http://www.itpro.co.uk/business-intelligence/big-data-column/19594/future-cities-widens-its-reach-big-data

Present Situation Be Damned, Full Speed Ahead

The Affordable Care Act’s Healthcare was reviewed, state-by-state, last week.  This week brings another table (below) of dubious data collected with sincere effort to try to estimate the ACA’s impact on Audiologists.

Requests for updates and corrections last week went unheeded.  Logical explanations, in order of probability, are 1) nobody reads this column except Harvey Abrams, 2) few readers understand the healthcare provisions of the act, and 3) the data were correct. Logical proofs follow:

  1. Dr Abrams requested permission to use last week’s Table 1 in an upcoming presentation.  No one else commented or requested permissions.  Ergo, no one reads this column except Harvey Abrams.
  2. The Onion’s headline:  “Man Who Understands 8% Of Obamacare Vigorously Defends It From Man Who Understands 5%.”  According to the article, both men understood 3% in post-discussion.  Ergo, few readers understand the healthcare act.
  3. If data go undisputed, they are not proved incorrect.  Ergo, they are correct.

Perhaps such logic underlies reports of the Present Situation, in which the US Government is closed, even the USS Enterprise can’t make it through the online health insurance portal, and fewer than 1/3 of medical groups are agreeing to participate in the healthcare system.  Economists are tough and don’t let trifles such as these stand in their way.  Hearing Economics is made of the same stuff and forged ahead this week, slicing through the Present Situation.

The Portal

healthnet confirmation of aca plan coverage
Figure 1. Proof of Portal Passing.

Despite claims to the contrary, it IS possible to self-enroll for health insurance via the online portal. I did it (see Figure), it only took a week, and it answered 3 questions:  How hard was it? Could I get a better insurance rate?  Did Arizona enrollees seriously qualify for a “one hearing aid per year” benefit? The answers were:  Not Bad, Yes, and Yes.

The portal is amazing but it’s easy to see why it remains a work in progress. Those poor software engineers and managers have done a fantastic job of navigating HIPAA, political, insurance, and state specific obstacles, not to mention a government shutdown, inadequate funding, too many chiefs, and direction that was too little and too late.

Put yourself in the following scenario and ask yourself why the code writers didn’t commit group seppuku weeks ago:

As late as the last week of September, officials were still … debating whether consumers should be required to register and create password-protected accounts before they could shop for health plans.

Holy Cow.  Medicare took a decade to get online and roll out HIPAA requirements.  The Portal People tried to create something as big as Medicare, state-by-state, in a matter of months.  When this is over, they all deserve medals, time off, and raises.

How Many Hearing Aids is That?

 

The insurance actuaries probably know, but they’re not sharing and I don’t know anyone else who can answer that question. Not every state, in fact NO state except Arizona, has the 1 hearing aid per year benefit built into the state plan.  That makes Arizona a good place to start playing around with data and making wild predictions.

The first question is “How many additional people will be covered in each state?”  Last week’s table gave percentages but Audiologists and Economists like to know “percentage of what?” Ditto for medical groups, which may explain why so few have signed up as providers so far.

Real numbers are hard to come by, given the Present Situation of a closed Census Bureau.  But why let lack of data stand in the way? The following Table uses secondary sources to try to estimate numbers of insured and numbers of insured with hearing loss. If everyone who qualifies in Arizona enrolls and avails themselves of benefits, well over 100,000 hearing aids could be dispensed annually in Arizona.  Thassa lotta hearing aids.  We’ll see how many end up getting dispensed, at what prices, and by whom.

Economically, hearing aid subsidies beget supply-side shocks which beget increased utilization rates which beget shifts in the Demand Curve, altogether shifting equilibrium.  It’s not a free market, but it’s a market that’s shifting rightward — more quantity at lower prices.

Let me know where I’ve miscalculated or missed the boat entirely.  Otherwise, logic will say that these data are correct, which I strongly doubt. Please join in — Harvey shouldn’t have to do this alone!  (Editorial note:  big tables are tricky in wordpress.  If the table doesn’t look right, try a different browser — Chrome, Mozilla, etc).

State

%

Insured[i]

Labor Force     (ages 16-64)[ii] Estimated # of Uninsured[iii] Estimated # Hearing Loss[iv]
AL 18.8

2,158,000

405,704

81,141

AK 21.8

365,800

79,744

15,949

AZ 20.5

3,024,900

620,105

124,021

AR 21.9

1,350,400

295,738

59,148

CA 23.2

18,479,600

4,287,267

857,453

CO 17.1

2,740,400

468,608

93,722

CN 9.9

1,877,400

185,863

37,173

DE 9.6

444,200

42,643

8,529

DC 7.5

363,900

27,293

5,459

FL 22.8

9,377,100

2,137,979

427,596

GA 22.5

4,806,500

1,081,463

216,293

HI 10.5

649,200

68,166

13,633

ID 17.2

772,800

132,922

26,584

IL 17.2

6,587,800

1,133,102

226,620

IN 16.7

3,141,600

524,647

104,929

IA 11.8

1,634,400

192,859

38,572

KS 14.6

1,486,400

217,014

43,403

KY 19.8

2,077,500

411,345

82,269

LA 24

2,081,600

499,584

99,917

ME 14.8

705,500

104,414

20,883

MD 12.3

3,124,000

384,252

76,850

MA 4.5

3,471,900

156,236

31,247

MI 15.4

4,653,000

716,562

143,312

MN 11.5

2,965,600

341,044

68,209

MS 21.7

1,333,600

289,391

57,878

MO 16.4

2,988,500

490,114

98,023

MT 16.9

508,400

85,920

17,184

NE 15.9

1,021,300

162,387

32,477

NV 23.3

1,376,300

320,678

64,136

NH 13.6

742,100

100,926

20,185

NJ 15.2

4,597,700

698,850

139,770

NM 20.1

935,500

188,036

37,607

NY 13

9,581,000

1,245,530

249,106

NC 19.4

4,723,500

916,359

183,272

ND 13.8

392,800

54,206

10,841

OH 14.7

5,733,600

842,839

168,568

OK 21.4

1,803,900

386,035

77,207

OR 17.6

1,957,800

344,573

68,915

PA 11.9

6,493,100

772,679

154,536

PR 6.7

1,209,700

81,050

16,210

RI 15.2

561,200

85,302

17,060

SC 20.5

2,164,500

443,723

88,745

SD 14.4

445,200

64,109

12,822

TN 17.6

3,108,400

547,078

109,416

TX 28.8

12,596,100

3,627,677

725,535

UT 15.7

1,354,000

212,578

42,516

VT 9.2

355,900

32,743

6,549

VA 14.7

4,203,400

617,900

123,580

WA 16.9

3,476,400

587,512

117,502

WV 19

806,000

153,140

30,628

WI 11.8

3,046,400

359,475

71,895

WY 21.3

305,900

65,157

13,031


[i] 2011 US Census data as reported in AARP Bulletin Oct 2013, p 32.

[iii]Calculated as ( % Uninsured * Labor Force)/100

[iv] rough estimate from Linn data & Kochkin MarkeTrak report

photo courtesy of it pro

About Holly Hosford-Dunn

Holly Hosford-Dunn, PhD, graduated with a BA and MA in Communication Disorders from New Mexico State, completed a PhD in Hearing Sciences at Stanford, and did post-docs at Max Planck Institute (Germany) and Eaton-Peabody Auditory Physiology Lab (Boston). Post-education, she directed the Stanford University Audiology Clinic; developed multi-office private practices in Arizona; authored/edited numerous text books, chapters, journals, and articles; and taught Marketing, Practice Management, Hearing Science, Auditory Electrophysiology, and Amplification in a variety of academic settings.