Wonkbook’s Chart of the Day: U.S. households feel better about their finances than any time since mid-2009
Wonkbook's Top 5 Stories: (1) Obamacare surprises; (2) FCC's big decisions; (3) what California's "yes means yes" law means; (4) solar power's quiet rise; and (5) the FAA arson policy fallout.
1. Top story: The latest Obamacare surprises
HHS may emphasize the individual-mandate penalties to boost sign-ups. "It would be a calculated approach to prompt sign-ups, a task that the law’s supporters expect to be more difficult, or at least more complex, than in its coverage’s inaugural year....The administration and Burwell frequently repeat the point that the law is 'working' — meaning that millions of people are getting affordable health coverage. Over the next several months, they’ll surely talk more about actual individuals who got coverage in the first year and hammer home that the law offers tax subsidies to many. Last year, advocates were worried about concentrating too much on one of the law’s least popular aspects. Rather than emphasize punishment, they tried to tout benefits. But focus groups conducted by PerryUndem found that the mandate was a strong motivator to getting people to sign up." Jennifer Haberkorn in Politico.
Government will release preliminary data on pharma's payments to doctors. "President Barack Obama's health care law requires manufacturers to report payments and gifts to physicians, unless they are valued at less than $10. It's part of a shift under his administration...to open the books of the medical profession. A few months ago Medicare released its massive claims database, showing program payments to more than 825,000 providers for 2012....Some doctors' offices have started curbing pharmaceutical marketing....But many doctors also receive significant payments to help drug companies conduct clinical research." Ricardo Alonso-Zaldivar in the Associated Press.
Explainer: What we're learning about drug-company payments to doctors. "Many, many health professionals have relationships with industry....Some doctors have relationships with many companies....The biggest companies aren’t always the ones that spend the most. Some smaller drug companies spend big, too....Meals vastly outnumber all other interactions between drug companies and doctors. But they account for a much smaller share of costs....Does any of this disclosure work? Well, it depends on what your definition of 'work' is....Some patients have told us that a payment has caused them to question a doctor’s prescription for a certain drug. Other patients have said that it gives them confidence that their physician is an expert." Charles Ornstein, Ryann Grochowski Jones and Eric Sagara in The New York Times and ProPublica.
And Texas and Florida did expand Medicaid — for kids. "Republican lawmakers in Florida and Texas snubbed the Affordable Care Act’s Medicaid expansion for adults, but their states did broaden the program this year -- for school-age children....That little-known provision of the health law is a key reason hundreds of thousands of kids gained coverage in the state-federal health insurance program for the poor, according to a Kaiser Health News survey of a dozen states. While many of those kids were previously enrolled in another government insurance program, children are typically better off in Medicaid....Several other factors helped drive the increases: Some of those kids might have been eligible under the old rule, but enrolled this year because of the focus on the health law’s open enrollment." Phil Galewitz in Kaiser Health News.
In addition to these... Here are some other Obamacare surprises. Joanne Kenen and Sarah Wheaton in Politico Magazine.
Money talks: Medicaid expansion makes headway in Republican states. "Two things have led to a change of heart for some Republican politicians. Most of the 27 states that are already expanding the program have begun to reap billions in federal subsidies for insurers, hospitals and healthcare providers, putting politicians elsewhere under intense pressure to follow suit. As demonstrated by Pennsylvania's deal with Washington, the Obama administration has also proved willing to accept tweaks that give the private sector a greater role in providing healthcare and place new responsibilities on beneficiaries. All of that has got as many as nine states talking to the administration about potential expansion terms." David Morgan in Reuters.
Related: As Obamacare pays medical bills, red states feel even more pressure on Medicaid. Bruce Japsen in Forbes.
HHS watchdog: Medicaid quality, access vary wildly across states. "Each state is largely free to set its own standards for care, including the distance a patient travels to see a doctor, the time a patient must wait for an appointment and the patient-to-doctor ratio within certain regions. Those standards vary widely across states and are largely unregulated by the federal government, according to an investigation by the inspector general’s office....As a result, federal officials say they don't know whether a state’s standards 'are adequate to ensure access to care.' While setting standards is a state responsibility, the audit says the federal government should strengthen its oversight and provide more guidance to states about how to run a managed Medicaid program." Sarah Ferris in The Hill.
It's not just a Medicaid issue. It's a health-care issue. "The inspector general’s report focused on Medicaid, but Obama administration officials are wrestling with similar issues as they set standards for private health plans sold on insurance exchanges under the Affordable Care Act. Standards for 'network adequacy' have become an explosive political issue. Many consumer advocates want the federal government to set stricter standards. But many insurers say they have been able to hold down premiums by providing access to a limited group of doctors and hospitals. The Obama administration is caught in the middle. It wants to guarantee access to a wide range of providers while holding down premiums, which are paid by consumers and subsidized by the federal government." Robert Pear in The New York Times.
Long read: Experts outline how they'd improve Obamacare for year two. Politico Magazine.
Poll: Americans still confused about Obamacare. Sarah Ferris in The Hill.
Federal doctor ratings face accuracy, value questions. "Consumers searching this fall for the best doctor covered by their new public or private insurance plan won't get very far on a federal database designed to rate physician quality. The Affordable Care Act requires the Centers for Medicare and Medicaid Services to provide physician quality data, but that database offers only the most basic information. It's so limited, health care experts say, as to be useless to many consumers. This comes as people shopping for insurance on the state or federal exchanges will find increasingly narrow networks of doctors and may be forced to find a new one. Many with employer-provided plans will face the same predicament." Jayne O'Donnell in USA Today.
Should you be able to see any doctor you want? "People don't like being told 'no,' especially when it comes to something as personal as their health care. They also don't like rising health-care costs. And therein lies the health-care system's existential debate about narrow networks. Narrow networks...aren't new, but they're emerging as one of insurers' major levers for keeping down costs under the Affordable Care Act. The ultimate question for the health-care system and everyone who interacts with it is just what limits patients can accept before avoiding another 1990s-style backlash against managed care. In just a few weeks, voters in South Dakota will actually get to weigh in on this question, thanks to a ballot initiative." Jason Millman in The Washington Post.
Other health care reads:
Drug patents put overseas can pare tax bills. Andrew Pollack in The New York Times.
Why hospitals want patients to pay upfront. John Tozzi in Bloomberg Businessweek.
BINDER: Report shows employers reining in health-care spending — with a twist. "The same report shows that employers are spending more than they did last year on their portion of the premiums. Moreover, they are voluntarily spending additional sums of money above and beyond what they pay in health insurance premiums...First, about two-thirds of the large employers that offer high-deductible plans voluntarily pair them with tax-protected health savings accounts that help employees pay out-of-pocket costs....Many are also paying to exclude some benefits from the deductible requirements, such as preventive care, prescription medications or physician services for diabetics. What are we to make of this? Employers’ first consideration is not cost, but value." Leah Binder in Forbes.
BAGLEY: What should the law do about out-of-network ER doctors? "The absence of meaningful choice when it comes to emergency care may provide an opportunity for Labor to enact a rule treating the costs of such care differently. What if Labor issued a rule saying that payments to out-of-network ER docs would count toward the out-of-pocket spending cap, so long as the care was received at an in-network hospital? This would be only a partial solution. Before they reach their out-of-pocket cap, patients would still be on the hook for out-of-pocket payments to ER physicians. But at least they’d have some financial security in the event that they racked up extraordinary out-of-pocket costs. In any event, these sorts of abusive billing practices have got to end." Nicholas Bagley in The Incidental Economist.
FRAKT: Auto-renewing your coverage may be bad for you — and for competition. "My colleagues Margot Sanger-Katz and Amanda Cox wrote recently that shopping around for the best price can be crucial for people renewing their coverage on the health insurance exchanges this fall. But evidence suggests that many people probably won’t do that. Not only is that bad for them, but it can also harm competition, which is bad for everyone. A basic truth about health insurance, as with many other things, is that people hate to shop around and change products. They have a status quo bias. That bias can be exacerbated by a large number of plan choices, as consumers in some exchanges face." Austin Frakt in The New York Times.
ZANDI: Job creation key to economy's comeback. "On the whole, I'm upbeat about our economy's current prospects. Growth has kicked into higher gear since the start of 2014, as job creation has picked up, particularly for middle- and higher-paying positions. But the better news still leaves plenty to worry about. Most immediate is the prospect of rising interest rates. Given the Federal Reserve's unprecedented action to combat the weak economy, it is not clear whether the central bank can pull back in a way that neither ignites inflation nor undermines growth....The recent slowdown in business formations is worthy of careful attention. New businesses are what make our economy tick." Mark Zandi in The Philadelphia Inquirer.
DeLONG: The rise of the robots. "From 1850 to 1970 or so, rapid technological progress first triggered wage increases in line with productivity gains. Then came the protracted process of income-distribution equalization, as machines, installed to substitute for human legs, and fingers created more jobs in machine-minding, which used human brains and mouths, than it destroyed in sectors requiring routine muscle power or dexterity work. And rising real incomes increased leisure time, thereby boosting demand for smiles and the products of minds. Will the same occur when machines take over routine brainwork? Maybe. But it is far from being a safe bet on which to rest an entire argument, as Thiel has." J. Bradford DeLong in Project Syndicate.
COURTOVICH: What school choice, Uber have in common. "What's true for blood and capital is true for transportation. Washington is always focused merely on passing bills for more government spending on infrastructure. But this Beltway bickering takes place far away from where the rubber really hits the road, on the highways and back streets. What is needed are not simply new legislation and regulation; what is needed is new thinking, new leadership and a new collaborative relationship among union representatives, policy makers and business. At stake is not just our failing infrastructure, and failing schools, it's the country's ability to compete successfully on a global scale." James C. Courtovich in The Wall Street Journal.
HASEN: The voting wars heat up. "Although the issues in each of these four cases differ in their particulars, they all raise the same fundamental two questions: When is the Constitution violated by cutbacks in voting rules, and when does a burden on minority voters violate Section 2 of the Voting Rights Act by depriving these voters of the same opportunity as other voters to participate in the political process and to elect representatives of their choice? At one extreme is the opinion of the 6th Circuit in the Ohio case....At the other extreme is the opinion of the federal court in North Carolina....The principle the Supreme Court should apply, although it may not apply, is that legislatures should not be able to put significant burdens on minority voters or any other voters without a decent reason for doing so." Richard L. Hasen in Slate.
BIGGS AND SCHIEBER: The imaginary retirement income crisis. "Sen. Maria Cantwell (D., Wash.) claimed...that 92% of Americans are unprepared for retirement. Other senators noted studies claiming that 53% to 84% of Americans will have inadequate income in old age. Progressives cite these statistics as grounds for increasing Social Security benefits, and the New America Foundation wants to curtail tax incentives for private retirement plans because it says these plans have failed. These statistics are vast overstatements, generated by methods that range from flawed to bogus. Changing policy based on these fanciful claims would threaten government budgets, not to mention the income security of future American retirees." Andrew G. Biggs and Sylvester J. Schieber in The Wall Street Journal.
SOCARIDES: SCOTUS's marriage choice. "Each of these cases squarely presents the question of whether the Constitution guarantees same-sex-marriage rights everywhere the country. The veteran Supreme Court observer Linda Greenhouse recently commented, 'It would come as no great surprise if the Supreme Court takes a pass this term. All my court-watching experience tells me that. But still, it’s hard to resist the sense that there is a moment at hand.' The group Freedom to Marry is now running a national ad campaign (its first) on the Sunday-morning talk shows featuring the tagline 'It’s time.' The hope this week is that the Supreme Court will be tempted not to wait." Richard Socarides in The New Yorker.
Unconventional petting interlude: This cat loves to be vacuumed.
2. Big decisions on TV and Internet await the FCC
The FCC could vote today to loosen the NFL's blackout rule. "Ending the F.C.C.’s so-called blackout rule...would allow cable and satellite companies to get around league rules that call for a team’s game to be blacked out on the local broadcast channel if the game is not sold out. The league rule would remain in effect, however, so it remains unclear how far-reaching the effect of an F.C.C. repeal would be. If a cable provider wants to show a game blacked out on the local broadcast channel...it will require permissions that might be hard to come by....Because of the growth of the league, the F.C.C. says that the blackout rule 'has become outdated.' Repealing it, the commission says, would eliminate unnecessary regulation." Edward Wyatt in The New York Times.
Later, the FCC could redefine TV to include the Internet. "The move would help the online services get cheaper access to major network programming and could allow them to become stronger competitors to the dominant pay-TV providers like Comcast....The proposal would apply only to online services that offer streams of prescheduled programming. So the rules wouldn't cover Netflix....But it could revive the controversial online video service Aereo....Classifying the online services as cable providers would bring a variety of regulatory perks, but it would also carry some burdens—such as requirements to provide certain stations and offer closed captioning." Brendan Sasso in National Journal.
On net neutrality, FCC chairman has perspective from both sides. "In the last few months, Mr. Wheeler’s guidelines for net neutrality, the concept that users should have equal access to any legal online content, have become a lightning rod for criticism. More than 3.7 million comments about the policy have flowed to the commission. Many of them argue that Mr. Wheeler’s plan does not go far enough to protect an open Internet. Underlying much of the criticism has been Mr. Wheeler’s long history as a lobbyist or investor in companies he now regulates. But almost a year into the job, Mr. Wheeler has established a record as a formidable opponent to the industries he used to represent." Edward Wyatt in The New York Times.
Explainer: 5 questions, answers on net neutrality. Anne Flaherty in the Associated Press.
FTC worries tough net-neutrality rules could hurt its ability to regulate ISPs. "It's the second time in as many weeks that the FTC has complained about the possible loss of authority under the FCC's net neutrality rules. Speaking on C-SPAN (and to The Washington Post), Republican FTC Commissioner Maureen Ohlhausen said that despite the 'possibility' that Internet service providers would abuse their ability to control access to consumers, reclassifying broadband under Title II would put ISPs beyond the legal reach of the FTC, one of the nation's technology regulators." Brian Fung in The Washington Post.
A vision of a non-neutral Internet. "A different kind of non-neutral Internet is emerging on wireless networks, as mobile companies offer low-cost plans that only give users access to certain popular apps like Facebook....Such plans, known as 'zero rating,' don’t comport with net neutrality....And in these cases there is transparency — the user is fully aware of what’s going on because it’s a plan he or she has chosen. The question is whether such plans could someday find their way to wired networks, and how they would fit into the Federal Communications Commission’s view of what Chairman Tom Wheeler calls an 'open Internet.' Wheeler indicated in recent weeks that he is seriously considering expanding his proposed rules to cover wireless networks." Gautham Nagesh in The Wall Street Journal.
In other news, Reagan-era order was used to justify NSA surveillance programs, docs show. "The NSA relied on Executive Order 12333 more than it did on two other laws that have been the focus of public debate following the leaks exposing U.S. surveillance programs by former agency contractor Edward Snowden, according to the papers....The order, signed in 1981 by President Ronald Reagan, was intended to give the government broad authority over surveillance of international targets. A legal fact sheet on the memo produced in June 2013, two weeks after Snowden's disclosures, said the NSA relied on the executive order for the 'majority' of its activities involving intelligence gathered through signals interception." Nate Raymond and Aruna Viswanatha in Reuters.
Only Congress can crack Apple's spy-proof phones. In the Snowden era, good luck with that. "If the government wants to listen in on your phone calls, it can. That’s the crux of the Communications Assistance for Law Enforcement Act....But Calea has never been expanded from phone networks to phones themselves, and now phone makers....are releasing handsets with encryption that makes it impossible for the handset maker to retrieve data from the phone, warrant or no....But there’s not much...law enforcement can do to stop it, absent some help from Congress....Lawmakers may not be as accommodating as they once were. Revelations about National Security Agency spying have made sanctioned surveillance into a political hot potato" Joshua Brustein in Bloomberg Businessweek.
A federal phone contract is creating a national-security brouhaha. "An obscure federal contract for a company charged with routing millions of phone calls and text messages in the United States has prompted an unusual lobbying battle in which intelligence officials are arguing that the nation’s surveillance secrets could be at risk. The contractor that wins the bid would essentially act as the air traffic controller for the nation’s phone system, which is run by private companies but is essentially overseen by the government. And with a European-based company now favored for the job, some current and former intelligence officials...say they are concerned that the government’s ability to trace reams of phone data used in terrorism and law enforcement investigations could be hindered." Eric Lichtblau in The New York Times.
Young whippersnappers interlude: Kids react to one of the 1980s/1990s' classic toys.
3. California clarifies consent on college campuses. How will it work?
California becomes first to adopt affirmative-consent or 'yes means yes' law. "The legislation says silence or lack of resistance does not constitute consent. Under the bill, someone who is drunk, drugged, unconscious or asleep cannot grant consent. Lawmakers say consent can be nonverbal, and universities with similar policies have outlined examples as a nod of the head or moving in closer to the person. Advocates for victims of sexual assault supported the change as one that will provide consistency across campuses and challenge the notion that victims must have resisted assault to have valid complaints....The bill requires training for faculty reviewing complaints so that victims are not asked inappropriate questions when filing complaints. The bill also requires access to counseling, health care services and other resources." Associated Press.
Explainer: What California's new affirmative-consent law means for its colleges. Eric Kelderman in The Chronicle of Higher Education.
Studies suggest clarity on the concept of consent is needed. "A survey last year of 185 college students found that men tend to give and get consent nonverbally, while women think that saying yes to sex is something that happens out loud. About three-quarters of the women said they’d give consent using verbal cues, sometimes in combination with nonverbal ones, but less than a third of men said they got consent based on verbal affirmations. The study...also found that women tended to wait for men to ask if they were OK with what was happening before themselves expressing their desire to continue or stop having sex." Natalie Kitroeff in Bloomberg Businessweek.
How 'yes means yes' works on other campuses — and how it aims to change norms. "Consent can be highly ambiguous in a sexual encounter, and, as colleges consider cases of sexual assault, it has often proved difficult for them to determine what constitutes consent....Strict requirements, like Grinnell’s, that stipulate students must gain affirmative consent in sexual interactions are not the rule in higher education, although several other campuses have adopted such policies. They are designed to try to clear up the ambiguity surrounding consent and to change the norm when it comes to sex, moving it from an emphasis on no means no to yes means yes." Robin Wilson in The Chronicle of Higher Education.
Fewer than one-third of students found guilty are expelled. Many colleges don't release info at all. That could soon change. "Information provided by the nearly three dozen schools that did provide data on sexual violence cases showed fewer than a third of students found guilty of sexual assault are expelled. Ten institutions, however, declined to provide any information, four did not respond to multiple requests and several others provided incomplete information. Several cited the Family Educational Rights and Privacy Act as preventing them from disclosing such information. However, FERPA does not block an institution from providing these numbers....Legislation, known as the Campus Accountability and Safety Act, introduced on July 30 by a bipartisan group of senators would require colleges and universities to disclose the number of sexual assaults adjudicated and their outcomes." Tyler Kingkade in The Huffington Post.
Complainants and respondents in campus sex-assault cases raise privacy concerns. "Advocates say that confidentiality in investigating sexual assault and harassment cases is crucial to promoting an environment in which victims feel comfortable coming forward. So colleges’ individual sexual assault harassment policies usually err on the side of more privacy, not less. But is there such a thing as too much confidentiality? Two recent cases of sexual harassment, both involving a student accuser and a professor defendant, suggest that balancing all parties’ right to privacy with their right to address it publicly — especially when some details become public anyway — remains a delicate act." Colleen Flaherty in Inside Higher Ed.
Other education reads:
Treasury doesn't see student loans leading to meltdown. Ann Saphir in Reuters.
Animal buddies interlude: Monkey is obsessed with this cat that just wants to take a catnap.
4. The quiet rise of solar power — and the financial problem that could arise
IEA: Solar may become largest power source by 2050 thanks to falling costs. "Photovoltaic plants may provide as much as 16 percent of global electricity, and concentrating solar facilities could generate another 11 percent, the IEA said....The Paris-based organization details what is required to reach these figures in two scenarios it sets out to reach the goal....The technologies are expensive to develop, so lowering the cost of capital is of primary importance to achieve this vision, she said. The IEA is the latest organization to suggest the potential of renewable energy, particular solar, to transform the global power system." Marc Roca in Bloomberg.
When it comes to rooftop solar, a battle is brewing worldwide against utilities and users. "It's still less than one percent of energy capacity worldwide, but the surge in installations of rooftop solar panels is beginning to hit utilities and their business model of charging customers on the basis of consumption. Joined by traditional energy companies, they are lobbying governments to reverse decades of subsidies to green, renewable energy such as solar and, in some cases, to tax them. In Europe, Australia and in the United States, energy companies have powerful lobbies that argue that they form a cornerstone of the economy and provide jobs to tens of thousands. Governments are forced to pay heed and in some cases they have acted." Tracy Rucinski and Byron Kaye in Reuters.
Study suggests these utilities could face dire straits without policy changes. "All these solar households are now buying less and less electricity, but the utilities still have to manage the costs of connecting them to the grid. Indeed, a new study from Lawrence Berkeley National Laboratory argues that, without policy changes, this trend could soon put utilities in dire financial straits. If rooftop solar were to grab 10 percent of the market over the next decade, utility earnings could decline as much as 41 percent. To avoid that fate, many utilities are now pushing for reforms that would at least slow the breakneck growth of rooftop solar — say, by scaling back those 'net metering' laws. And that's opened up a war with many fronts." Brad Plumer in Vox.
East Coast to get its first LNG export terminal. "Dominion Energy received federal approval late Monday to export liquefied natural gas from its Cove Point terminal on the Chesapeake Bay in Maryland. In its decision, the Federal Energy Regulatory Commission concluded that the project, as approved with conditions, would minimize potential adverse impacts on landowners and the environment. FERC has approved three other LNG export projects, but this is the first one on the East Coast. The others are in the Gulf of Mexico." Frederic J. Frommer in the Associated Press.
Studies fault man-made global warming for much, but not all, of 2013's wildest weather events. "Scientists looking at 16 cases of wild weather around the world last year see the fingerprints of man-made global warming on more than half of them. Researchers found that climate change increased the odds of nine extremes....For years, scientists said they could not attribute single weather events — like a drought, heat wave or storm — to man-made global warming. But with better computer models and new research, in some cases scientists can see how the odds of events increase — or not — because of climate change. Other researchers question the usefulness and accuracy of focusing on single extreme events." Seth Borenstein in the Associated Press.
Timeline: A timeline of 2013 extreme weather and global warming. Brian Kahn in Climate Central.
Other environmental/energy reads:
Developing countries key to climate pact. Zack Colman in the Washington Examiner.
GOP divided over oil export plan. Elana Schor in Politico.
Kiss cam interlude: These baseball fans celebrated their kiss cam moment in a unique way.
Close call interlude: Cat has a close call with an alligator.
Most people want to live past 75, but they haven’t given much thought to dying. Jason Millman.
The economic roots of Hong Kong’s fight with China. Matt O'Brien.
Big Tobacco is cool with scary e-cigarette warnings because no one reads them anyway. Roberto A. Ferdman.
Kansas’s mid-term elections are a referendum on supply-side economics. Max Ehrenfreund.
Mistrust of police is highest where law enforcement is most needed. Michael A. Fletcher.
Name That Data answers, Week 10. Christopher Ingraham.
When all cigarette packs look the same, fewer people buy them. Roberto A. Ferdman.
As Modi takes Manhattan, here’s how the U.S. economy is increasingly tied to India. Christopher Ingraham.
Switzerland rejects single-payer, will keep its own version of Obamacare. Jason Millman.
Our infant mortality rate is a national embarrassment. Christopher Ingraham.
Mapped: How the "creative class" is dividing U.S. cities. Emily Badger.
Supreme Court justices embark on road to same-sex marriage ruling. Adam Liptak in The New York Times.
GOP aims for gains in state legislatures. Steven Shepard in Politico.
Incumbent governors fear wipeout in November. James Hohmann in Politico.
3 VA whistleblowers reach settlement with agency. Michael Muskal in the Los Angeles Times.
Americans step up spending, but home market weakens. Jason Lange in Reuters.
Supreme Court rules 5-4 for Republican plan to limit early voting in Ohio. Robert Barnes in The Washington Post.
Six years after AIG bailout, trial asks: was it legal? Aruna Viswanatha in Reuters.
New U.S. weather tool promises more warning of disasters. Brian K. Sullivan in Bloomberg.
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Wonkbook is produced with help from Michelle Williams and Ryan McCarthy.