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It's More or Less Final: Obamacare Has Insured About 11 Million People

| Thu Jul. 10, 2014 12:31 AM EDT

Jonathan Cohn passes along the results of a new study from the Commonwealth Fund which estimates that the ranks of the uninsured have dropped by about 5 percentage points since the start of the Obamacare rollout:

To put that in more concrete terms, there are still a lot of Americans walking around without health insurance today. But there are about 9.5 million fewer of them than there were last fall, almost certainly because so many people have enrolled in the newly expanded Medicaid program or purchased subsidized insurance through the Obamacare marketplaces.

How does that compare to expectations? The Congressional Budget Office predicted that, one year into full implementation, Obamacare would reduce the the number of Americans without insurance by 12 million. That included the young adults who got insurance before 2014, by signing onto their parents’ plans. There’s been some controversy over exactly how many people that is, but the best estimates I’ve seen place it somewhere between 1 and 2.5 million. Add that number to the 9.5 million from the Commonwealth survey, and you're close or equal to the CBO projections.

So that's probably a total of around 11 million or so. Nearly all of the estimates now seem to be converging around this number, and given the inherent uncertainty in measuring the uninsured it seem like this is about as good as we're going to get.

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Quote of the Day: "This Isn't Theater"

| Wed Jul. 9, 2014 7:18 PM EDT

From President Obama, asked why he wasn't making a visit to the border during his trip to Texas today:

This isn't theater. This is a problem.

"I'm not interested in a photo-op," he said. "I'm interested in solving a problem." It would be nice if he weren't the only one.

The Legacy of the Hobby Lobby Case: Protecting Anti-Gay Discrimination?

| Wed Jul. 9, 2014 6:49 PM EDT
A protester patiently awaits the Hobby Lobby decision outside the Supreme Court

In his majority opinion in the recent Hobby Lobby case, Supreme Court Justice Samuel Alito took pains to frame the ruling, exempting companies from complying with Obamacare's contraceptive mandate if it violated the religious beliefs of their owners, as a narrow one. But gay and civil rights groups have long warned that a decision permitting such a religious exemption could have broad ramifications, potentially allowing employers to discriminate against gays. Now, their fears may be coming to pass.

"What we've seen since last week's decision came down is that opponents of LGBT equality have pushed a misreading of that decision as having broadly endorsed discrimination against people, including LGBT people in the workplace," says Ian Thompson, a legislative representative for the American Civil Liberties Union.

Cecile Richards, president of the Planned Parenthood Action Fund, told Mother Jones that the Hobby Lobby ruling "opens the door for corporations to discriminate against anyone that doesn't look, sound, or share the religious beliefs that they do. This isn't a business agenda; it's an extreme social agenda and it is deeply unpopular with the American people."

For God's Sake, Stop What You're Doing and Go Buy Tickets to See Nick Cave

| Wed Jul. 9, 2014 3:01 PM EDT
Nick Cave at San Francisco's Warfield Theater on July 8
Nick Cave at San Francisco's Warfield Theater on July 8 Michael Rosenthal

Most concert reviews are ponderous, so I'll keep this one short: The quirky, passionate Australian musician Nick Cave, who was profiled in Sunday's New York Times Magazine if you care to read up on his latest doings, basically just renewed my faith in rock and roll—a concept that this scrawny, sexy, histrionic, 56-year-old love child of David Bowie and Tom Waits and something much darker more or less embodies.

Regardless of whether you've kept up with his oeuvre (I certainly haven't) or can even name any Nick Cave songs, he's a fabulous performer whom you need to see before you die—or before he does. Last night, during his second sold-out evening at San Francisco's Warfield Theater, the audience was smitten as Cave bounced around the stage like a gothic scarecrow, styled out in his signature dark suit and black velvet, taking full advantage of his rich voice and theatrical tendencies.

Reaching into the front rows, and occasionally throwing himself halfway down into them, Cave connects intimately and powerfully with his audience, leavening lyrical intensity with dark humor: Within the twisted landscape of "Higgs Boson Blues," Cave croons: "If I die tonight, bury me / In my favorite yellow patent leather shoes / With a mummified cat and a cone-like hat / That the caliphate forced on the Jews." On the contemporary track "We Real Cool," he sings, "Wikipedia is heaven / When you don't want to remember no more." And if you've never heard Cave's unique take on "Stack-O-Lee" or "Stagger Lee" (or however you choose to write the name of the old murder ballad), well, yeah. It's not much like the other hundred versions you might have heard.

Cave's talented band, the Bad Seeds, is a marvelous cast of characters to boot, especially the guy I'm calling the Mad Fiddler (and flautist, guitar, keyboard, and mandolin player). All wild hair and long, scraggly half-gray beard, he attacks his violin like some deranged fiddler on the roof. Together the Bad Seeds highlight Cave's quieter moments with subtlety, exploding with their bandleader when the time is right into mad catharsis. Rock and fucking roll at its finest. Tour dates are here.

Medicare Just Keeps Producing Great Budget News

| Wed Jul. 9, 2014 2:20 PM EDT

Medicare has been a bastion of good news lately. Every year, the CBO reduces its baseline estimate of Medicare costs, which have dropped by more than $1,000 since 2010. So what's going on? Tricia Neuman and Juliette Cubanski of the Kaiser Family Foundation round up the evidence:

It is clear that the Medicare savings provisions in the ACA, such as reductions in provider payment updates and Medicare Advantage payments, have played a major role....In addition, the Budget Control Act of 2011 also exerted downward pressure on Medicare spending through sequestration that reduced payments to providers and plans by 2 percent beginning in 2013.  And yet even after incorporating these scheduled payment reductions in the baseline, CBO has continued to lower its projections of Medicare spending.

So what else might be going on here? In addition to scheduled reductions in Medicare’s more formulaic payment rates, providers may be tightening their belts and looking to deliver care more efficiently in response to financial incentives included in the ACA, and it is possible that these changes are having a bigger effect than expected. For example, CMS recently reported that hospital readmission rates dropped by 130,000 between January 2012 and August 2013. It is also possible that hospitals and other providers are using data and other analytic tools more successfully to track utilization and spending and to reduce excess costs. Another more straightforward factor is that several expensive and popular brand-name drugs have gone off patent in recent years, which has helped to keep Medicare drug spending in check.

No one knows for sure if these reductions are permanent, or whether high growth rates will reappear in the future. But even if the low growth rates of the past few years can't be sustained, I suspect that Medicare growth will continue to be lower than anyone expected. There are two reasons for this. First, the growth rate of medical costs in general has been declining steadily for the past 30 years, and this has now been going on long enough that it's highly unlikely to be a statistical blip. After a surge in the 80s and 90s, we really are returning to the growth rates that were common earlier in the century, and obviously this will affect Medicare.

Second, Obamacare really will have an impact. Not everything in it will work, but it includes a lot of different cost-cutting measures and some of them will turn out to be pretty effective. And who knows? If Republicans ever stop pouting over Obamacare, we might even be able to experiment with different kinds of cost reductions.

There's a fair amount of year-to-year variability in health care inflation, and we should expect to have some years of high growth. But I'll bet the average over the next decade is somewhere around 2 percent above the general inflation rate. That's not too bad.

George R.R. Martin Has 2 Words for People Scared He'll Die Before Finishing "Game Of Thrones" Series

| Wed Jul. 9, 2014 1:38 PM EDT
Ball so hard.

Game of Thrones author George R.R. Martin is 65 years old. Because of this, some of his fans are deeply worried that he won't finish writing his A Song of Ice And Fire fantasy book series (which began in 1996, and is the basis for the hit HBO show) before he dies. (See: the case of fellow fantasy author Robert Jordan.)

Well, he was asked about this during a recent interview with Swiss newspaper Tages-Anzeiger. Here's his response:

Well, I find that question, you know, pretty offensive, frankly, when people start speculating about my death and my health. So, 'fuck you' to those people. [Laughs.]

You can watch the "fuck you"—and Martin's accompanying flipped middle finger—here.

This isn't the first time Martin has addressed this concern among his readers. In 2012, he wrote a blog post trolling his fans who are so obsessed with the series that they routinely berate him for working on other projects. It reads:

Reading. I just finished THE KING'S BLOOD, the second volume of Daniel Abraham's "Dagger and Coin" series. Books like this remind me why I love epic fantasy. Yes, I'm prejudiced, Daniel is a friend and sometime collaborator... but damn, that was a good book. Great world, great characters, thoroughly engrossing story. The only problem was, it ended too soon. I want more. I want to know what happens to Cithrin, and Marcus, and Geder, and Clara. And I want to know NOW. God damn you, Daniel Abraham. I know for a fact that you are writing more Expanse books with Ty, and more urban fantasies as M.L.N. Hanover, and doing short stories for some hack anthologist, and scripting some goddamn COMIC BOOK, and even sleeping with your wife and playing with your daughter. STOP ALL THAT AT ONCE, and get to writing on the next Dagger and Coin. I refuse to wait.

"Fuck you" is more succinct.

(h/t Gawker)

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Is Montana More Corrupt Than Miami?

| Wed Jul. 9, 2014 12:44 PM EDT

For such a sparsely populated state, Montana has managed to generate some outsize headlines lately. There's the GOP Senate candidate who made news by suggesting that creationism should be taught in public schools. Then there's Missoula's reputation as the "rape capital" of the world, thanks to, among other things, serious allegations of sexual assault committed by University of Montana football players. And continuing that theme, there's also the Justice Department's investigation of the Missoula County Attorney's office alleging that prosecutors had been systematically discriminating against female sexual-abuse victims.

Now comes new data showing that Montana is leading the country in public corruption prosecutions, suggesting that the state's reputation for graft (dating back to the days of the Copper Kings) hasn't changed much. Clocking in with 18 active cases, the federal judicial district of Montana has had more public corruption prosecutions in 2014 than those in South Florida, Southern California, and even New Jersey, according to data crunched by the Transactional Records Access Clearinghouse at Syracuse University.

How is it that such a small state has so many prosecutions? "Why prosecutors do what they do is a mystery," says TRAC's David Burnham. But the prosecutors in Montana have a good explanation: They've recently organized a major crackdown on corruption on American Indian reservations, of which the state has seven. 

A recent AP investigation concluded that, nationally, tribal governments are five times more likely to have "material weaknesses" in their administration that make corruption possible, and reporters for years have been sounding alarms that federal prosecutors have largely turned a blind eye to these problems. Montana decided to change that trend, at a time when millions in additional federal dollars have flowed into tribal governments thanks to the federal stimulus package enacted after the financial collapse in 2008.

In 2011, the US Attorney's office launched a task force, dubbed the Guardians Project, with the FBI, the IRS, and inspectors general of various federal agencies, to target corruption on American Indian reservations. The results have been telling: In 2012, Montana had only one official corruption prosecution, but by August of last year, the Guardians Project had netted 25 indictments against people who'd allegedly done all sorts of devious things to keep federal money from reaching those it was supposed to help.

Prosecutors promised there would be more to come, and there have been. Just last month, four members of the Blackfeet tribe were sentenced to prison for involvement in a scheme to steal federal mental-health and substance abuse treatment funds from a $9 million contract. More than $225,000 intended for the program ended up being spent on travel and gambling, among other things.

Six people have pleaded guilty to embezzling federal dollars from a $361 million pipeline project designed to bring freshwater to the Rocky Boy's Indian Reservation. Another seven people from the Crow reservation were indicted for stealing at least a half-million dollars from the tribe in a double-billing scheme operated out of the tribe's historic preservation office. One of the people convicted in the scheme allowed a coal company to take a backhoe to a 2,000-year-old sacred bison burial site. The corruption investigations have already ensnared a former state representative and Chippewa Cree tribe official, Tony Belcourt, who in April pleaded guilty to bribery, theft, and tax-evasion charges related to the water project, as well as construction of a multimillion-dollar clinic.

Overall, though, Montana itself probably isn't more scandal-plagued than New Jersey or Miami. Montana's US attorney has just taken a harder line on prosecuting the abuses on its reservations, and all those cases have added up to boost Montana to the top of the rankings in terms of public corruption prosecutions. "These figures from Syracuse reflect only a portion of our effort," US Attorney Mike Cotter said in a statement Tuesday. "Many of the public corruption indictments brought in Montana were initiated before last October. Relatively speaking, Montana is a small office; a David among Goliaths. But the Guardians have done truly remarkable work. Their efforts have unearthed widespread criminal activity and flagrant abuses of trust with regard to federal programs and grants designed to provide for the common good of our Indian communities."

We're Still at War: Photo of the Day for July 9, 2014

Wed Jul. 9, 2014 11:31 AM EDT

The 173rd Airborne Brigade Paratroopers participate in a ceremonial rotation of forces in Latvia. (US Army National Guard Photo by Spc. Cassandra Simonton, 116th Public Affairs Detachment)

This Is the Democratic Plan to Reverse the Hobby Lobby Decision

| Wed Jul. 9, 2014 11:02 AM EDT

On Monday, Senate Majority Leader Harry Reid promised "to do something" about the Supreme Court's recent Hobby Lobby decision. Now two members of his caucus say they are preparing a bill that would reverse some of the controversial aspects of last week's decision.

Take it away, TPM:

The legislation will be sponsored by Sens. Patty Murray (D-WA) and Mark Udall (D-CO). According to a summary reviewed by TPM, it prohibits employers from refusing to provide health services, including contraception, to their employees if required by federal law. It clarifies that the Religious Freedom Restoration Act, the basis for the Supreme Court's ruling against the mandate, and all other federal laws don't permit businesses to opt out of the Obamacare requirement.
...

This bill will restore the original legal guarantee that women have access to contraceptive coverage through their employment-based insurance plans and will protect coverage of other health services from employer objections as well, according to the summary.

This is all well and good, but unfortunately this bill will never survive a cloture vote in the Senate; even if it did, it would be dead on arrival in the House of Representatives. The only way that Hobby Lobby stands even a chance of being overturned legislatively is if John Boehner is forced to hand over the Speaker's gavel to a Democrat. That's probably something someone at the DCCC should remind people of as we head into the midterms.

Vladimir Putin Abandons His Erstwhile Allies

| Wed Jul. 9, 2014 10:31 AM EDT

Julia Ioffe writes about the latest from Ukraine:

As the Ukrainian army chases separatists from the strongholds they've held for months, Moscow has barely said anything—despite its springtime rants about protecting Russians wherever they may be in the world....As I wrote back in May, now that he's sown chaos in Ukraine—but uneager to participate in someone else's civil war—President Vladimir Putin has thrown the rebels under the bus. In June, rebel leader Igor Strelkov said that "Putin betrayed us," and that betrayal has only deepened as Kiev launched its all-out offensive last week. Moscow, having started all this, has offered no help to the rebels.

The betrayal, it seems, may be even nastier than that. According to a Ukrainian security council spokesman, the Russians have sealed their border, shutting down three key crossings. Not only are they not letting men and materiel into Ukraine from Russia, but they're also blocking men and materiel from flowing in the opposite direction. That is, the very men that Moscow has riled up to the extent that they have taken up arms and are ready to die in order to get the region out of Ukraine and into Russia are not welcome to seek refuge in Russia. (Not even, it seems, the ones originally from Russia.) A group of 300 fleeing rebels reportedly even came under fire by the Russians as they tried to escape into Russia.

That Putin. He's quite the guy, isn't he? It appears that he eventually figured out that Ukraine wasn't going to fall neatly into his lap, and the cost of fomenting an all-out war there was simply too great. It turned out that Ukrainians themselves didn't support secession; Western powers were clearly willing to ramp up sanctions if things got too nasty; and the payoff for victory was too small even if he had succeeded. So now he's had to swallow a new, more pro-Western Ukraine—the very thing that started this whole affair—along with the prospect of renewed anti-Russian enmity from practically every country on his border.

But he got Crimea out of the deal. Maybe that made it worth it.