ADA’s Assault on the Web: Your Turn, Congress

The Economist reports on a phenomenon I’ve been covering all year, how lawyers are beginning to churn out assembly-line complaints against businesses over their websites’ lack of Americans with Disabilities Act, or ADA, accessibility:

[Texas attorney Omar Weaver] Rosales says extending ADA rules to websites will allow him to begin suing companies that use color combinations problematic for the color-blind and layouts that are confusing for people with a limited field of vision.

While as I noted in January the Obama administration has declined to issue long-anticipated regulations prescribing web accessibility, its Department of Justice has taken the less visible route of supporting private lawsuits intended to accomplish many of the same goals, including (to quote The Economist again):

“Boss” Aldrich and the Founding of the Fed

America’s Bank, Roger Lowenstein’s 2015 book on the founding of the Fed, is, as I said in reviewing it for Barron’s, both well-written and well-researched.  Few pertinent details of the story appear to have escaped Lowenstein’s notice. However, in assembling and interpreting these details, Lowenstein appears not to have entertained the slightest doubt that the Federal Reserve Act, for all the political maneuvering that led to it, was the best of all possible means for ending this nation’s periodic financial crises.

Instead of turning a critical eye toward the 1913 Act, Lowenstein writes as if history itself were a reliable judge.  What it has condemned he condemns as well; and what it has favored he favors.  Consequently he treats all those persons who contributed to the Federal Reserve Act’s passage as right-thinking progressives, while regarding those who favored other solutions to the nation’s currency and banking ills as so many reactionary bumpkins.

That some strains of triumphalism should have found their way into Lowenstein’s account of the Fed’s origins is hardly surprising.  Though research by economic historians and others supplies precious little support for it, the view that the Fed has been a smashing success is, after all, a well-established element of conventional wisdom, and one that Fed officials themselves never cease to promote.  Nor have those officials ever devoted more effort to doing so than in the course of celebrating the Fed’s recent centennial.  Even a much more hard-bitten journalist than Lowenstein could hardly have been expected to resist setting considerable store by an institution so universally (if undeservedly) hallowed.

Still, one might have expected a note of skepticism, if no more than that, to have found its way into America’s Bank.  Lowenstein was, after all, writing about an institution that was supposed to end U.S. financial crises once and for all, and doing so in the wake of a crisis at least as bad, in many respects, as those that inspired its creation.  (Those who suppose that the Fed did all it could and should have done to combat the recent cataclysm are encouraged to read this, this, this, and this.)  He had, furthermore, encountered the many arguments — and most were far from being plainly idiotic — of pre-1913 experts who favored other reforms, as well as those of some of the pending Federal Reserve Act’s critics, who predicted, correctly, that it wouldn’t be long before its results would acutely disappoint those of its champions who sincerely yearned for financial and economic stability.

Employment-Based Green Cards Are Mostly Used by Family Members

The United States’ immigration system favors family reunification – even in the so-called employment-based categories.  The family members of immigrant workers must use employment-based green cards to enter the United States.  Instead of a separate green card category for spouses and children, they get a green card that would otherwise go to a worker. 

In 2014, 56 percent of all supposed employment-based green cards went to the family members of workers (Chart 1).  The other 44 percent went to the workers themselves.  Some of those family members are workers, but they should have a separate green card category or be exempted from the employment green card quota altogether. 

Chart 1

Employment Based Green Cards by Recipient Types

 

Source: 2014 Yearbook of Immigration Statistics, Author’s Calculations

ObamaCare: Not Promoting Quality Care As Planned

At The Health Care Blog, Jeff Goldsmith and Bruce Henderson of Navigant Healthcare offer a grim assessment of ObamaCare’s performance that is worth quoting at length:

The historic health reform law passed by Congress and signed by President Obama in March, 2010 was widely expected to catalyze a shift in healthcare payment from “volume to value” through multiple policy changes. The Affordable Care Act’s new health exchanges were going to double or triple the individual health insurance market, channeling tens of millions of new lives into new “narrow network” insurance products expected to evolve rapidly into full risk contracts.

In addition, the Medicare Accountable Care Organization (ACO) program created by ACA would succeed in reducing costs and quickly scale up to cover the entire non-Medicare Advantage population of beneficiaries (currently about 70% of current enrollees) and transition provider payment from one-sided to global/population based risk. Finally, seeking to avoid the looming “Cadillac tax” created by ACA, larger employers would convert their group health plans to defined contribution models to cap their health cost liability, and channel tens of millions of their employees into private exchanges which would, in turn, push them into at-risk narrow networks organized around specific provider systems. 

Three Surprising Developments
Well, guess what? It is entirely possible that none of these things may actually come to pass or at least not to the degree and pace predicted. At the end of 2015, a grand total of 8.8 million people had actually paid the premiums for public exchange products, far short of the expected 21 million lives for 2016. As few as half this number may have been previously uninsured. It remains to be seen how many of the 12.7 million who enrolled in 2016’s enrollment cycle will actually pay their premiums, but the likely answer is around ten million. Public exchange enrollment has been a disappointment thus far, largely because the plans have been unattractive to those not eligible for federal subsidy. 

Moreover, even though insurers obtained deep discounts from frightened providers for the new narrow network exchange products (70% of exchange products were narrow networks), the discounts weren’t deep enough to cover the higher costs of the expensive new enrollees who signed up. Both newly launched CO-OP plans created by ACA and experienced large carriers like United and Anthem were swamped in poor insurance risks, and lost hundreds of millions on their exchange lives. As for the shifting of risk, it looks like 90% plus of these new contracts were one-sided risk only, shadowing and paying providers on the basis of fee-for-service, with bonuses for those who cut costs below spending targets. Only 10% actually penalized providers for overspending their targets.

The Medicare Accountable Care Organization/Medicare Shared Savings Program, advertised as a bold departure from conventional Medicare payment policy, has been the biggest disappointment among the raft of CMS Innovation Center initiatives. ACO/MSSP enrollment appears to have topped out at 8.3 million of Medicare’s 55 million beneficiaries. The first wave, the Pioneer ACOs, lost three-fourths of their 32 original participating organizations, including successful managed care players like HealthCare Partners, Sharp Healthcare, and Presbyterian Healthcare of New Mexico and others. The second, much larger wave of regular MSSP ACO participants lost one third of their renewal cohort. Only about one-quarter of ACO/MSSP participants generated bonuses, and those bonuses were highly concentrated in a relative handful of successful participants. 

Of the 477 Medicare ACO’s, a grand total of 52, or 11%, have downside risk, crudely analogous to capitation. As of last fall, CMS acknowledged that factoring in the 40% of ACO/MSSP members who exceeded their spending targets and the costs of the bonuses paid to the ACOs who met them, the ACO/MSSP programs have yet to generate black ink for the federal budget. And this does not count the billions care systems have spent in setting up and running their ACOs. It is extremely unlikely that the Medicare ACO program will be made mandatory, or voluntarily grow to replace DRGs and the Medicare Part B fee schedule. 

And the Cadillac Tax, that 40% tax imposed by ACA on high cost employee benefit plans, a potentially transformative event in the large group health insurance market, which was scheduled to be levied in 2018, was “postponed” for two years (to 2020) by an overwhelming Congressional vote. In the Senate, a 90-10 bipartisan majority actually voted to kill the tax outright, strongly suggesting that strong opposition from unions and large employers will prevent the tax from ever being levied. Presumptive Democratic nominee Hillary Clinton has announced her support for killing the tax. So the expected transformative event in the large group market has proven too heavy a lift for the political system. 

As a result, the enrollment of large group workers in private health exchanges, the intended off-ramp for employers with Cadillac tax problems, has arrested at about 8 million, one-fifth of a recent forecast of 40 million lives by 2018. Thus, the conversion of the enormous large group market members to narrow network products seems unlikely to happen. As a recent New York Times investigation revealed, the reports of the demise of traditional group health insurance coverage (based on broad network PPO models) have been greatly exaggerated.

NATO’s Warsaw Summit

At the end of this week, leaders from the United States and Europe will convene in Warsaw, Poland, for a NATO summit. The meeting – only the second summit since Russia’s 2014 invasion of Ukraine – will include high level strategic discussions, and will likely see the announcement of an increased NATO troop presence in the Baltic States to counter potential Russian aggression there.

The biggest question leaders intend to address in Warsaw is how to deter Russian aggression towards NATO members in Eastern Europe following its seizure of Crimea and involvement in the conflict in Eastern Ukraine. In effect, leaders will try to find a compromise solution which reassures NATO’s eastern members, provides additional deterrence, but does not provoke further military buildup and distrust from Russia. They will almost certainly fail in this endeavor.

In fact, the expected announcement of the deployment of 4 battalions of additional troops to the Baltics has already produced heated rhetoric from Russia. These deployments will likely lead to a Russian response, ratcheting up tensions and increasing the risk for inadvertent conflict in the region. In other words, they will contribute to a classic security spiral of mistrust and overreaction. The irony is that such deployments are largely symbolic, not strategic. Even four battalions will not change the fact that Russia could likely conquer the Baltics quickly if it so chose. And even though some would argue that their deterrent value is largely as a ‘tripwire,’ it isn’t clear why the existing Article V guarantee is insufficient for that purpose.

To be frank, in the focus on how to defend the Baltics, leaders have largely overlooked the low likelihood of a conflict in that region. For one thing, there is a qualitative difference between attacking Ukraine and attacking a NATO treaty member; Vladimir Putin certainly knows this. For another, Russia’s force posture simply doesn’t indicate that it has any intentions on the Baltics.

Alton Sterling Shooting Raises Questions

In the early morning hours of Tuesday, July 5th police officers in Baton Rouge, Louisiana shot and killed Alton Sterling, a 37-year-old black man who was reportedly selling CDs outside a convenience store. The shooting was filmed by at least two citizens. The two officers involved in the shooting, who were wearing body cameras, are on administrative leave, and the Department of Justice has launched an investigation. The shooting raises a range of questions concerning police use-of-force, body cameras, and police procedure.

According to an unnamed senior law enforcement official, Sterling presented a gun to a homeless man, who then called 911. During the scuffle between Sterling and the officers, which ended with Sterling on his back and both officers on top of him, one of the officers yelled “He’s got a gun!” Shortly afterwards Sterling was shot numerous times at point blank range. Footage shows that Sterling did not have a gun in his hand when he was shot. 

Cato research associate Jonathan Blanks wrote about the shooting at Policemisconduct.net, highlighting (among other things) the “cooling off” period granted to many officers after they are involved in a shooting and before they answer questions.  

Today, I discussed the shooting with Caleb O. Brown, the Cato Institute’s multimedia director. 

What Do We Know about Education?

It’s the 50th anniversary of the legendary Coleman Report, as George Will discusses today in the Washington Post. Will summarizes what experts in 1966 believed about education, and what additional experience revealed:

The consensus then was that the best predictor of a school’s performance was the amount of money spent on it: Increase financial inputs, and cognitive outputs would increase proportionately. As the postwar baby boom moved through public schools like a pig through a python, almost everything improved — school buildings, teachers’ salaries, class sizes, per-pupil expenditures — except outcomes measured by standardized tests.

Andrew Coulson put that key fact in a handy chart:

Education spending and results

Politicians, experts, and the education establishment still aren’t willing to accept the lesson demonstrated by this chart.

But if money doesn’t work, what does? Coleman emphasized cultural factors, notably strong families. Coulson believed that schools could improve, and that competition could help us discover best educational practices. This fall, public television stations will broadcast his documentary asking why educational innovations are so rarely tested and replicated.