iftttwall

As problems with Obamacare’s
federal exchange system have continued, supporters of the health
law have turned to a backup argument. Sure, the law is struggling
due to technical problems, but in the states that decided to set up
their own exchanges, it’s actually going reasonably well.
California, in particular, is being singled out for its high
enrollment numbers—numbers that some reports have said put the
state on track to hit its enrollment targets.

The reality of the state-run exchanges is a little more
complicated. There’s no question that the state systems are, on the
whole, working better than the federally facilitated exchanges. But
serious problems continue to plague a significant minority of the
state-run exchanges. And even states said to be success stories may
not be quite as successful as claimed.

The argument that state-run exchanges, put in place by state
governments that wanted to make the law work, predates the October
launch. Obama himself made a version of the argument during the
last week in September, when he went to Maryland to give a
speech about the law, and to tout its state-run exchange.

But Maryland is one of the states that has struggled most to get
its exchange up and running. The technical troubles are significant
enough that it turned to paper applications and other workarounds.
But it’s not getting the sign up numbers it was hoping for. As
The Washington Post
reports, just 1,278 people signed up for private coverage in
the state during October, and another 465 in the first week of
November. Those low numbers, the Post piece notes, “raise
questions about whether Maryland will achieve its enrollment target
of 150,000 by the end of March.”

Maryland has at least managed to get some people to the final
step of the private plan enrollment process. The same can’t be said
for Oregon. Not a single person has yet to enroll in private
coverage through the state’s broken exchange,
according to  Reuters. The state exchange—which The
Washington Post
once described as “the White House’s favorite health
exchange—was delayed before the October launch, and has never gone
online. And there’s no sign that it will in the foreseeable future.
Reuters says that its marketplace is “out of commission and
unavailable to the public indefinitely.” I suspect the White House
isn’t too thrilled anymore.

These aren’t the only state-run systems that have had or still
have serious problems. As The New York Times
noted last week, Hawaii’s site went down on launch day, didn’t
come back online for weeks, and “users continue to report
problems.” Vermont’s exchange system does not yet process
individual payments for insurers, which presumably complicates
enrollment. Vermont’s system was
built by CGI Group—the same contractor that botched the federal
exchanges.

So it’s not all flowers and rainbows in the state-run exchanges.
And even where things are going relatively well, there are still
problems. In Washington state, for example, a pricing glitch means
that about 8,000 people are finding out that they’ll be
eligible for a smaller federal subsidy for their insurance than
they were initially told. One of those people was a woman whom
President Obama highlighted in a speech as being able to finally
obtain affordable insurance. Her new, revised price is so high that
she
now says she expects to remain uninsured.

In other states,
like Kentucky, Connecticut, and California, the demographic mix
of people signing up for plans appears to skew old, which could
pose longer-term problems if the insurance pools turn out to be
more expensive than expected.

And that’s presuming that any of these states actually hit their
enrollment targets. The Los Angeles Times
reported this week that the numbers so far suggest that
California is on track to meet its 2014 enrollment goals after a
“sharp increase in November.”

But the enrollment numbers released for the state so far don’t
actually say how many people have completed the enrollment process.
An
HHS report on Obamacare signups from last week counts 35,364
individuals as having “selected a Marketplace plan” in California,
which means they’ve dropped it into their online shopping cart. A
Los Angeles Times
report from last weekend merely describes people as having
“selected” health plans.

And there appear to be issues with income and subsidy
verification as well. The same HHS report lists the  number of
people determined “eligible to enroll in a Marketplace plan with
financial assistance” as not applicable; that data is available in
most of the other state-run exchanges. Last weekend’s Los
Angeles Times report noted significant problems for enrollment
assisters. One potential applicant
told the LAT that “You can look, but you can’t use the
website to do the income calculation.”

That’s what Obamacare’s state-run exchanges look like. Even
where they appear to be working, it’s not clear they’re working all
that well.

As problems with Obamacare’s
federal exchange system have continued, supporters of the health
law have turned to a backup argument. Sure, the law is struggling
due to technical problems, but in the states that decided to set up
their own exchanges, it’s actually going reasonably well.
California, in particular, is being singled out for its high
enrollment numbers—numbers that some reports have said put the
state on track to hit its enrollment targets.

The reality of the state-run exchanges is a little more
complicated. There’s no question that the state systems are, on the
whole, working better than the federally facilitated exchanges. But
serious problems continue to plague a significant minority of the
state-run exchanges. And even states said to be success stories may
not be quite as successful as claimed.

The argument that state-run exchanges, put in place by state
governments that wanted to make the law work, predates the October
launch. Obama himself made a version of the argument during the
last week in September, when he went to Maryland to give a
speech about the law, and to tout its state-run exchange.

But Maryland is one of the states that has struggled most to get
its exchange up and running. The technical troubles are significant
enough that it turned to paper applications and other workarounds.
But it’s not getting the sign up numbers it was hoping for. As
The Washington Post
reports, just 1,278 people signed up for private coverage in
the state during October, and another 465 in the first week of
November. Those low numbers, the Post piece notes, “raise
questions about whether Maryland will achieve its enrollment target
of 150,000 by the end of March.”

Maryland has at least managed to get some people to the final
step of the private plan enrollment process. The same can’t be said
for Oregon. Not a single person has yet to enroll in private
coverage through the state’s broken exchange,
according to  Reuters. The state exchange—which The
Washington Post
once described as “the White House’s favorite health
exchange—was delayed before the October launch, and has never gone
online. And there’s no sign that it will in the foreseeable future.
Reuters says that its marketplace is “out of commission and
unavailable to the public indefinitely.” I suspect the White House
isn’t too thrilled anymore.

These aren’t the only state-run systems that have had or still
have serious problems. As The New York Times
noted last week, Hawaii’s site went down on launch day, didn’t
come back online for weeks, and “users continue to report
problems.” Vermont’s exchange system does not yet process
individual payments for insurers, which presumably complicates
enrollment. Vermont’s system was
built by CGI Group—the same contractor that botched the federal
exchanges.

So it’s not all flowers and rainbows in the state-run exchanges.
And even where things are going relatively well, there are still
problems. In Washington state, for example, a pricing glitch means
that about 8,000 people are finding out that they’ll be
eligible for a smaller federal subsidy for their insurance than
they were initially told. One of those people was a woman whom
President Obama highlighted in a speech as being able to finally
obtain affordable insurance. Her new, revised price is so high that
she
now says she expects to remain uninsured.

In other states,
like Kentucky, Connecticut, and California, the demographic mix
of people signing up for plans appears to skew old, which could
pose longer-term problems if the insurance pools turn out to be
more expensive than expected.

And that’s presuming that any of these states actually hit their
enrollment targets. The Los Angeles Times
reported this week that the numbers so far suggest that
California is on track to meet its 2014 enrollment goals after a
“sharp increase in November.”

But the enrollment numbers released for the state so far don’t
actually say how many people have completed the enrollment process.
An
HHS report on Obamacare signups from last week counts 35,364
individuals as having “selected a Marketplace plan” in California,
which means they’ve dropped it into their online shopping cart. A
Los Angeles Times
report from last weekend merely describes people as having
“selected” health plans.

And there appear to be issues with income and subsidy
verification as well. The same HHS report lists the  number of
people determined “eligible to enroll in a Marketplace plan with
financial assistance” as not applicable; that data is available in
most of the other state-run exchanges. Last weekend’s Los
Angeles Times report noted significant problems for enrollment
assisters. One potential applicant
told the LAT that “You can look, but you can’t use the
website to do the income calculation.”

That’s what Obamacare’s state-run exchanges look like. Even
where they appear to be working, it’s not clear they’re working all
that well.

Possessing
up to an ounce of marijuana in California is an “infraction”
punishable by a $100 fine. In other words, state
law treats pot smoking as a transgression akin to jaywalking
or fishing without a license. Yet growing and selling marijuana are
felonies that can send you to prison for years. If consuming
marijuana is not a crime, asks Senior Editor Jacob Sullum, how can
it be a crime merely to help someone consume marijuana? That is a
question voters will confront next fall if the California
Cannabis Hemp Initiative qualifies for the ballot.

View this article.

Last September the CDC
noted with alarm that the percentage of teenagers who had
tried electronic cigarettes doubled between 2011 and 2012. “Many
teens who start with e-cigarettes may be condemned
to struggling with a lifelong addiction to nicotine and
conventional cigarettes,” CDC Director Tom
Frieden worried. In a Medscape interview a
few weeks later, Frieden suggested that fear had already
materialized, asserting that “many kids are starting out with
e-cigarettes and then going on to smoke conventional cigarettes.”
Yet the CDC’s data, which came from the 2012 National Youth Tobacco
Survey (NYTS), did
not support that claim. In fact, nine out of 10 high school
students who reported vaping in the previous month were already
cigarette smokers, suggesting that the increase in e-cigarette
consumption might signal successful harm reduction. Last week the
CDC
reported additional NYTS data that further undermine Frieden’s
claim, showing that smoking among teenagers fell as vaping
rose.

Between 2011 and 2012, when the share of middle school students
who reported using e-cigarette in the previous month rose from 0.6
percent to 1.1 percent, the share reporting past-month consumption
of conventional cigarettes fell from 4.3 percent to 3.5 percent.
Among high school students, past-month e-cigarette use rose from
1.5 percent to 2.8 percent, while past-month consumption of tobacco
cigarettes fell from 15.8 percent to 14 percent. Although these
trends do not necessarily mean e-cigarettes are responsible for the
decline in smoking, the numbers hardly seem consistent with the
story Frieden is eager to tell: that the availability of
e-cigarettes is leading to more smoking than would otherwise occur.

Since the numbers showing an increase in vaping come from the
very same survey as the numbers showing a decrease in smoking, it
is puzzling that the CDC decided to highlight the first trend two
months before the latter one, especially since the smoking data
suggest Frieden’s fear, which was repeated and amplified by various
activists and politicians pushing for
strict e-cigarette regulation, is misplaced. But the omisision
is puzzling only if you assume the CDC is mainly interested in the
truth, as opposed to scientific-sounding justifications for an
irrational anti-vaping prejudice. Boston University public health
professor Michael Siegel, who sees e-cigarettes as a valuable harm
reduction tool,
comments: 

This decline in cigarette smoking was not reported in the
earlier CDC report on the increase in electronic cigarette use, nor
was it mentioned in any of the multitude of interviews or news
articles regarding the increase in youth e-cigarette use….

The opportunity to see the data on trends in cigarette smoking
would have helped the public to see that there was no scientific
support for the CDC’s conclusion. I thus find it curious that these
important data were not reported until weeks after the media [had]
already disseminated the conclusion that e-cigarettes are a
dangerous gateway to cigarette smoking. The CDC officials certainly
had plenty of opportunity to let the public know that there was no
discernible increase in cigarette smoking among youth concomitant
with the observed increase in e-cigarette use. It seems to me that
this is a critical finding to report.

My impression remains that there is, for some reason (perhaps
related to ideology), a pre-determined conclusion that e-cigarettes
are evil. Instead of fairly reporting all of the evidence, only the
evidence that supports the pre-determined conclusions [is] being
shared. 

Does the gateway effect Frieden fears—a switch from e-cigarettes
to conventional cigarettes among people who otherwise would never
smoke—show up after high school? Not according to a
recent survey of college students, in which only 3.3 percent
said e-cigarettes were the first form of nicotine they’d tried. Of
those, only one (2.3 percent) later started smoking conventional
cigarettes. “It didn’t seem as though it really proved to be a
gateway to anything,” the lead researcher said.

[Thanks to Bill Godshall for the tip.]

City officials in Miami Shores
Village, FL threatened a couple with steep daily fines until they
agreed to uproot a vegetable garden they had been cultivating for
nearly two decades. Now, the couple is taking the city to court for
violating their right to privacy.

This May, the city revised its zoning
code to “protect the distinctive character of the Miami Shores
Village” and eliminate aesthetic blemishes, according to
Watchdog.org. Oddly, the code specifically prohibits vegetable
plants in front yards, but allows for trees, fruit plants, and
kitsch items like pink flamingos and garden gnomes.

Hermine Ricketts and Tom Carroll, who spent 17 years raising an
extensive garden not just as a hobby but to feed themselves, fell
victim to this new regulation. City officials informed Ricketts and
Carroll that their food source was illegal and needed to be
removed, or else the couple would face a $50 fine every day that
the garden remained. The couple explained that their garden could
not be relocated to the back yard, because it does not receive
enough sunlight to sustain their production. They also made
multiple formal requests to be allowed to keep their garden, but
were denied by the code enforcement board.

The Institute for Justice (IJ), a public interest law firm,
announced that it is representing the couple in a case a against
Miami Shores. An IJ press
release states that “Miami Shores will have to prove that
its ban promotes a compelling governmental interest and is narrowly
tailored to advance that interest.”

Miami Shores Village Attorney Richard Sarafan
told The Miami Herald that people turning their yards
into gardens is “not harmonious with our community. This is not an
agricultural zoning area.”

IJ’s stance, on the other hand, is that “government has no
legitimate interest in preventing people from seeing vegetables.”
The law firm also believes the law is explicitly on the couple’s
side, because “Hermine and Tom’s fundamental right to put their
property to peaceful, productive use is guaranteed by the Florida
Constitution’s Basic Rights Clause.”

Ari Bargil, IJ’s lead counsel on the case,
explained to Watchdog.org, “We’re not suing for money. We’re
asking the court to rule that this law is unconstitutional so
Hermine and Tom can plant their garden again.”