The Insurance Exchanges

There is a lot to unpack about last Thursday and Sunday. But before we dive into that, a little story from the New York Times that caught my eye from Friday.

Where there are no real options
Where there are no real options

The map shows the counties in the United States where there is one health insurer and no health insurer. Further on in the piece a small multiple gallery shows that progression from 2014 and highlights how the drastic changes are seen only in 2017 and 2018.

The problem is often not that people cannot buy insurance if no insurers are in the marketplace. The marketplace is for federally-subsidised coverage and insureres appear to be moving to offering policies outside the marketplace for non-subsidised customers.

The White House claims Obamacare is in a death spiral. It is not. But after seven years it could use a little maintenance.

Credit for the piece goes to Haeyoun Park and Audrey Carlsen.

Here We Go Again

Well as of last night, we are having yet another vote on AHCA, better known as Trumpcare. I will not get into the details of the changes, but basically it can be summed up as waivers for Obamacare regulations. And as of last night, $8 billion over five years to cover those at high-risk. What about after five years? What if, as experts say, that sum is insufficient and it runs out before five years are up?

This is still a bad bill.

But thankfully we have FiveThirtyEight who looked at support before the Upton amendment—the $8 billion bit—and found that the bill could still fail because of a lack of moderate support.

Round and round we go
Round and round we go

The basic premise is this: In order to get the conservative Freedom Caucus, which scuppered the bill a few weeks ago, on side Ryan et al. had to make the bill more conservative. They likely had to make it cover fewer people at a higher cost. I say likely because Ryan is not sending this to the Congressional Budget Office (CBO) to score the bill, something typically done to see how much it costs and whether it might work. Problem is, by making the bill more conservative, they push away moderate Republicans. Yes, Virginia, they do exist.

Today’s question is whether an $8 billion throw-in will buy in enough moderate votes.

It’s going to be a long day.

Credit for the piece goes to Harry Enten.

One Insurer Counties

Let’s go back in time briefly to last week and the whole Obamacare thing. It’s not perfect and could be improved. I stridently believe that what the administration proposed was worse. But this article from Vox does highlight one of the things that could be improved—making more choices available to consumers. And they make the point with a map.

Lots of red counties there
Lots of red counties there

That map shows the counties where there is only one insurer and almost a dozen counties in Tennessee where there are none. Note the colour—blue are counties that voted for Clinton and red for Trump. If Trump attempts to “explode” Obamacare, he will—much like the plans from last week—be hurting most those people who voted for him. Very strange politics if you ask me.

Credit for the piece goes to Sarah Frostenson.

Those Who Will Lose Subsidies for Trumpcare

As much as I like trains…we need to get back to Trumpcare. As you probably know, it will cover fewer people than Obamacare. Just how many fewer people? Somewhere in the ten to twenty million range. The poor, the elderly, and the sick are those who will be worse off. Because the poor, the elderly, and the sick are the ones who clearly do not need healthcare. Higher-income young people, your subsidies are about to go up.

But I digress, the Los Angeles Times looked at county electoral and tax data to see just where the pain falls geographically, and more importantly where it falls politically. So they took a look specifically at the bracket that will be hurt the most: the poor and elderly, 60 and earning $30,000.

Trump won the vast majority of counties that will be hardest hit
Trump won the vast majority of counties that will be hardest hit

Well, it looks like all those people who voted against the idea of Obamacare just voted themselves to get even less assistance. Trumpcare’s going to be great, guys. Unless you’re old. Or poor. Or sick.

Credit for the piece goes to Priya Krishnakumar.

How Trumpcare Differs from Obamacare

We are going to have a busy week this week. From the CBO release on Trumpcare costs and coverage to the elections in the Netherlands. Oh, and it might snow a wee bit here in Philadelphia and the East Coast. So let’s dive straight into today’s post, an article all the way from the West Coast and the LA Times.

It looks at a comparison between Trumpcare and Obamacare.

How the changes affect the young, middle-aged, and the elderly by income level
How the changes affect the young, middle-aged, and the elderly by income level

The clearest takeaway is that they are using some pretty good colours here. Because purple.

But in all seriousness, the takeaway from this graphic is that Trumpcare as proposed will cost more for the poor and the elderly. And it will cost especially more for those who live in rural and more isolated areas. And that basically comes down to the fact that Trumpcare will not factor in the local cost of insurance, which generally costs more in non-urban areas.

But for the fullest understanding of the differences, you should read the full piece as it offers a point-by-point comparison.

Credit for the piece goes to Noam N. Levey and Kyle Kim.

A Look Back

Well, we are one day away now. And I’ve been saving this piece from the New York Times for today. They call it simply 2016 in Charts, but parts of it look further back while other parts try to look ahead to new policies. But all of it is well done.

I chose the below set of bar charts depicting deaths by terrorism to show how well the designers paid attention to their content and its placement. Look how the scale for each chart matches up so that the total can fit neatly to the left, along with the totals for the United States, Canada, and the EU. What it goes to show you is best summarised by the author, whom I quote “those 63 [American] deaths, while tragic, are about the same as the number of Americans killed annually by lawn mowers.”

Deaths by terrorism
Deaths by terrorism

I propose a War on Lawn Mowers.

The rest of the piece goes on to talk about the economy—it’s doing well; healthcare—not perfect, but reasonably well; stock market—also well; proposed tax cuts—good for the already wealthy; proposed spending—bad for public debt; and other things.

The commonality is that the charts work really well for communicating the stories. And it does all through a simple, limited, and consistent palette.

But yeah, one day away now.

Credit for the piece goes to Steven Rattner.

How Did Obamacare Change Our Healthcare?

We are counting down the days until President Obama steps aside. And shortly thereafter his signature work, the Affordable Care Act, may be repealed. But looking back, what is the legacy of the first few years under Obamacare? Besides the obvious death panels, of course. Well FiveThirtyEight took a look. And in this graphic, we see simple line charts. But what I really like is the attention that went into the titling/labelling. The titles draw you down through the story, explaining just what you are looking at.

How have things changed?
How have things changed?

Credit for the piece goes to the FiveThirtyEight graphics department.

The Affordable Care Act You Likely Know as Obamacare

It just won’t die. Grandma, that is, in front of the death panels of Obamacare. Remember those? Well, even if you don’t, the Affordable Care Act (the actual name for Obamacare) is still around despite repeated attempts to repeal it. So in this piece from Bloomberg, Obamacare is examined from the perspective of leaving 27 million people uninsured. In 2010, there were 47 million Americans without insurance and so the programme worked for 20 million people. But what about those remaining 27?

I am not usually a fan of tree maps, because it is difficult to compare areas. However, in this piece the designers chose to animate each section of the tree as they move along their story. And because the data set remains consistent, e.g. the element of the 20 million who gained insurance, the graphic becomes a familiar part of the article and serves as a branching off point—see what I did there?—to explore different slices of the data.

This is a tree map I actually think works well
This is a tree map I actually think works well

So in the end, this becomes one of those cases where I actually think the tree map worked to great effect. Now there is a cartogram in the article, that I am less sure about. It uses squares within squares to represent the number of uninsured and ineligible for assistance as a share of the total uninsured.

I'm not sure the map is necessary here
I’m not sure the map is necessary here

Some of the visible patterns come from states that refused to expand Medicaid. It was supposed to cover the poorest, but the Supreme Court ruled it was optional not mandatory and 19 states refused to expand the coverage. But surely that could have been done in a clearer fashion than the map?

Credit for the piece goes to Jeremy Scott Diamond, Zachary Tracer, and Chloe Whiteaker.

Old Healthcare Policy Renewal

Let’s start this week off with cartograms. Sometimes I like the idea, sometimes not so much. Here is a case where I really do not care for the New York Times’ visualisation of the data. Probably because the two cartograms, a before and after of health policy renewals, do not really allow for a great side-by-side comparison. I imagine there is probably a way of condensing all of that information into a single chart or graphic component.

The before map
The before map

Credit for the piece goes to Keith Collins, Josh Katz, Katie Thomas, Archie Tse, and Karen Yourish.

Explaining Why Some People Are Losing Their Health Insurance Plans

I have received a few questions in the non-blog world about why certain people have been receiving notices in the post that they are about to lose their insurance plans. The short answer for many of those people is that they likely bought individual, private plans and those plans fall short of the new minimum requirements. But, if you are not satisfied with that explanation, the New York Times does a much better job explaining it than I ever could. It is a piece worth a quick read.

The private insurance market
The private insurance market

Credit for the piece goes to Larry Buchanan, Alicia Parlapiano, and Karen Yourish.