) that "wellness" proponents ignore that most of our ills come from aging and campaign to stigmatize and denormalize the uncompliant.

Someone like me, in a medical scheme that rewarded doctors for their patients' compliance and penalized them for uncooperative clients, would be undesirable to doctors—I wouldn't visit for checkups, wouldn't quit my bad habits, and wouldn't take the drugs. I don't want to be turned into a career patient.

I'd be happy to have my dental bills paid, but when I had employment-related insurance, we were incensed to be told that dental implants weren't covered, because the IRS considered them cosmetic—even the molars. They covered bridgework, which damages perfectly good teeth on either side.

For me, it's single payer or catastrophic coverage.

I've been lucky so far; my mother had a lot of health problems, but my father was fairly robust, and I seem to have taken after him. Others' needs may vary.