Obamacare rate increases in Mississippi

Mississippi will be ground zero for ObamaCare’s individual mandate to buy coverage or pay a tax penalty.

The state already is near the bottom when it comes to the percentage of the subsidy-eligible individuals who are enrolled via HealthCare.gov — just 38%. Now Mississippi’s subsidized premiums are about to jump far more than any of the 36 other states using HealthCare.gov.

For 30-year-olds in Yazoo City earning about $25,000 (214% of the poverty level), the after-subsidy cost of the cheapest bronze plan will spike by $554, or 60%, in 2016.

There is more here.  To be sure that is lemon picking from the data, but in politics the people who suffer the most often end up with the biggest say.  Furthermore the reported seven percent average rate hike is not so small either, so perhaps the Mississippi story will resonate.  Here is more on the ambiguity in the numbers on reported rate increases.  Still, this is not developing in a favorable manner.

Comments

I drew first.

I just found out the other day that since I'm living overseas, I'm exempt from Obamacare. This is on top of the tax break I get for the first $90k of income that I don't have to pay tax on (and since my work comes from the USA, online, I don't ever pay tax on anything I earn in my host country, presently the Philippines).

It's a wonder why anybody pays taxes...I guess it's the little people that don't know any better or are afraid to leave the USA. Good on them, and good for me. Oh yeah, I'm officially a resident of South Dakota, for obvious reasons. Have visited once, it was nice blue sky country.

You are exempt from the 90k because otherwise people would be double taxed if they worked overseas. It would be very brutal, indeed.

If you receive income from overseas, the Philippines may indeed not tax it, as they are a normal country with a territorial tax system, but you should be paying taxes if the actual work is done in the Philippines. You could always report that.

Also, you don't pay taxes on your chicken farm?

@Harun - the chicken farm is just breaking even at the moment, not making a profit, but even if it does I'm running it as a non-profit, meaning any profits go to the employees, not me

According to John Boehner, every dollar you get is taxed by the IRS, which is why the high Obama tax rates, (thanks to the 3.8% Medicare tax on capital gains), on small businessmen has stopped all hiring of workers.

Listening to Boehner and other conservatives for the past decade, I thought I should have become a CPA doing the books for these guys because I'd be able to siphon millions out of the pockets, claiming its Obama's taxes on revenue that goes to pay A/R and payroll.

How do you manage to not pay taxes on you first $90K? Is that because ypou are overseas? I was under the impression that the law required you to pay taxes to either the US or the foreign government. You can't get away with not paying either one (legally).

If you live outside the US for more than some set period, I think about 330 days a year, then you get an exemption from the first 90K of income.

Otherwise some poor oil engineer or programmer sent overseas for a year would be paying US taxes and foreign taxes.

Over 90k and you are paying double.

It is possible to pay zero taxes if you have an income stream from a zero tax locale like British Virgin Islands.

If you lived in a territorial tax country, not the USA, and had exactly 90k of income from a zero tax locale, you could indeed pay zero income taxes. Not so simple to set up, but possible.

So why is he not paying Phillipine income taxes either? He suggests it is because the work comes from the USA online, but then that implies the Phillipine government thinks he is paying US taxes.

Many nations only tax income earned in that nation. So if one is a resident of a nation that taxes income earned in that nation and earns income outside in a nation that doesn't tax expatriot income they could pay no taxes.

Nope, he's pretty much exempt on non-Phillipine source income under their National Internal Rev Code sec 23(D) and 24(A)(1)(c). The chicken farm and pimping enterprise do not qualify, though.

Hazel -

If Ray is a consultant for, say, a US company which pays him into his North Dakota bank account, then the Philippines never sees that money. As far as they are concerned, he doesn't exist for purposes of taxation.

To all appearances, Ray pays US taxes. If he tried a bit harder, he could make that disappear, too.

He could expatriate but have to pay an exit tax on gains on a marked-to-market basis, over certain thresholds. Otherwise, we tax his ass on worldwide income ('cept for that Sec 911 exemption) till he dies and on his death for good measure. And if he doesn't file all those FBARS, 5471s, etc we get to fine him $10k per failure to file.

By the way, that $90k exclusion under s911 only applies to income earned in the Philippines, but he's telling Filipinos that its earned in the U.S. For shame!

"that $90k exclusion under s911 only applies to income earned in the Philippines"

Note quite. The exclusion applies to income received for services performed during a time when a) you have a "tax home" in a foreign country and b) you are physically present for a period of at least 330 days in foreign territory or have established "bona fide residence" in a foreign country. Having a "tax home" in the Philippines does not mean that one necessarily pays income taxes or reports taxable income there. It only means that either one's main business or place of work is located there, or if you have no regular business or place of work, it is where you live regardless of visa status.

These definitions have always made my head hurt a bit after reading them but the bottom line is that earned income need not be taxed by a foreign government or be considered income "earned there" to be free from U.S. income taxes.

Ray, How are you complying with FATCA? That law alone make it very difficult to be an expat unless you can afford to have Ernst & Young handle your financial filings, or have someone you trust who is not american own your bank account.

@Justin Kelly - FATCA is easy to comply with. You download an electronic Adobe Acrobat PDF (only that company! I use Sumarta PDF so I had to install Adobe), fill out the form, digitally sign it (done automatically), upload it to the FATCA website, and you're done. It used to be a paper hardcopy but they change the law last year I think. It's easy and painless.

@Govco - you are correct, and I believe I comply with the law, as the income is not earned in the PH, as the client is not in PH but the USA and I don't use any PH resources to answer the client's question, except my own mind. I'm sure if the money was big enough, the PH would dispute this, but I think I have a strong case. Anyway I'm on a tourist visa here (which can be easily extended for years, unlike in the USA where you have to jump through hoops) so I'm technically not working here.

I had seen the op-eds and publicity about the horrible FACTA tax form. I downloaded it out of curiosity. It is actually pretty trivial--you just list your foreign bank account balances (perhaps the highest balance) and apply the currency conversion rate.

Much to do about nothing.

I don't know about the expense and risk to the banks; but what my direct observations on the individual taxpayer form suggest that any complaints of certain FACTA opponents should be viewed with a lot skepticism.

FATCA is quite easy to comply with. You just list the account number, address of bank, and maximum account value (converted into U.S. dollars using rates posted on the U.S. Treasury website) for the calendar year for any account you have a financial interest in. Of course, if you have 50 accounts in the names of various shell corporations and intermediaries spread across 20 different countries, compliance might be tricky but so would managing all those accounts and relationships. Of course, even an account a non-American friend opens and manages on your behalf still must be reported. Filing an FBAR is much easier than filing an income tax return, in my experience.

Being an expat is easy. Hiding money from the tax authorities is difficult and deliberately so. Ray is benefiting from a loophole or gray area where many countries including the Philippines have not clearly stated that income derived from work performed remotely over the internet is taxable since this is a relatively new phenomenon. I believe the IRS has clearer rules about this sort of thing and a non-American who decides to stay in the U.S. on a tourist visa and perform work for compensation over the internet could get in trouble for both a visa violation and for tax evasion.

So the states that didn't want to set up their own exchanges and relied on the federal government are going to be the ones that complain the federal government wasn't holding down costs, and this is proof Obamacare isn't working?

That's what happens when the people who run the government are the ones who want to drown it in a bathtub.

Oh you think the problem is that Mississippi is using the federal exchange rather than their own? The costs of the federal website are far higher than one locally run by a bunch of mississippi bureaucrats? That this whole situation would be improved by having the STATE OF MISSISSIPPI OPERATE ITS OWN EXCHANGE?

Please tell me: What evidence do we have that the state of mississippi does anything better than the federal government?

The people of Yazoo City don't need health insurance subsidies, they need bus tickets and U-Haul rentals.

There just aren't that many economically viable communities along the southern Mississippi delta. The sooner we recognize that and help people move to where the opportunities are, the better.

Alternatively, we can let Mississippi become a Special Economic Zone with looser regulations to encourage investment.

It's not the cost of the exchange. It's the cost of a very unhealthy state population and that fact he Mississipi as a healthcaer environment has done almost none of the things that lots of other states have to improve quality and reduce costs through care coordination, etc.

Perhaps Mississippi does Delta Blues better...but of course the real reason behind the increase is the failure to take the Medicaid expansion, which means hospitals now have to pay for the emergency health care of the indigent but don't have the extra federal funds to pay it, which means the premiums go up on those who do pay. The dysfunction isn't be accident it is by design...

So when you foist policies on people who don't want them, it is their moral duty to try to salvage them? And when the policies turn out to confirm their pessimistic expectations, it is their fault for not taking control of it themselves?

It is is a state that is not trying at all. Case in point, they are one of the few states to not even have one methadone treatment program. Why? It's that the demand isn't there. They have lots of Mississippians going over state lines to get their dose. Just a very abd health care culture.

Should say "it's *not* that the demand isn't there."

Lol, you seriously think the state exchanges are working better? Come to Oregon, I will show you how ours worked out.

You guys are going federal.

Oregon spent $10 million on advertising for a website that did not work.

Its almost meta-waste at that point: money wasted on wasted money.

That's awareness advertising, the website still directs to the federal exchange. You're being disingenuous now. Go visit it.

http://www.oregonhealthcare.gov

Are you being intentional obtuse, Jan? They ran ads for a website for an entire year despite the fact the product didn't even function.

Then when they admitted failure, moved over to the fed exchange, rates exploded.

http://www.wsj.com/articles/oregon-backs-hefty-rise-in-health-insurance-premiums-1435873598

You're conflating two different issues. Just to clarify how this works -- the platform on which the exchange runs (state or federal) has nothing to do with how much the insurance plans themselves cost. Premiums depend on the market, insurance commissioner rate review, etc. If you're trying to say that rates exploded because they moved to the federal exchange, you need to explain the mechanism.

Oregon was trying to deploy its own technical solution for operating the exchange--Cover Oregon--and it sucked, so it is now using the federal one. However, Cover Oregon did enroll 69,000 people in private plans and over 170,000 in Medicaid, so it's not like it did not work at all. In any case, the awareness campaign was a success: "The 7 percent public awareness of Cover Oregon in May, he said, had soared to 78 percent in September, based on follow-up polling." And today, the Oregon insurance exchange website simply directs to an Oregon-specific gateway to the federal exchange, so it's not as if people looking for Cover Oregon won't make their way to the exchange.

My state minnesota, has 41% increases this year. They set up their own exchange. How are we at fault again?

@Bob, 'racism', duh!

The issue isn't whether it's a state-run or a Federal-run exchange. Unexpectedly, costs rose requiring higher taxes. These are tax (Supreme Court ruling it's taxation or Obamacare would be unConstitutional) increases, which no elected legislator enacted. I once read in a history book, "No taxation without representation."

For the umpty-umphth time, Obama lied. He said no one earning less than $250,000 a year would pay higher taxes.

One of the very first bills Obama signed raised taxes on smokers, almost all of whom make less than $250k. The bill also defunded the voucher program that allowed poor kids to attend Malia and Sascha's school in DC (to be fair, that cruelty to poor chdren was crass political pay-back, not snootiness).

The number of students was in the hundreds because Boehner did not really want to offer the 100,000 poor kids in DC school choice, but only to score political points.

Why not simply make vouchers an entitlement for all kids in DC living under $x income so the number getting vouchers might be 1000 or 100,000?

Instead it was a matter of picking a few winners and a hundred times the number of losers.

So the ACA wasn't passed by the democratically elected Congress and signed by elected president? That is very surprising.

'In a favorable manner' from Obama's point of view means that it blows up more than five minutes after he leaves office, and so gets to blame 'mismanagement of his legacy achievements' on someone else.

George W. Bush almost achieve this. Missed gor a few months.

It was a bit of ironic satisfaction that Jerry Brown had the budget crisis under his second governorship because he's the guy who allowed unionization of state employees.

And then while he was busy not being governor the other clowns in charge decided to not put the pension money away like everyone agreed to do.

Do you live in California?

I don't think so.

Because if you did you'd understand how state employee compensation ballooned.

That's not "setting aside pension money" but spending even more.

http://www.sacbee.com/site-services/databases/article2573210.html

"California police officers made, on average, $97,500, including overtime, incentive pay and payouts upon retirement during 2013, according to a Bee analysis of new data from the state controller's office. Firefighters and engineers earned, on average, $125,100. Average pay for police captains across the state was $166,500; for fire captains, it was $153,600."

And the distribution is fairly Gaussian. Most of the firefighters are earning $100-140K. Most of the cops are clustered around $90K-$100K.

That's just not sustainable over the long run.

Harun, nice non response.

Crocodile tears. Mississippi is one of the states that refused expanded Medicaid.

http://politicalcalculations.blogspot.com/2015/06/how-medicaids-expansion-tips-scales.html#.VjEVfGaFMy8

Medicaid expansion may cause rate increases to be even worse.

What will lack of coverage cost for a population that is disproportionally poor and disproportionally obese?

That's an interesting theory that I have not heard. But they don't seem to have actual Medicaid and exchange plan enrollment data to prove it. Looks like they are using 2012 income data for the people who in theory qualify for Medicaid in expansion states by age. I'm not saying it is necessarily wrong, but has it been confirmed?

Strawman alert.

Medicaid expansion is topped at 138% of poverty. The example given was 214% so not Medicaid eligible.

Medicaid expansion pays for everyone up to 138%. No expansion, then these people still get emergency care, but the feds no longer pay for it. So the hospitals have to raise the premiums of everyone else.
Because the ACA assumed Medicaid expansion, it phased out subsidies for emergency care, which is now starting to hit all hospitals in states that did not expand Medicaid. Pretty simple. This is a self-inflicted wound by Mississippi (which is not surprising)

Looks like the incentives line up for a return to all-out freeloading emergency room services. If my untaxed small share of my employer-provided insurance goes up to cover for these takers, I am going to be really angry.

No there is no return; the increases have occurred "in spite of" Obamacare. Search for "increase in emergency room visits".

Oh, its going to get worse as people learn how to game the ACA, game the penalty, etc.

The penalty is there is largely as a signal. People comply because the large majority of Americans follow the rules of society and actually want to have insurance, not because they did a cost benefit analysis to find out that it is better financially for them to protect themselves from having to pay out of pocket for a catastrophic health problem.

Tim, who did you vote for in 2012?

Obamacare is and will forever be miraculous. This is just more Republican disinformation.

Supporters of Obamacare at this point are just religious believers.

It's pretty good overall--big step from where we were. It has its faults, but there is literally no politically viable alternative that people on either side of aisle have proposed.

It's having a number of rather sucky effects on my employer-based plan, contrary to the belief that people with employer-based health care would be unaffected.

They got rid of the EPO at my workplace and replaced it with a HDHP. Surprisingly, the result of this is that young healthy single people will pay LESS, and people with families and/or chronic conditions will pay more, to the tune of about $4,000/year.

You ought to be concerned about effects like this, because the ACA's supporters frequently argue that the benefit is that it forces young single people to pay more. It's actually having the opposite effect on employer based plans, which means it's doing unexpected, unanticipated things.

I'm actually surprised that the EPO went away because, although it paid 100% of costs (except for co-pays), it only covered in-network doctors. So I wouldn't have though that the 'Cadillac Tax' would hit it. It also had deductibles and lifetime maxes for some types of treatment. I'm not entirely sure if the Cadillac Tax was the reason, but I'm pretty sure that *something* about the ACA prompted the change to structured high-deductible plans.

Aside from lack of coverage generally, the employer based model is the biggest problem with our system. Everyone is afraid to blow it up, which is really what we need to do.

As to your particular plan, just keep in mind that HR departments were given an amazing gift in the ACA, as they can blame almost any change in benefits that employees don't like on it.

We really need the Cadillac tax to disincentives those seriously expensive plans and to control cost increases.I realize this affects unions and public employees mostly, but their compensation structure is part of what drives up utilization unnecessarily, and overall costs.

I actually agree. The employer-based system needs to be blown up. Problem is that the ACA mandates that employers offer plans, and does not offer subsidies to any employee who opts to use the exchanges if they decline to use their employer's plan. You're basically *forced* to use your employer based plan, which severely limits your options. I basically have THREE plan choices, all from United HealthCare, because that's what my employer offers.

I agree, that is a real problem, especially if you don't like the options at your job.

Also, the ACA put limits on some high deductible plan because of the annual out of pocket spending limits and the mandatory covered services. However, somewhat ironically, some also blame the ACA for the increase in plans that some say have too high a deductible and excessive cost sharing.

Yes. One of the wierd things about it is that although it has a higher deductible, the out of pocket limit nearly negates the point of the co-insurance that kicks in after wards. You'r basically paying 100% of everything (except your 3 preventive visits per year) until you hit the deductible, and then paying 20% of the next couple thousand and then zero after wards. it's almost like a flat rate $5,000 fee for having children or a chronic condition.

Another thing is that it's completely unclear what is going to be free "preventive" care or full-priced treatment.
Kids go to the doctor a lot for well visits, vaccinations, and common maladies. Your basically rolling the dice if it's going to cost you $0 or $100-$200 per visit. Or, if you go see an endochrinoligist to get a regular blood test is that "preventive" (Free!) or not ($100!)? And if it's not preventive, then won't that disincentivize people from managing chronic conditions?
The point of high deductibles is to make prices more transparent, but the lack of transparency about what is considered "preventive" negates that.

I recall a variety of reform ideas in late 2000s, but the majority rejected outright anything that didn't increase regulatory control. McCain's plan (borrowed from someone at Brookings I think) severed the links between employer/insurer/insureds. Also, the HMO era reduced costs, until state legislators started adding mandatory coverage.

Some sensible ideas that others proposed to increase supply-- train (or import) more doctors, reduce time in med school, reciprocal board certification between states. Liberalize medicine imports and reform FDA obstacles. Expand Nurse Practitioners/Physician Assistant contributions, Malpractice/tort reform. Allow insurance dollars to be used abroad. Hotspotting, shift away from fee-for-service, deployment of technologies already prevalent in less regulated sectors (eg, SMS reminders of medication, appointments, etc., hotspotting, diversity of payment options).

It's not my area, but those sounded like pretty good ideas to reduce costs. And a certain part of all this increase in coverage is just expanding Medicaid, not a novel ACA secret sauce. I doubt the radical conversion of this sector into a public utility governed by HHS (and billions spent) were the best choice.

Many of the things you mention are State law issues, and contrary to the claims, Obamacare deferred to the States on almost everything, like insurance policies and premiums are still overseen by State insurance regulators, licencing doctor, etc is by State law, malpractice is State tort law just like almost all torts, and Medicaid is State run which is the reason Mississippi didn't expand it, with sharing of costs. Note that poor States like Mississippi pay 26%, while Mass and NH pay 49%, MD pays 43%, and California pays 44%, all based on formulas that recognized that 80% of health care costs are independent of local living costs - a cancer drug or antibiotic pill does not cost 40% of the price in Mass simply because wages are 40% of Mass wages in old Miss.

What you are arguing for is the Bernie Sanders solution, Medicare for All which eliminates the tie between employer and health care, private for profit insurers, affordability,...

You're assuming it was that big a problem to begin with, remember 85+% of people were satisfied with their pre-ACA situation. It didn't require a 10k+ page volume to blow up the current system in order to fix the remaining 15%, the expanded medicaid would have covered most of it. Also, the R's have proposed many reasonable changes but nobody cares while the other side has the presidency.

You mean the Republican proposals for high deductible plans - catastrophic - ie $6000 deductible per person - ie bronze plans

But its the bronze plans that conservatives and Republicans focus on when describing the horrors of Obamacare where people buy the cheapest bronze policy and then go bankrupt on the first $5000 of out of pocket expenses.

Will the bronze plans suddenly make people healthy without any medical care provided at all so they are suddenly cheaper than they are today?

And to say that fees will be 50% by magic does not change the first $6000 coming out of pocket for the now $25,000 hospital bill, down from $50,000 by conservative invisible hand voodoo.

"the expanded medicaid would have covered most of it."

I've always had the suspicion that a lot of people who argue this way would never actually support the alternative they propose once it becomes a live bill before Congress and would actively fight for its repeal if it was ever to be enacted. Medicaid has a sharp income threshold for eligibility. If you raise that threshold and do nothing else, you do exactly what an entire generation of conservatives and libertarians have told us not to do which is give people incentives to not work or to work less.

Of course, we could turn Medicaid into a public option but we already know who would oppose that. Or we could do some version of what we are doing now which is to heavily subsidize people who are near the Medicaid income threshold and have those subsidies gradually drop away as income increases so that low-income people are guaranteed coverage and don't have to worry about losing their coverage if they work overtime or get a raise.

"would never actually support the alternative they propose once it becomes a live bill before Congress", "actively fight for its repeal", the passed version of ACA didn't have a single R vote yet that didn't stop them. I never said people wouldn't fight it, just that it's a better alternative to what they ended up with.

A 7% average rate hike (assuming that number is accurate) doesn't seem like that much to me; rather it seems like the annual increase in loss expenses that one would expect from a correctly-priced insurance plan that tracks inflation of its primary coverage.

okay, read article. 12-13% is high.

What would be the tax penalty for a 30 year old earing $25,000 a year if he/she didn't enroll?

Maybe 0% if you vote Trump or Cruz.

"What would be the tax penalty for a 30 year old earing $25,000 a year if he/she didn’t enroll? "

Roughly $500 for 2015 and $625 for 2016. Could be a little less if the 2%/2.5% is counted after FICA taxes are paid.

There was not increase in the nationally weighted average of ACA insurance premiums from 2014 to 2015. Some did increase, other decreased. I do remember hearing quite a bit that they were going to skyrocket this year, and they didn't, on average. Will it be the same story again?

http://www.commonwealthfund.org/publications/blog/2014/dec/zero-inflation-nationwide-for-marketplace-premiums

You do understand the insurers get subsidies the first few years?

Those co-ops are now going out of business.

In 2017 the subsidies go away for good.

But you keep convincing yourself that it will bend the cost curve.

Are you talking about the risk corridors? You do realize those bailout, subsidies, whatever didn't even happen last year, right? Your beloved Heritage reports. You're grasping at straws.

Also, the subsidies would've been about 2.5 billion, which is almost nothing in the nearly $3 trillion health care system.

http://www.heritage.org/research/commentary/2015/10/how-congress-stopped-the-next-big-obamacare-disaster

According to CMS: "The risk corridors payments for program year 2014 will be paid in late 2015. The remaining 2014 risk corridors claims will be paid out of 2015 risk corridors collections, and if necessary, 2016 collections. Since this is a three-year program, we will not know the total loss or gain for the full three years of the program until the fall of 2017. "

Given that the "Cromnibus" legislation prohibits CMS from paying out any more in risk corridor payments than they collect from insurers, I am skeptical Congress would make a special appropriation to provide more funds in the future, if the program is not budget neutral over its three-year lifetime. And again, $2.5 billion is a drop in the bucket when it comes to health care spending. Medicare Part D spent that much on a single prescription drug in 2013.

And it's not just Republican-run states that let their co-ops collapse. New York state poured hundreds of millions into its co-ops.

http://www.nytimes.com/2015/08/15/us/most-health-insurance-co-ops-are-losing-money-federal-audit-finds.html?_r=0

They're mostly losing money and once the subsidies start receding, they'll all be gone.

My experience in Colorado: a 2 person HSA with 13k annual deductible and $750 monthly premium replaced by bronze plan with $1500 monthly premium. HSA plan apparently not legal under ACA any longer.

Oh, you have the awesome high deductible/high premium plans like in Massachusetts. I'm cancelling my insurance next year and self-insuring. This is full retard, I assume most people who support this stuff either don't use the ACA or had expensive pre-existing conditions and could get any coverage before.

Maximum out of pocket spending under ACA 6k/year.

Thats not worth paying 8k for. Plain and simple the non subsidized, non-pool, small business people get raped by ACA as they dund the subsidies instead of the population as a whole. That's the truth. Douchebags like Krugman still refuse to admit it. Don't be that douchey person Jan.

And don't spit out irrelevant ACA talking points like - hey we forced you to buy a better plan you didnt want now go out and spend a lot on minor healthcare care costs you don't need, douchebag.

6k for an individual. If you have a family it is $13k before adding in the premiums, which could easily take you over $20k.

Jan turns out to be wrong again. A 2 person or family plan can be up to 13k

you're a real populist, tyler....hey, they can just eat more beans, right?

Here is a potentially interesting hypothesis (one which I do not think is true, by the way)... He actually does care, but he is, to put it as politely as possible, easily fooled by uber-credentialed people who do not care, but who have worked hard to enjoy, for pseudo-Pascalian reasons, the feeling of being seen to care ,within their high-IQ low-empathy communities. How many commenters on a typical economics blog could, if woken up in the middle of the night and asked to state how many other people they cared about, could come up with even a fleetingly Christian answer?

I have never worked as a graduate student at a college, but from what I hear on the internet from grad students who work or worked as research assistants etc while getting their science phd's etc, there are a whole lot of sociopathic, extremely exploitative professors out there.

Ironically, an emergent feature of the recent health care legislation is that it is too intrusive, even if you don't care about it it cares about you, and likes to play favorites. It is like a new religion that way.

i m driving me p/u, thru the hills, . . .

Mississippi opted out of the Medicaid expansion. This is intellectual malpractice.

That's pretty much a content-free post. There were good reasons for states to avoid getting sucked into that black hole.

Please list the reasons.

"Please list the reasons."

Money. Funds. Bucks. Dinero. Greenbacks. Specie. Wampum. Benjamins. Bread. Clams. Ducats. Lettuce. Folding stuff. Lucre. Moola. Simoleons.

http://www.beckershospitalreview.com/finance/medicaid-expansion-costs-1k-more-per-person-than-expected.html

dear f o's, listen 2a girl sing . . .

my fear is that at some point we realize america isn't nearly as valuable as the markets think it is. not just a tech, or education or health bubble but that when taken into perspective everything here is overvalued and over leveraged.

Oh, the humanity.

"in politics the people who suffer the most often end up with the biggest say."

Really? Both empirical evidence and public choice theory point towards the already influential having the most influence. Almost by definition, those with the most influence tend to suffer the least.

And to the extent that it is true (such as which US state suffers the most under a federal policy having the biggest say) isn't this normatively desirable due to risk aversion?

Tyler needs to be more careful with sources. Investors Business Daily is the paper that published the editorial stating that Stephen Hawking would be dead if he were under the British Healthcare system. Prof. Hawking replied 1) he is alive, 2) he is British, and 3) covered by their National Healthcare system.

Hawking has had a lot of help directly from companies that would not have done so if here were not Hawkins.

If he were the average Brit, he'd likely be dead.

I'm not sure why your claim (citation please) addresses the issue. I suspect your claim is correct because I doubt any country's health system would support the extensive personalized care and advance technology that Hawking benefits from; without which he would have been in a nursing home.

The point is that Britains NHS does not preclude people of means from getting the care Hawking received and that any claims from IBD should be regarded with skepticism.

I'll add I read Marginal Revolution because Tyler and Alex often have useful insights; unfortunately at times they sometimes don't filter well.

If he were the average Brit he wouldn't have ALS and would be doing fine. Keep calm and carry on.

I would be worried about this if it weren't obvious that Yazoo City is an entirely fictional locale that can't possibly exist outside of a Pynchon novel.

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