Jonathan Cohn

An Overdose of Out-of-Pocket Expenses

Its one of the most important studies in the history of research about health care. Its also one of the most frequently misunderstood, and most commonly misapplied, studies.

Attention 2016 Health Policy Shoppers: Read the Fine Print

T he 2016 presidential campaign is under way, and health care, as always, is playing a prominent role. Most of the debate is still about the Affordable Care Act, and in many ways the conversation sounds a lot like the one that took place in 2012. Republicans say they want to repeal the law and replace it with conservative alternatives. Although some Republican candidates have fleshed out these plans with actual policy details, others have stuck mostly to slogans. But all the candidates say they have the same basic goals: ending “one-size-fits-all” insurance, giving price relief to the young, and reducing the fiscal strain on government. The Democratic side of the debate has evolved a bit more, if only because this time the president who shaped and then signed “Obamacare” is not on the ticket. There’s talk about preserving the law and defending it from attempts at repeal, of course. But there’s also talk of improving it, by bolstering the protection against out-of-pocket costs that insurance provides and using government’s leverage as a buyer of medical care to drive down prices. The rhetoric makes both sets of ideas sound attractive, even though they are radically different, which is not so surprising. After all, politicians are salespeople, trying to sell policy. They focus on the good and ignore the bad, much as carmakers don’t dwell on the extra maintenance costs for a luxury sedan and cell phone companies downplay the difficulty of getting out of a long-term contract. But the trade-offs are real, on both sides. Here are a few of them.

What Louisiana Tells Us About the ACA Medicaid Expansion

O ne of the biggest health care stories these days doesn’t get nearly the attention it deserves. It is the slowbut-steady expansion of Medicaid, the program that’s been providing insurance to the poor since the 1960s, as part of the Affordable Care Act (ACA). If you follow the political debates about “Obamacare,” chances are you hear much more about changes to the private insurance market and what those changes mean for consumers. But the number of people who have coverage thanks to the law’s Medicaid expansion (roughly 15 million as of 2016) is actually a bit larger than the number getting coverage through the exchanges (roughly 13 million).1 The Medicaid expansion’s impact on economic security and public health is probably larger too. In June, I got an early glimpse of what a bigger Medicaid program could mean for Louisiana, thanks to a group visit for journalists organized by the Henry J. Kaiser Family Foundation. Until recently, Louisiana was among the states whose officials were refusing to expand Medicaid eligibility as the ACA’s architects had originally envisioned. But in 2015, John Bel Edwards ran for governor on a promise to join the expansion—that is, to make Louisiana’s version of Medicaid available to all people in households with incomes below 133% of the poverty line. (In 2016, that’s

A Blueprint for Repair and Renovation of the ACA

15,800 for an individual and

The Long and Winding Road of Mental Illness Stigma

26,813 for a family of 3.) Edwards won and on January 12, 2016, one day after taking office, he signed an executive order implementing the expansion. The ink was barely dry when state agencies began trying to sign up as many people as possible—by automatically enrolling those who were already receiving other forms of state assistance and by conducting outreach efforts through health clinics and other venues that serve lowincome communities. Coverage was set to begin paying for services on July 1, 2016. By the time of my visit, roughly 2 weeks before that start

The perils of health care nostalgia.

The Supreme Court’s decision in King v Burwell this past summer may turn out to be a watershed moment. The lawsuit, crafted by longtime opponents of the Affordable Care Act (ACA), challenged the federal government’s authority to offer health insurance subsidies in roughly two-thirds of the states. A decision for the plaintiffs would have crippled the law’s new private insurance marketplaces in those states, forcing millions of people to lose coverage. But the Court rejected the lawsuit, with 2 Republican appointees joining the 4-member Democratic minority.

Fifty-two Years Later, We Are Still Arguing About LBJ's Promise: Fifty-Two Years Later, We Are Still Arguing About LBJ's Promise

Sometimes research gets your attention because it teaches you about a new problem. And sometimes research gets your attention because it teaches you about an old problem that hasn’t gone away.