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August 10th, 2013:

Saturday video break: Twist And Shout

Song #7 on the Popdose Top 100 Covers list is “Twist And Shout”, originally by The Isley Brothers and covered by The Beatles. Here’s the original:

Dave Barry has written about how much he prefers this version to the Beatles’ version – he called it the kind of song that if it comes on the radio while you’re driving, “if you turn it up loud enough, [it] can propel you out of the car to dance with toll-booth attendants”. That was the column that ultimately led to his famous Book Of Bad Songs, after numerous readers strongly objected to his disparaging remarks about Neil Diamond. Oh, and see here for the excellent Jeff MacNelly cartoon that accompanied that column. How’s that for a digression? Now here’s the Beatles:

The ratio of song groovability to stiffness of the singers is just off the charts, isn’t it? Of course, if you’re of a certain age, you can’t help but associate that song with this movie:

I guess that proves Dave Barry’s point about dancing. I saw that in the theater back in the day with my college roomie and best friend Greg. Not long after, I wound up at Rice, in The MOB, where an arrangement of that was one of our staples. Yes, we danced, and sang the AAAAAAAH part, and we got everyone at Notre Dame’s football stadium to do it along with us in 1988, and it was all kinds of awesome. So yeah, positive memories with this song.

School superintendents for Early To Rise

From the press release:

(Houston, TX) Today Harris County Superintendents participated in a press conference for the Early to Rise campaign, which is seeking to create a dedicated funding stream to improve the quality of early childhood education through a ballot measure in November. Representing over 400,000 students and their families, the superintendents gave comments on the program. In attendance were Dr. Terry Grier Superintendent of Houston Independent School District, and Dr. Wanda Bamberg Superintendent of Aldine Independent School District. Dr. Mark Henry Superintendent of Cypress Fairbanks Independent School District, Dr. Guy Sconzo Superintendent of Humble Independent School District and Dr. Duncan Klussman of Spring Branch Independent School District, were unable to attend but provided comments.

This campaign has garnered the approval of over 145,000 of our fellow Harris County citizens who have signed a petition to place this important initiative on the November ballot, making it the largest petition drive in the history of Harris County. The Early to Rise campaign will help to raise the standards, training and educational outcomes for young children up to age 5 so that they can begin Kindergarten excited, curious and ready for school.

All representatives felt that making this kind of investment in early childhood education is absolutely critical to the region’s social progress and economic vitality. The first steps toward prosperity begin in the early years and this innovative effort is supported by extensive research.

That’s an impressive number of signatures. I presume they will turn in the petitions next week, to be followed by someone filing a lawsuit, because that’s what I’ve expected all along. As with Sheriff Garcia, it makes sense for school supers to support this. It’s very much in their interest for kids to show up for kinder as prepared for it as possible.

The exchanges are coming

Texas can resist all it wants, the health insurance exchanges will be here in 2014, with signups beginning in October, whether Rick Perry and Greg Abbott like it or not.

It's constitutional - deal with it

It’s constitutional – deal with it

The federal Health Insurance Marketplace at www.healthcare.gov is scheduled to open on Oct. 1 — two months from now. Enrollment will be open until March 31, though those who sign up before the end of the year can start getting coverage on Jan. 1.

For a little over half of Texans, health insurance will remain a job benefit. People who get health insurance through their employer won’t need to use the new insurance exchange. It is meant for people who buy insurance on their own, or who don’t have health insurance.

“The plans are going to be affordable, but we really haven’t seen what the prices are going to be yet,” said Mimi Garcia, Texas director of Enroll America, a nationwide campaign to get people to take advantage of insurance made available under the Affordable Care Act. The group has strong ties to President Barack Obama’s administration and to the health care industry.

Bert Marshall, president of Blue Cross Blue Shield of Texas, said recently that premiums are going up for individuals, but the cost will depend on subsidies keyed to a person’s income.

The Society of Actuaries (professionals who analyze the financial consequences of risk) took a detailed look at the cost of individual and small group insurance policies marketed across the country, and projected how the Affordable Care Act would change that landscape. In Texas, they estimated the monthly premium for the average individual policy would go from $249 in 2013 to $333 in 2014 under the Affordable Care Act.

The study also estimated that the uninsured rate in Texas would fall under the law from 27.1 percent of the population to 10.2 percent.

Federal health official Hash said premiums have come in lower than expected in several states that have announced average rates, such as California, New York and Montana.

[…]

Currently, the state’s individual insurance market, where people buy coverage for themselves with no help from an employer, serves only about 5 percent of the population. The market is unavailable to or prohibitively expensive for people with chronic health conditions, said former Texas Medicaid official Anne Dunkelberg.

“The current individual market includes few older or sicker people — they are either denied or priced out,” said Dunkelberg, associate director of the Center for Public Policy Priorities, which supports the federal law and advocates for low- and moderate-income Texans.

“Only the sickest and those who can afford it get [state] risk pool coverage,” she said, referring to a subsidy program for 23,000 Texans, including nearly 2,400 in Dallas County and 1,400 in Collin County.

It is scheduled to cease operations when the federal law’s ban of denying a person coverage for a pre-existing condition takes effect Jan. 1.

“Average rates must increase when we move to a world where no one is denied,” Dunkelberg said.

[…]

This year, thousands of individual insurance policies were available in Texas with annual premiums ranging from $363 for a single, nonsmoking man under 30 to $8,387 for a single 30-year-old woman who smokes. The plan costing the least — $30.25 a month — is a catastrophic care policy that doesn’t provide insurance until after the policyholder spends $10,000, and then only picks up half the tab until the policyholder has spent $17,000.

The most expensive policy — at $698.92 a month — provides insurance once the policyholder has spent $500. It picks up 80 percent of the cost of healthcare until the policyholder has spent $3,000, and then absorbs all of the cost.

The variety of plans won’t necessarily end once the Obamacare marketplace goes into effect. But unless the plans meet the requirements of the new law, purchasers could still face the penalty for not buying insurance. In 2014, that penalty will be $95 or 1 percent of income, whichever is greater. The penalty increases in 2015.

Cigna’s Smithberger said premiums in Texas could go down as well as up, depending on the buyer. The Affordable Care Act limits the difference insurers can charge because of a person’s age, for example. That could mean higher premiums for young people, but lower premiums for someone older.

“I would venture to say even in Texas some people may be seeing significant premium decreases based on their age and health status,” he said.

You can find that Society of Actuaries study, which was released in March, here, with the data here. Note that in a previous post I said that full participation in the exchanges could lead to Texas’ share of uninsured people to drop from 27.1% to 14.9%. The DMN story says 10.2%, which I believe is a mis-reading of the data. That lower figure is what the uninsured population would be if Texas also expanded Medicaid. In the absence of Medicaid expansion, which is the situation we are dealing with, the higher figure applies. The tables from which I get this are S1 and S2 on pages 7 and 8.

Note also that when one talks about the cost of policies under the Affordable Care Act and the insurance exchanges, it’s policies on the individual market that we’re talking about. If you get your insurance through your employer (or your spouse/partner’s employer) or some other group, that’s not a part of this calculation, as those policies are not part of the exchange. This is a point that Kaiser Health News attempted to clear up:

Q: Does the study predict health insurance premiums will go up 32 percent by 2017?

No. First, it’s only forecasting the individual insurance market. That’s where millions of Americans newly covered under the ACA are expected to find policies. The report says nothing about costs for employer-based health insurance.

Equally important, the 32 percent forecast is for medical expenses paid by insurers, not what insurers will charge in premiums, and not what consumers will pay.

Q: But if medical claims go up, shouldn’t insurance prices also go up? How much difference could there be?

A: In the individual market designed under the health law, quite a bit, say supporters. The ACA limits insurer profits and also gives government regulators oversight of rate increases, both of which could hold premiums down.

Even if sticker prices rise, an important feature of the health law is subsidies for people to buy insurance, through tax credits for those with lower incomes. So what many newly-insured people actually end up paying themselves won’t be the same as what the insurance company bills.

Thanks partly to subsidies, “many people buying individual coverage today will see decreases in costs,” said Larry Levitt, senior vice president at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

Insurers who end up signing lots of sicker members will also be partly reimbursed for several years by a reinsurance pool designed to lower their risk. That will lower their expenses, and it wasn’t accounted for by the SOA study.

Q: Does it matter where I live?

A: Yes. The report found huge variability, based on geography. While the estimated increase would be 62 percent for California by 2017, in New York state, the report estimates claim costs would drop by almost 14 percent.

Q: Will health plans offer the same coverage in 2017 that they do now?

A: That’s another reason the 32-percent headline could be misleading. Thanks to ACA minimum coverage requirements, benefits will be more generous starting next year. So what insurers pay in claims can expected to be higher, too.

“The number of people who are underinsured has grown dramatically over the last decade,” said Sara Collins, a vice president at the Commonwealth Fund. “One reason claims might be a lot lower now is the benefit package is so crummy.”

The health law was intended to shift spending into the commercial insurance system that is now outside it: high out-of-pocket costs for those in low-benefit plans; uncompensated emergency-room care; patients paying in cash, and so forth. Moving those costs under the insurance umbrella increases insurance-based spending.

Q: The idea of the insurance exchanges is to create competition, isn’t that supposed to lower costs?

A: Yes. The idea behind state health exchanges is that insurers will compete for business by pressing providers for discounts and passing part of the savings to members. The actuary study didn’t account for that kind of competition.

“Every insurer I’ve talked to says they’re building lower-cost networks that they plan to use for their exchange plans,” said Levitt.

It’s a complex situation with a fair bit of nuance, which means that it’s ripe pickings for all manner of liars, hucksters, and shameless partisan hacks who want to see this fail because they care more about their ideology than a bunch of uninsured people. The bottom line is that unless you are currently uninsured, you are almost certainly not going to be directly affected by this. If you are currently uninsured, you will have the ability to buy an affordable health insurance plan that actually covers things. You’ll have to make some decisions about how much you want to spend for varying levels of coverage, but the choices you’ll have will be realistic and worthwhile. Keep all that in mind when you see some apocalyptic warnings in your inbox or on your Facebook wall. Consider the source, because there’s going to be a lot of propaganda and misinformation out there. Thankfully, as of October, we’ll have some hard facts. Hang on till then.

A reduction in funding for women’s health leads to fewer women getting health care

Shocking, I know.

Right there with them

Right there with them

The number of claims filed for medical and family planning services in the new state-run Texas Women’s Health Program has dropped since the state ousted Planned Parenthood from it and set up its own program without federal financing, according to figures from the Health and Human Services Commission.

Stephanie Goodman, a spokeswoman for the commission, wrote in an email that the program is “running at about 77 percent of the number of claims this year compared to last year.” She added that the agency expects to “see a similar trend with the number of women served,” though those numbers are more difficult to calculate.

“We expected to see a drop-off in the number of claims when we moved to the state program because we knew some women wouldn’t want to change doctors,” Goodman said. “We’ve been able to find new doctors for women who call us, and we’ve got the capacity to increase the number of women we’re serving in the state program.”

[…]

While Planned Parenthood continues to provide services with community donations and other revenue, Danielle Wells, a spokeswoman with Planned Parenthood of Greater Texas, said many patients have expressed frustration “that politicians are telling them where they should and should not go for their health care.”

“We’re still hearing from patients who were in the program and were unable to locate a provider or schedule services in a timely manner,” she said. The exclusion of Planned Parenthood requires many women to travel farther to find an available provider, she said, and to make “tough decisions about paying out of pocket for care or simply putting off vital care that could potentially save lives.”

Amanda Stevenson, a research associate at the University of Texas at Austin’s Texas Policy Evaluation Project, a three-year study evaluating the impact of the 2011 women’s health policy changes, said determining whether women still have adequate access to care is complicated. While the health commission is working hard to enroll new providers to replace Planned Parenthood, she said women may delay care because they do not know which providers are available or end up paying out of pocket costs by continuing to seek services at a Planned Parenthood clinic.

“We’re seeing obviously that access is diminishing in places, particularly [those] that rely heavily on Planned Parenthood providers,” she said. But other areas of the state have not been as affected by the policy changes, she added, referencing a data application created by the researchers that shows how the 2011 policy changes and funding cuts have affected women’s health services regionally.

She also noted that more data is necessary to determine whether the percent reduction in claims represents a persistent trend.

“If things were getting better then we would expect consistent reduction in that proportion, but it’s not happening,” Stevenson said. “There might be a trend, and we might see it, but it’s not enough here to say that it is.”

To be as fair as I can to something that doesn’t deserve fair treatment, Planned Parenthood had previously served forty percent of the Women’s Health Program clients, but the decline in participation is now only about 23% of the pre-cutoff total, which means that at least some of the women who were directly affected by this bit of ideological bloodletting have since found an acceptable alternative. Hooray for small victories. Of course, they were all still forced to change doctors, and we have no way of knowing how much less convenient or more expensive these new arrangements are for them. And Lord knows the people that brought you this little catastrophe aren’t interested in finding out the answer to that. But again, as I said before, even if you could reasonably claim that access to health care is no worse than it was before, hundreds of thousands of women had their access to health care disrupted, for no good reason. And a lot of legislators plus our state leaders count that as a victory.

In related news, that ballyhooed restoration of family planning funds this session is less than meets the eye.

The Texas Women’s Healthcare Coalition has raised concerns that a bipartisan effort to restore access to family planning services by expanding a state-run primary care program isn’t shaping up as planned.

During hearings in the regular legislative session, David Lakey, the commissioner of the Department of State Health Services, told lawmakers that 60 percent of the $100 million allotted to expand the primary care program for women’s health care in the 2014-15 biennium would be used to provide family planning services and contraception. But the forms created by DSHS for health providers to apply to take part in the program do not explicitly state that 60 percent of providers’ services must go toward family planning.

In a letter sent Monday to DSHS and lawmakers, the coalition — which counts the Texas Medical Association, Texas Academy of Family Physicians and Texas Association of Community Health Centers among its 39 members — argued that the proposed rules don’t ensure that the program will achieve lawmakers’ intent of restoring access to family planning services.

“We’re concerned that this was really like a bait and switch,” Dr. Janet Realini, chairwoman of the coalition, said in an interview. Although she does not believe DSHS has intentionally disregarded the legislative intent to increase family planning services, she said, “the system to do that is missing an essential piece of direction for the contractors.”

Carrie Williams, a spokeswoman for DSHS, said the department received the coalition’s letter and is working to clear up misunderstandings about the program.

“We’ve been very open in developing and talking about this program, so it was disappointing to see these inaccuracies being promoted as fact,” Williams said in an email to the Tribune.

She added that family planning services are emphasized throughout the department’s materials on the program, but that the program does not exclusively provide family planning services.

“The 60 percent target for family planning was what we have been proposing all along. While that threshold is not explicitly stated in the materials, it has long been the plan and we have never indicated otherwise,” said Williams.

In its letter, the coalition recommended that the department explicitly prioritize family planning services by setting specific targets and performance measures for contractors. The state could save money and avert unintended pregnancies, the coalition argues, by setting performance targets for family planning services and giving funding priority to contractors that have demonstrated the ability to provide these types of services.

“I think putting it in the materials to let contractors know what you’re looking for is important,” said Realini.

In the private sector, we call that setting metrics. Metrics reflect goals and values. You can draw your own conclusions.

Chron for Uber

The Chron editorializes in favor of Council approving a change to city ordinances that would allow Uber to set up shop here.

Uber, a car service software company, wants to start operating in Houston so that folks can reserve Town Cars via their smart phones. Unfortunately, city ordinances place strict prohibitions on how taxi, Town Car and limousine services operate within city limits. This is a great policy if you’re a taxi company trying to avoid competition. But, as with most regulatory capture, it doesn’t really benefit anyone else.

Houston is supposed to be fertile ground for entrepreneurs and a prime example of a free market. City Council should live up to that promise and update Chapter 46 of the City of Houston Code of Ordinances to let businesses like Uber operate in Houston.

In dozens of cities (including Dallas), Uber allows people to use a smart phone application to arrange rides with otherwise unoccupied Town Cars. Think of it as an Orbitz or Expedia for car service companies. Riders can even use the app to review specific drivers and get an estimate on a trip’s cost before riding, which is tracked by GPS.

Houston’s regulations prevent Town Cars from charging less than $70 and require that rides be arranged at least minutes in advance. So if you wanted to use Uber to book a ride from a Mont-rose restaurant to the Theater District, the city would require that you overpay and wait 30 minutes, even if there is a car around the corner.

These restrictions serve no purpose but to force Houstonians to take taxis, and unless you’re in downtown or at a hotel, taxis may as well not exist in Houston. Sure, you could reserve a pick-up, but at that point they’re not really acting as cabs. They’re acting as inexpensive Town Cars, but for the guaranteed pick-up and quality of service.

See here and here for previous blogging on the subject. I don’t have much to add at this time, but as you know I am generally in agreement with the Chron on this. The taxi folks have set up a meeting for several of us local bloggers to present their perspective on things, as I noted in my last entry, and I’ll be sure to report on that afterward. In the meantime, two points to note. One is that there is already an app to hail a cab in Houston. I couldn’t tell you the last time I took a cab in Houston, so I have no experience with this. Have you ever used it? Also, in the course of my normal Internet surfing I came across this account of using Uber by Mark Evanier. Executive summary: He really liked it. Make of that what you will.