Thursday, April 26, 2018

Medicare for all Madlibs: Nomenclature for Democrats' new health plans

The good news is that Democrats are trying to expand public health insurance to more Americans. The bad news is they have almost a dozen plans to expand coverage with the word “Medicare” in the title, creating a rhetorical nightmare. So I created this helpful nomenclature to simply describe what the different plans do.

These three areas are not the only places plans differ, but they represent the most important policy disagreements over which much of the political debate will likely take place: Whether or not everyone will have access to the new program, whether or not private insurance will be allowed to continue to exist, and how cost sharing will be involved are the big differences among Democrats right now. Names aside, these are the details that matter.  

Universal - Everyone can access it if they want
Limited - Only certain people due to age, income, location or employment arrangement are allowed to take part
Buy in - An individual or company would need to actively choose to use the program
Opt-out - If an individual did nothing they would be automatically enrolled in a new public insurance program, but they could do something to choose private insurance instead.
Only - The new Medicare program will be the only basic health insurance for people; private insurers would be forbidden from offering duplicate coverage.
Free at point of service care - No copays, coinsurance or deductibles for coverage benefits
Nominal cost sharing - Nominal co-pays for some services
Traditional cost sharing - Co-pays, deductibles, and/or coinsurance similar to current Medicare and many employer-based plans.

For example:
  • HR 676, the Improved and Expanded Medicare for All, is Universal Medicare Only with Free at point of service care 
  • The Center for American Progress’s Medicare Extra for All is Universal Medicare Opt-out with traditional cost sharing 
  • Rep. Brian Higgins’ Medicare Buy-in Option Act is an age limited Medicare Buy-in with traditional cost sharing

Here are most of the current plans to expand public insurance, and almost all have a title of Medicare. By 2020 there are likely to be at least a half dozen more:

Thursday, February 1, 2018

Predicting the news cycle in every state post marijuana legalization

Now that several states have legalized marijuana, it has become almost comically easy to predict how the news cycle will develop in each new state. It always follows this basic pattern:
We are now getting to see the pattern start all over again in California.

Tuesday, January 23, 2018

My four year-old marijuana prediction was off by just three weeks

Vermont has become the ninth state to legalize marijuana and the first state to do so via the legislature instead of a ballot measure. So I'm going to take a moment to toot my own horn.

Back in January 2014, I published After Legalization: Understanding the future of marijuana policy. In it, I predicted that by 2018 roughly nine states would have legalized marijuana and that Vermont was likely to be the first to legalize marijuana via the state legislature. I also predicted Canada was likely to be the first major country to move forward with legalization in 2017.
2017 –This is when the fight is likely to move from the ballot to the state legislature. After voters in multiple states approve legalization, politicians in other states will feel comfortable backing the idea—or political pressure will force them to approve it. It's very likely that Vermont, Hawaii, and Rhode Island will move forward with marijuana legalization in early 2017 or 2018. They are three of the most liberal states in the country and have a history of being progressive on marijuana reform: Hawaii was the first state legislature to adopt medical marijuana, Vermont was the second, and Rhode Island was the third. I also expect the changing political environment created by a wave of victories in 2016 to push many state legislatures to adopt smaller reforms, such as reducing their penalties for simple possession.
At the same time, several foreign countries will probably adopt legalization. The political situation in Canada regarding this issue is worth watching, because it could put some real pressure on the United States to finally act. In 2013, the leader of the Liberal party of Canada endorsed marijuana legalization,i and there is a very good chance his party could win back control after the next federal election likely to take place at the end of 2015. If the Liberals are serious about moving forward with marijuana reform, a smart time to do it would be right after the United States’ 2016 election, when several American states on or near the Canadian border are likely to legalize marijuana.
While not every one of my predictions has been perfect, I'm very happy with how well I have done so far. One my biggest mistakes was that I thought the District of Columbia wouldn't legalize until 2020 because people in the District would be too afraid of Congress interfering. The people of the District did approve marijuana legalization in 2014, but Congress stepped in to block the city from adopting a regulatory model -- so I got it half right.