Must-Read: CBO: American Health Care Act

Must-Read: CBO: American Health Care Act: “CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law…

…Later, following additional changes to subsidies for insurance purchased in the nongroup market and to the Medicaid program, the increase in the number of uninsured people relative to the number under current law would rise to 21 million in 2020 and then to 24 million in 2026… in large part from changes in Medicaid enrollment—because some states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee spending in the program would be capped. In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law….

In CBO and JCT’s assessment, however, the nongroup market would probably be stable in most areas under either current law or the legislation. Under current law, most subsidized enrollees purchasing health insurance coverage in the nongroup market are largely insulated from increases in premiums because their out-of-pocket payments for premiums are based on a percentage of their income; the government pays the difference…. Under the legislation… subsidies to purchase insurance, which would maintain sufficient demand for insurance by people with low health care expenditures, and grants to states from the Patient and State Stability Fund… would, in the agencies’ view, lower average premiums enough to attract a sufficient number of relatively healthy people to stabilize the market….

The ways in which federal agencies, states, insurers, employers, individuals, doctors, hospitals, and other affected parties would respond to the changes made by the legislation are all difficult to predict, so the estimates in this report are uncertain. But CBO and JCT have endeavored to develop estimates that are in the middle of the distribution of potential outcomes.

Must- and Should-Reads: March 13, 2017


Interesting Reads:

Must-Read: Kevin Drum: Trump OMB Director Claims Obama “Manipulated” the Unemployment Figures

Must-Read: Why are economists who work for Trump still received in polite society? John Taylor, Mike Boskin, Greg Mankiw, Glenn Hubbard, Ed Lazear, Ben Bernanke, Harvey Rosen, Marty Feldstein, Alan Greenspan, George Shultz: this mess is on your side of the fence–you clean it up. Please.

Kevin Drum: Trump OMB Director Claims Obama “Manipulated” the Unemployment Figures: “Along comes OMB Director Mick Mulvaney…

…to add yet another ugly accusation:

We thought for a long time, I did, that the Obama administration was manipulating the numbers in terms of the number of people in the workforce to make the unemployment rate, that percentage rate, look smaller than it actually was…. The BLS did not change the way they count, I don’t think, but you can have a long conversation when you’ve got a numerator and a denominator, how to arrive at a percentage…

Should-Read: Ben Thompson: Breaking Down the Father on BBC Being Interrupted by His Children

Should-Read: Ben Thompson: Breaking Down the Father on BBC Being Interrupted by His Children: “There seemed to be a special resonance to this clip of a father in South Korea…

…commenting on the removal of once-President Park Geun-hye, only to be interrupted on live TV by his kids breaking into his home office. If I might say so myself, I am uniquely qualified to break this video down: I’ve been on TV from a home office, I have children, and, crucially, I am a man (who like Robert E Kelly, our protagonist, lives in Asia)….

I tweeted today, “There but for the Grace of God Go I”. You know what though? Being Professor Kelly seems like a pretty good gig: a nice house, a nice look, an irrepressible daughter, a shockingly mobile baby, and a wife that will do anything to help him succeed.

Plus he gets to be on the BBC.

Should-Read: Aaron Carroll: The AHCA Doesn’t Make Sense

Should-Read: Two possibilities:

  1. Paul Ryan and company are simply not competent–somebody put a real, highly punitive continuous coverage requirement into the ObamaCare Repeal bill; somebody else said “that’s too punitive” and changed it; and nobody did the addition.

  2. Paul Ryan and company want this bill–if passed–to lead to an adverse selection meltdown of their (or, rather, Trump’s) health care exchanges.

Is there a third alternative?

Aaron Carroll: The AHCA Doesn’t Make Sense: “I’m having a really hard time with this…

…The Republicans hate the individual mandate. I get that…. They also, however, understand the need for some sort of carrot/stick to get healthy people to buy insurance so that we don’t get adverse selection and see the private insurance market enter a death spiral. So they need to replace it…. I’m not saying that you can’t replace the individual mandate.

Many… believe that too few healthy people are joining the exchanges…. To fix that, we could increase the size of the mandate penalty (stick), increase the size of the subsidies to make insurance cheaper (carrot), or both (carrot and stick). The AHCA plan, though… eliminates the stick… reduces the carrot… puts in a… 30% insurance markup if people lose continuous coverage…. That’s a tiny, tiny penalty in the scheme of things. Let’s say I’m single and I’m in my late 20’s, and insurance costs me $3000. With the promised $2000 subsidy, I’d have to pay $1000 more to get insurance. Or… I could just forego it this year, and if I need it next year, it will cost me $3900 (I will owe $1900). In just one year, I make money. If I skip a number of years, I can save even more. I’m not sure this is much of a stick….

Once I’m out of the market, I’m left alone. It’s not until I re-enter that I’m hit with the penalty. The longer I stay out, the longer I avoid the pain. It’s an inducement to remain uninsured. We know what needs to happen to reduce adverse selection. We need to make the carrots and/or sticks stronger. This seems to do the opposite. I don’t get it.

Does targeted or universal pre-Kindergarten better serve low-income kids?

Pre-K teacher Epernay Kyles, center, talks about class activities with her students.

Investing in early childhood education is a research-backed, cost-effective strategy for boosting long-term U.S. economic growth. For instance, economics Nobel Laureate James Heckman’s analyses of two comprehensive early childhood programs suggest a 7 percent to 13 percent annual return on investment in improved school and labor-market outcomes, as well as reduced public costs in remedial education, health, and criminal justice spending.

While the imperfect consensus is that early childhood education is a solid investment, we know far less about how best to ensure efficient spending of public dollars. The readiness gap between lower- and higher-income children shows up on the very first day of kindergarten, suggesting a persistent need for effective investment in low-income children. Indeed, this gap was part of the impetus behind the federally funded and means-tested Head Start program, which began in 1965 as part of President Lyndon Johnson’s War on Poverty and today serves about 1 million poor 3- and 4-year-olds annually.

Yet the federal Head Start program serves fewer than half of all eligible children due to chronic underfunding of the program. Moreover, millions more working families with incomes above the federal poverty level ($20,090 for a family of three in 2015) face severe economic pressure from high and rising childcare costs. In the absence of federal action, state experimentation with public pre-Kindergarten has blossomed over the past decade.

Forty-two states plus the District of Columbia offer some version of publicly funded pre-K, but the allocation of funds varies dramatically across programs. State programs can be roughly divided into three categories. One is universal, low-standard programs, which provide universal access to age-eligible children regardless of income but with few and/or low standards—Florida’s pre-K program exemplifies this approach. Another is targeted programs, which are means-tested or targeted to address other risk factors, with stringent state standards—Tennessee is a prime example of this approach. And the third category is universal, high-standard programs, which provide universal access and have stringent state standards for quality. Georgia and Oklahoma have such pre-K programs in place.

Which type of program best achieves the goal of boosting achievement for low-income children?

New research from Dartmouth University economist Elizabeth Cascio provides compelling evidence for the efficacy of high-quality universal pre-K as compared to high-quality programs targeted at disadvantaged children. Using a large, nationally representative dataset that allows her to track outcomes for a cohort of children born in 2001, Cascio isolates the causal impact of pre-K attendance on a range of academic and social-emotional outcomes for low- and high-income children across different types of programs. In general, she concludes that “state-funded pre-K appears to be more effective for low-income children when programs are universal rather than targeted.”

Specifically, Cascio’s new research demonstrates that universal state-funded pre-K programs generate statistically significant and substantial positive improvements in early reading scores for low-income 4-year-olds. State-funded programs targeted to disadvantaged children do not. The same findings hold for improvements in early math scores and noncognitive social-emotional skills such as engagement and negativity, though the findings are less definitive on these two metrics.

Cascio also finds that universal pre-K boosts the performance of low-income children more than it increases the performance of higher-income students, thereby playing a significant role in closing the income-based achievement gap in kindergarten school readiness. Indeed, her estimates suggest that universal pre-K attendance can more than close the income-based test score gaps that exist prior to pre-K entry.

The differences between universal and targeted programs cannot be explained away by program requirements or by the demographics of the children and their families. Nor can they be explained away by the alternative preschool programming available to parents. Together, Cascio’s findings suggest that universal pre-K programs offer relatively high-quality learning environments as compared to targeted programs. Importantly, this research suggests that the quality of universal and targeted pre-K programs differ in important ways that are not reflected in typical measures of school or program quality or state standards.

So why do universal pre-K programs do a better job serving low-income students than programs specifically targeting poor kids? Universal programs may be of higher quality, even if they have the same formal quality standards as targeted programs. Peer effects also may explain much of this quality differential. Lower-income children may benefit from direct interaction with higher-income peers. If higher-income children enter pre-K more prepared, as suggested by the income achievement gaps of incoming pre-K students in Cascio’s data, then universal programs may attract and retain better teachers—for instance, teachers with warmer, more engaged, more creative, and more positive interactions with students.

In short, the presence of higher-income students in the classroom may change the expectations of what all children should learn, which can accelerate learnings gains for all students. Teachers and programs may be under more parental pressure to perform, especially if the engaged parent body includes higher-income, highly educated parents. They may also have access to a range of informal resources, including parental human capital.

While Cascio’s research provides some suggestive findings regarding the mechanisms through which universal pre-K programs are able to deliver for disadvantaged kids, more research remains to be done in this space. What we do know is that universal programs simply reach more kids, including many low-income students who are not quite poor enough for means-tested programs and thus would otherwise lack a quality preschool experience. In 2013, just 54.9 percent of all 3- and 4-year-olds were enrolled in any pre-primary school program, suggesting considerable room to increase preschool attendance. Cascio’s evidence suggests that low-income kids are better served by universal programs. The arithmetic seems to be adding up in favor of high-quality universal pre-K.

College may not be the great equalizer across race and ethnicity

Brooklyn College students walk between classes on campus in New York.

There’s a common perception that college is the great equalizer in the United States, a pathway to leveling the playing field between students from different socioeconomic groups. But the jury’s still out on whether that’s actually the case, at least according to two new papers. Amid conflicting answers to this question, research on the matter has often left out an equally important dimension: race and ethnicity.

There are many studies that previously explored the relationship between parents’ socioeconomic status and their children’s financial success post-college graduation. Adding to this literature, a recent working paper by Raj Chetty of Stanford University, John Friedman of Brown University, Emmanuel Saez and Danny Yagan of University of California, Berkeley, and Nicholas Turner of the U.S. Treasury Department makes the case that college may help equalize opportunities for students up and down the income ladder. The researchers find that while a student’s access to higher education depends on parental income, students from the same college have very similar earnings outcomes after graduation, regardless of their parents’ income.

Another recent study argues otherwise. Dirk Witteveen and Paul Attewell from the City University of New York show that four years and 10 years after graduation—even after controlling for college selectivity, major choice, and academic performance—there are substantial earnings gaps between students from lower-income families and students from the top.

The contradictory results between Chetty and his coauthors and Witteveen and Attewell surely complicates the debate on whether higher education is fulfilling its promise for students across the income spectrum. But both studies overlook a very important piece of the puzzle by leaving out race and ethnicity.

A new research brief published by the Federal Reserve Bank of St. Louis picks up at this exact intersection. Researchers William Emmons and Lowell Rickets highlight that trends in access to college and post-graduation outcomes vary tremendously by race. While college enrollment gaps between African American and Latino students and their white counterparts are narrowing, the researchers show that the four-year-college completion rate gaps are not. They refer to these differences as “quantity gaps.”

After college, the researchers find that “quality gaps” begin to appear. Specifically, Emmons and Rickets find that African Americans and Latinos with a college degree earn 80 percent and 70 percent, respectively, of the median income of a white family, and 10 percent and 13 percent, respectively, of the median net worth of a white family. Across race and ethnicity, college doesn’t have equal financial returns. In an extended version of Emmons and Rickets’ analysis, they assert that college’s promise is going unfulfilled for people of color primarily because of longstanding discrimination in higher education and the workforce.

All this is not to say that higher education isn’t valuable. On the contrary, it is well-established that a college degree generally affords better economic outcomes for every demographic group than a high school degree alone. Yet skepticism about whether college is the great equalizer begets questions about not only the U.S. higher education system but also the labor market’s shortcomings and structural racism’s role in it all.

Should-Read: Paul Krugman: Smart Republicans?

Should-Read: Paul Krugman: Smart Republicans?: “Sarah Kliff, in the new VoxCare newsletter, is puzzled by the apparent disagreement among Republicans about what CBO is likely to say…

…The only people who have advance access to the CBO numbers are the Republican legislators who actually worked on the bill. They’ve been working with the budget agency for months now to create a score…

But have they?… About anything resembling Obamacare 0.5? Everything else about the AHCA looks slapdash, like something thrown together in a few days by people who hadn’t thought at all about what a flat tax credit and a widened age band would mean for, say, people in Alaska with its expensive insurance, or low-middle-income Trump voters in their 60s. I have no inside information, but this sure looks as if they were still dithering… until at most a few weeks ago… didn’t work with CBO because they had nothing to work with… amateur hour because it is. [Paul] Ryan isn’t a skilled politician inexplicably losing his touch, he’s a con artist who started to believe his own con…

Should-Read: Sarah Kliff: Tom Price is lying about the GOP health plan

Should-Read: Sarah Kliff: Tom Price is lying about the GOP health plan: “Health and Human Services Secretary Tom Price made a bold promise during a Sunday morning interview with Meet the Press…

…“Nobody will be worse off financially” under the Republicans’ new health care plan, he boasted. Let’s be clear: This is a lie. Price is making an impossible promise. Low-income Americans would receive significantly less help to purchase private coverage on the individual market, under the Republican plan in Congress right now. The plan would also end Medicaid expansion in two years, forcing many even lower-income Americans to lose health coverage. There is nothing in the plan to suggest those low-income Americans would suddenly gain cheaper — or even comparable — coverage to make up for what they lose…. Officials are pretending that health policy doesn’t have trade-offs, that they have finally written a plan that is great for everyone…