J.K. Wall has a good article for the IBJ (h/t Indiana Law Blog entitled Ruling Could Leave 290k Hoosiers Uncovered. It’s a good article that you should read, but I disagree with the title. It’s not the ruling that would leave Hoosiers uncovered. The fault, dear Brutus, is not in our stars, but in ourselves; or rather, it would be in our lawmakers.

After last week’s U.S. Supreme Court ruling gave Indiana the option not to expand its Medicaid program and some state legislators promised to do exactly that, Indiana hospitals started to worry.

That’s because a decision by Indiana to leave its Medicaid program unchanged could leave as many as 290,000 Hoosier adults, who would have been newly eligible for Medicaid coverage, with no good options.

Out of mostly political pique, lawmakers could decide to take it out on those 300k Hoosiers who don’t qualify for Medicaid as currently structured but who would qualify for the Medicaid expansion because their income is 133% of the poverty level or less (about $32,000 for a family of four). I believe the rest of the health care reform law focuses on solutions for people with incomes above that level with the underlying assumption being that those earning below that level would have been covered by the Medicaid expansion. This gap includes pretty much all of the non-disabled, childless poor as well as adults with children if the family income is between about $6,000 and that $32,000 mark. In particular, it is:

[I]t is parents with incomes below 100 percent of the poverty limit and above 24 percent of the limit—as well as all childless adults below the poverty limit—that would be left out if Indiana did not expand its Medicaid program.

The reason federal lawmakers made the assumption that states would expand is because, as written, the law was pretty draconian in its response to states that did not expand — it defunded even current federal Medicaid contributions. The Supreme Court deemed that too coercive and struck the defunding provision, giving states much more freedom to decline expansion. There may be dispassionate policy arguments against expansion; but we are unlikely to get a dispassionate approach to this issue from lawmakers. Health care policy has been heavily politicized, and declining or agreeing to participate in the Medicaid expansion will be as much a tribal marker as anything else. If you’re not of Obama’s tribe, you’ll vote against expansion. If you are of Obama’s tribe, you’ll vote for it. Policy reasons will be given; but it’s difficult to believe at this juncture that those ostensible reasons will be much more than pretextual.

Apparently this would represent a serious blow to hospitals who would get Medicaid reimbursements of about $0.60 on the dollar for this group of people (leaving aside for a moment the huge issue about setting the proper baseline for medical costs) instead of the approximately $0.10 on the dollar they currently are able to realize on bad debt associated with this population. A study commissioned by Gov. Daniels (not necessarily a neutral actor) had Indiana’s share of expanded coverage at about $160 million per year between 2014 – 2020. (By my back of the napkin math, this represents about $533 per covered individual or about $23 per Hoosier per year; however you want to cut it.)

The Courier Press has an editorial on the health care decision. (An aside: I wonder if perception of the decision will be altered because it doesn’t have a snappy name like “Bush v. Gore” or “Brown v. Board of Education.” – National Federation of Independent Businesses v. Sebelius (pdf) doesn’t exactly roll off the tongue.)

The editorial noted a Rasmussen poll (a polling outfit that generally has its thumb on the right side of the scale) that said 54% of likely voters favored a ruling that the act was unconstitutional. But then it correctly noted that rulings on constitutionality shouldn’t be popularity contests. (Reminds me of the Onion piece: “Area Man Passionate Defender of What He Imagines the Constitution to Be” — “Mortensen told reporters that he’ll fight until the bitter end for what he roughly supposes the Constitution to be.”)

The Courier Press editorial says that upholding the mandate requirement will result in 30 million people being obligated to buy health insurance; of which maybe 4 million will opt to pay the penalty instead.

My understanding is that the impact on the uninsured is roughly as follows:

#No need to buy insurance if your income is below the tax reporting threshold. ($9,500 single; $19,000 married filing jointly).

#No need to buy insurance if the premium exceeds 8% of your household income.

#Option to pay the penalty instead of buying insurance. The penalty will start lower but will reach $695 or 2.5% of income. So, if you go with the penalty-as-tax rationale, it’s a 2.5% tax increase offset by a tax credit for those who buy health insurance.

The mandate is a necessary trade off for limiting or eliminating an insurer’s ability to deny coverage. Health insurance only works when there is uncertainty about who is going to get sick – we might be able to estimate the total incidence of sickness and the total cost of managing that sickness. That cost is manageable over the group as a whole but potentially unmanageable to any given individual. Each individual in the group is willing to kick-in to cover the costs in order guard against the possibility that particular individual might be the one who gets sick. It’s a way of managing risk. Once you have certainty as to who is sick, you are no longer managing risk.

If insurers can no longer deny coverage for pre-existing conditions, the incentive is gone to pay up front to manage risk. You just wait until you get sick before spending your money on insurance. That’s why they need to mandate purchase of insurance – or come up with some other way to make sure you’re kicking into the pool. Insurance only works when the healthy are subsidizing the sick.

In any case, I think we all need to do a better job of learning about and explaining to others the details of this health care bill. That 54% opposed number goes way down when the people are asked about the specifics of the plan. It’s only when it’s this vague abstraction called “Obamacare” that people really dig in their heels. And as a corollary to that, opponents of Obamacare should really be pressed on their alternate plans. The status quo is unsustainable and pretty much no one will go on record as being in favor of the status quo. But plans to repeal Obamacare immediately with only vague hand waving about an alternate system is nothing more than a plan to continue with the broken, expensive system we have now.

Now that the healthcare reform law has been upheld, I think there are at least two areas where the states (including Indiana) have to take action.

One area is Medicaid expansion. As written, I think the law basically forced states into expanding their Medicaid program. It penalized states for not expanding their Medicaid programs by gutting (eliminating?) federal funding for their existing programs. One majority of the court held that this penalty was unconstitutionally coercive. A separate majority of the court held that the remedy for this unconstitutional coercion was, basically, to read it out of the statute. So, states don’t put their existing Medicaid programs at risk by declining to adopt the expansion.

The expansion itself provides for Medicaid coverage to individuals with income 133% of the poverty line or below. This is up from something like 65% currently along with a requirement that you meet one of the eligibility categories. (Broadly speaking – there are nuances.) The federal government would pay all of the expansion expenses for the first few years and then requiring the states to contribute incrementally more, up to 10% of the costs in 2020 and thereafter. Now states have to decide whether they want to take the 90% federal government match or not. From a pure state cost/benefit perspective, it’s tough to walk away. But, from a political perspective, I imagine that a lot of red states will turn away the federal money at the expense of their poorer citizens.

The other major state action I know about has to do with healthcare exchanges. I’m going from an explanation from an acquaintance whose opinion I trust. What the law mandates, as I understand it, is that each state (or group of states) create an insurance exchange. If they don’t, the federal government will do it for them. Each exchange must have at least two insurance companies competing in it, of which one must be a not for profit. If not, the federal government will create a not-for-profit mutual insurance company. Inaction will, therefore, lead to federal interference.

The stories out of Colorado Springs about the Waldo Canyon fire are pretty horrific. Here is a recent one from the Guardian. Next to Indiana and Ohio, Colorado is probably the state I know best. My Dad moved there sometime around 1978, and I’ve been going there ever since. It’s where I first learned about drought. And probably something about government antipathy — I seem to recall picking up some dissatisfaction about water policy. (In particular, I remember flushing the toilet and saying, “there goes the water to Denver” to some general levity from adults in the vicinity.)

A couple of notes: 1) The idiots who pointed to snow storms as evidence that Al Gore was stupid and wrong about global warming should be offered up as human fire breaks. This doesn’t prove the case for global warming – just that they’re misguided for conflating weather with climate.

2) These fires go well beyond anything individuals can contend with on their own. Government is vitally necessary to combat the flame and will be vitally necessary to deal with the aftermath. It should be interesting to see how Colorado Springs – a hotbed of anti-government sentiment copes with that reality. My guess is by grabbing federal money and resources with both hands, ignoring the dissonance, and, if confronted, by explaining that their only against other, unspecified, types of evil government.

Also, as a final note, Indiana is dryer than I remember seeing it. The fireworks lobby is making noises about what a bad idea and potentially illegal for governments to restrict fireworks use. I’ve seen individuals grumping about their god-given right to use fireworks around the Fourth of July. Without getting too deep into the weeds on this issue just now, don’t be stupid people. I know the fireworks people need to make money, and people like to celebrate their country by blowing stuff up. But sending hot, flamey things into bone dry vegetation puts everyone at risk.

The fine folks at Mario Marathon are at it again; setting themselves a grueling task of playing video games to raise money for the kids. They got started on Friday, June 22 at 11 and, I believe, will take it through Monday the 25th. They are raising donations for the Child’s Play charity which, generally speaking, supplies games to hospitals for use by kids who have to be there.

In the spirit of the occasion, I will share my Mario story. It was the fall of 1990, a chilly night in November, if memory serves. I was dating a nice Pentecostal girl; and, after dating for several months, apparently the fact that I did not share her faith had become an issue. She was crying because she cared for me and I was going to hell because I didn’t believe what she had been told to believe. Strong words were exchanged, and I went back to my place. Super Mario Brothers for the NES was the obvious path back to emotional equilibrium. That and beer. A lot of beer. In fact, I got it into my head to drink an Old Milwaukee as I played each of Mario’s 8 worlds. Eight beers in eight worlds. A challenge for the ages!

This might have been an unachievable goal if it weren’t for the turtle tipping glitch on Level 3-1; that allows you to get 99 lives. So, I had plenty of Mario cannon fodder as the levels, the beers, and the difficulty mounted. Ultimately, I achieved my goal, calmed my emotions, and found a girl who was much more suitable for me. My point is that Mario works! So, please wander on over to Mario Marathon and donate.

One theme I keep coming back to in this blog is an annoyance at the notion that there was some perfect yesterday from which we are in decline. I notice it probably most often in those seemingly evergreen pieces that bemoan the state of “kids these days.”

Doghouse Riley takes down Maureen Dowd who apparently wrote one of those “things fall apart” columns in relation to the Jerry Sandusky matter. She suggests that our “formerly hallowed institutions” are sinking into a moral dystopia; leaving our sense of right and wrong more malleable. To which Doghouse responds:

Listen, I dunno about you, but I was filled to dyspepsia with mid-range Boomers like Dowd pretending there were such things as hallowed institutions and icons in their (my) youth, which have mysteriously sunk into anything in the interim, around two decades ago. Pius the Fucking Twelfth for the win, MoDo. These institutions were hallowed-out by the end of the 19th century. Did two World Wars escape your notice growing up? Maybe they weren’t routinely ignoring boy-buggering football coaches at Penn State in the 1950s. Would you care to guarantee it?

(Internal link added). This notion that humans have been in a state of decline since being ousted from Eden drives me nuts. It’s a kind of fatalism that’s frequently used to blame other (presumably lesser) people for things you don’t like. It allows you to sit on your ass, do nothing to change yourself or those around you, and bask in your moral superiority.

Humanity is not entirely good or entirely evil. We have a stunning array of coalitions of the two, both within ourselves and among others. Those coalitions are constantly regrouping, preserving, destroying and building. And if you think that, at one time, there was a center holding it together, that’s because you weren’t stepping back far enough to have much perspective. Like thinking the earth is the center because you have no notion of the sun or that the sun is the center because you have no notion of the galaxy, and on and on.

The kids are all right.

So, being a Dad has become pretty much the most important thing in my life. Funny, that. Before kids, I’ll be honest, I had little to no use for them. And, I knew it would be different for my kids – and I knew that I wanted kids; but there is no way I ever would have understood on a visceral level until I got my own.

I know that, from time to time, I’ll have occasion to eat my words; but, so far, I seem pretty good at it. My kids are generally well adjusted and well behaved. They even seem to like me. Of course, they’re 6 and 8 — that might be the easiest level there is. Liking you is just what they do. And the ways you screwed them up are often like seeds that take a bunch of years to really sprout. But, as the saying goes, you can only play the games on your schedule. And, so far, there seem to be more wins than losses.

Half (or probably a lot more than half) of the battle, of course, is having a spouse that makes you look good. Since I’m using sports analogies, and since it’s father’s day, I get to be the quarterback in this one. When your spouse is an unbeatable offensive line, you’re going to complete a lot of passes. I’m fairly sure that’s what is going on in my case.

There are guys who don’t seem to take these things seriously, and now *that’s* what I can’t seem to understand on a visceral level. I can understand, day-to-day that this or that might seem more fun or rewarding than whatever you should be doing with your family. And, frankly, if you don’t throw in some fun from time-to-time, you’ll end up not being a terribly good dad. But, as a life strategy, the more rewarding of life’s undertakings are slow, subtle, and hard. But, ultimately, worthwhile.

Happy father’s day to all you good dads out there!

Couple hundred million here, couple hundred million there, and eventually lawmakers are going to decide to take a closer look. That’s what’s happening with the state government. Niki Kelly reports that the State is going to hire Deloitte to take a look at the $500 million in “financial miscues” by the Indiana Department of Revenue.

Instead of financial miscues, I think we should call them “whoopsies”.

Lore Sjoberg, writing in Wired, has some good commentary about the spacecraft Dragon visiting the International Space Station and delivering food and computers to astronauts. The Dragon is a privately built and funded vehicle. This, Sjoberg notes, means the function is becoming routine; aside from the whole vacuum of space business, it’s like a long-haul trucker delivering goods to a government warehouse. He looks forward to the day it becomes so routine we have a corrupt and inefficient Space Docker’s union and we get maudlin country-western songs about the lonely but honest life of a geosynchronous cargo handler.

That said, I agree with Neil Degrasse Tyson who said that what makes many of us sad about the retirement of the space shuttle Discovery is that it was done without something else ready to go. We didn’t bemoan the end of the Mercury program when you had Gemini and Apollo ready to go. And, make no mistake, private enterprise will not forge new ground in this area. It might perfect and improve the ground already covered, but you won’t see private business pioneering planetary colonization or interstellar flight. Profit in those areas are far too uncertain. You needed Prince Henry the Navigator to get the Portuguese moving, you needed Queen Isabella for Columbus, and you needed the British Navy to get Captain Cook plying the Pacific. Once the exploration is done, private business will come along after to develop things, but you need a sovereign with something other than a spreadsheet in mind to jump start the project.

I might be getting the real world mixed up with Caddy Shack again, but it was something like that. Judge Smails Superintendent Bennett tells an aspiring student who can’t afford college, “The world needs ditch diggers, too.” “College isn’t for everyone.”

In reality, college — or more to the point, the expense of college — maybe isn’t for everyone. But, I’d probably let parents and families make that decision. Having the top educator send that message strikes me as a bad idea. He should be sending the message that education is valuable for its own sake. Instead, he is sending the message that education is valuable only insofar as it trains an individual for an occupation.

Individual enlightenment and betterment might be fine for the sorts of people who can afford college without government assistance, but for the rabble, your purpose on this earth is to labor for as long as you can without creating negative entries on the balance sheet.