The Dish

Yesterday, the government released detailed data on Obamacare enrollments. Cohn provides the chart seen above:

The figure bound to get most attention is the age breakdown. Insurers rely on premiums from healthier people to offset the costs of people with significant medical bills. And young people are a reasonably good proxy for healthy people—or, at least, as good a proxy as we have right now. According to a recent study by the Kaiser Family Foundation, about 40 percent of the population that could enroll in Obamacare exchange plans are between the ages of 18 and 34. But, according to the government’s new data, only 24 percent of the people signing up for coverage are in that age range. In short, the people who have gotten insurance through the Obamacare marketplaces so far are significantly older than the people who could, in theory, be buying insurance from them.

But is that really a big deal? In Massachusetts, according to analysis from MIT economist (and Obamacare architect) Jonathan Gruber, younger people tended to sign up later.

Philip Klein pushes back:

Though there’s a plausible case to be made that younger Americans will wait until later to sign up, the administration is still in a deep hole. Because the current number of young adult signups is significantly less than 40 percent, to make up ground, signups in the coming months will have to be significantly higher than 40 percent.

As an example, let’s just say all of the roughly 2.2 million Americans whom HHS says have signed up for insurance pay their premiums and complete enrollment, and the total paid enrollment number through March ends up being 5 million people. To meet the original demographic goal, about 1.4 million of the remaining 2.8 million enrollees — or roughly half — would have to be between the ages of 18 and 34.

Sarah Kliff digs deeper into the numbers:

Even more important than these top-line numbers is what’s happening in each state. Insurance rates are set on a state-by-state basis, so even if thousands of young people are signing up in California, it doesn’t effect the premiums in neighboring Nevada.

The new Health and Human Services report does show some variation by state, although most exchanges tend to hover somewhere in the 20-percent range. In the District of Columbia, 44 percent of enrollees are young adults, the highest for any exchange (and remember: This is just the individual marketplace, not the small business exchange where Congressional staff shop). Arizona and West Virginia have the lowest rates of young adult sign-ups, who make up 17 percent of their marketplace.

Avik Roy considers what happens if the exchanges skew older:

As Philip Klein notes, a recent article by Larry Levitt, Gary Claxton, and Anthony Damico of the Kaiser Family Foundation described an enrollment of 25 percent among 18-34 year olds as a “worst-case scenario,” estimating that insurers would lose money on these plans, because “overall costs…would be about 2.4% higher than premium revenues.” 2.4 percent may seem like a small number, but given that the average insurer has profit margins of 4 to 6 percent, a 2.4 loss on premiums—before we even count overhead costs—is a serious problem. It’s why Humana reported to the Securities and Exchange Commission that it expected meaningful losses in its exchange-based plans.

McArdle looks at the percentage of enrollees receiving subsidies:

Five million people were deemed eligible to buy a policy on the exchanges; 2.7 million, or 54 percent of them, were eligible for subsidies. But of people who actually selected a plan, 1.68 million, or 80 percent, were subsidized. To put it another way, 62 percent of the people eligible for subsidies selected a plan, but only 8.5 percent of those who weren’t eligible for subsidies actually purchased one. That is very different from the information we were getting in December, when most of the people who selected plans were not eligible for subsidies. … This is much closer to what the Congressional Budget Office was projecting, in terms of subsidized enrollment; it had predicted that about 85 percent of the people on the exchanges would get subsidies. So in one sense, it’s not novel. But it does show enrollment looking a lot more like the wonks had been projecting, and that’s important. The next step for the administration is to get the mix of young and healthy people more in line with initial forecasts.

Sprung looks on the bright side:

Signup rates are impressive in many large states in which Republican governors and legislatures have worked actively to undercut the law. On 12/28, the open enrollment period (Oct. 1 – Mar. 31) was just shy of half over — and signups were miniscule through the first week of December. Any state that had reached more than say one third of the CBO projection for first-year exchange signups might be deemed more or less on course. Major non-cooperating states that passed that threshold (as tracked by Charles Gaba’s invaluable spreadsheet)include Florida (33% of CBO projection, 158.0k signups), Michigan (47%, 75.5k), New Jersey (36%, 34.7k), North Carolina ((56%, 107.7k), Pennsylvania (39%, 81.3k), Virginia (35%, 44.6k) and Wisconsin (52%, 40.7k).

More good news: only about 20% of those choosing plans on the exchanges have opted for the cheapest bronze plans, where deductibles average $5,000 per person. Benefits are benchmarked to the second cheapest silver plan in each state, and subsidies that reduce deductibles. and maximum out-of-pocket costs, offered to buyers with incomes below 200% of the federal poverty level, are only available to silver plan buyers. Further, 79% of those who have enrolled in plans thus far have qualified for subsidies. Put those numbers together and it appears that most exchange buyers thus far may indeed find their coverage and care affordable.

Reporting on the shocking treatment of mentally ill inmates in South Carolina’s prisons, Andrew Cohen asks why the state has refused to do anything about it:

On Wednesday, in one of the most wrenching opinions you will ever read, a state judge in Columbia ruled that South Carolina prison officials were culpable of pervasive, systemic, unremitting violations of the state’s constitution by abusing and neglecting mentally ill inmates. The judge, Michael Baxley, a decorated former legislator, called it the “most troubling” case he ever had seen and I cannot disagree. Read the ruling. It’s heartbreaking. The evidence is now sadly familiar to anyone who follows these cases: South Carolina today mistreats these ill people without any evident traces of remorse.  Even though there are few disputed material issues of law or fact in the case, even though the judge implored the state to take responsibility for its conduct, South Carolina declared before the sun had set Wednesday that it would appeal the ruling—and thus likely doom the inmates to years more abuse and neglect. That’s not just “deliberate indifference,” the applicable legal standard in these prison abuse cases. That is immoral.

But what makes this ruling different from all the rest—and why it deserves to become a topic of national conversation—is the emphasis Judge Baxley placed upon the failure of the good people of South Carolina to remedy what they have known was terribly wrong since at least 2000.

Nicole Flatow examines the horrors the inmates suffered:

Jerome Laudman, a schizophrenic, intellectually disabled inmate in South Carolina, was placed in solitary confinement, although he was neither aggressive nor threatening. During his transfer to the “Lee Supermax” facility, he was sprayed with chemical munitions and physically abused by a correctional officer. Although the transfer should have been recorded, the videotape turned up blank. While Laudman was confined naked in his cell, officers observed that Laudman had stopped eating and taking his medication, and appeared sick and weak. They did not report it. A week later, he was found laying in his own feces with 15-20 trays of molding food in his cell, vomiting. Nurses and an officer refused to retrieve his body. When two inmates were eventually sent to remove him, he was transferred unconscious to a hospital, where he died of a heart-attack. …

Other plaintiffs in the case were held naked in restraint chairs for hours at a time without treatment of their injuries, left to urinate in place and forced to stay in a painful “crucifix” position for hours. In one instance, blood pooled beneath an inmate held in a restraint; in another, an inmate’s intestine was protruding from his abdomen as officers tightened restraints surrounding the wound. One inmate was restrained with his arms in a twisted position, soaked in water, and then left outside on a December night.

Last week, ahead of the Season 3 premiere of Girls, TV critic Tim Molloy asked Dunham why she does so many nude scenes. Molloy:

I don’t get the purpose of all the nudity on the show. By you particularly. I feel like I’m walking into a trap where you say no one complains about the nudity on ‘Game of Thrones,’ but I get why they’re doing it. They’re doing it to be salacious. To titillate people. And your character is often naked at random times for no reason.

Amanda Hess fires back:

Louis Peitzman, who created the above chart, argues that “show is, by and large, less explicit than True Blood or Game of Thrones“:

Hannah is a full-figured woman, and while she looks a lot like the majority of people in this country, she is not the stick-thin, big-chested woman who often populate our TV screens. Because she deviates from the norm in that way, Hannah stands out. She seems, to some, gratuitously naked, even if she’s only naked for a very small percentage of Girls.

That’s why questions like Tim Molloy’s are met with such indignation. Whether or not his intention was misogynistic or a means of body policing — and I’ll give him the benefit of the doubt that it wasn’t — that is the connotation the question carries. It’s not about the nudity itself, which is nowhere near constant, but rather how it makes the viewer feel. And in this case, that feeling of “wrongness” is inextricably tied to Dunham’s body, making her defensiveness all the more valid.

So while Girls may indeed be too sexually explicit for some, the nudity question doesn’t merit the kind of serious response Molloy may have been looking for. The characters simply aren’t naked all the time, and when they are, it’s because Girls, as Dunham put it, is “a realistic expression of what it’s like to be alive.”

Emily Shire also defends Dunham:

Although I do find nudity gratuitous sometimes, Girls‘ use of it, especially Dunham’s, feels natural. Guess what? We sometimes walk around our apartments naked. When we pee or have sex, at the very least the important parts have to be naked for it to work, and if we’re hanging out with people who have already seen us naked, we may stay nakedish, as Dunham’s Hanna Horvath did during a much maligned ping pong scene in season two’s “One Man’s Trash.”

So, one answer to Molloy’s question about why Dunham is naked if not for the purpose of being sexually arousing is because the show is committed to a certain realism. And as Apatow later stated, “I have people naked when they’re willing to do it.” Not all the actresses on Girls are willing to be naked, but when they are, the show uses nudity to bring that extra touch of reality to their interactions.

Megan Gibson adds:

Girls is peppered with moments that are funny and poignant and Dunham often uses nudity, her own and her casts’, to emphasize these moments. Sure, not every viewer enjoys it, but then again not everyone likes the provocative nudity on Game of Thrones. But what’s really troubling is not the amount of skin that appears on either  show, but the reaction to it. For anyone who thinks that female nudity should solely be about titillation — and are subsequently confused or even angry when that’s not the case — has a disturbing view of women’s place onscreen. And if Dunham and Girls helps shift that view, I say bring on the nude scenes.

As General Abdel Fattah Al-Sisi signals that he plans to seek the Egyptian presidency, Shadi Hamid compares his dictatorial style with that of Mubarak:

Mubarak was your run-of-the-mill autocrat, intent on restricting dissent, but also willing to tolerate a degree of opposition. He had no particular ideology except the preservation of power and, in his latter years, the accumulation of wealth. Sissi evinces no such modesty, hearkening back to the caudillos of Latin America with his populist paternalism. He is a compelling orator, comfortable speaking extemporaneously and with seeming conviction. Just weeks after his rise to power, Sissi, on state television, called for mass rallies to “authorize” him to do what was necessary in the fight against “terrorists.” A personality cult has grown accordingly, with Sissi-themed cupcakes and chocolates and even women’s nightwear featuring the general himself in dark sunglasses. …

Previously coy about his intentions, General Sissi appears to have made a decision. He has been driven by both personal ambition (a voice reportedly told him in a dream: “We will grant you what no one has had before”) and mounting public pressure. One pro-Sissi group filed a lawsuit in an attempt to “force” Sissi to run. Another pro-Sissi group, claiming 12 million signatures in support, would prefer to skip the formality of elections altogether.

Totten expects no good news from Egypt anytime soon:

The idea that Sisi would ever “restore” the democracy that went “off track” with Morsi, as so many activists claimed when he seized power, was always delusional. Egypt had no democracy to begin with. (A single election does not a democracy make.) Nor does the Egyptian military have a democratic cell in its corpus. Egypt’s choice is the same now as it has been for decades: Islamic theocracy or military dictatorship. It can’t be sustainably settled at the ballot box, so it will be fought over instead in the streets.

Peter Oborne looks glumly at this week’s constitutional referendum:

In no way can the referendum be called democratic. There are thousands of posters urging Egyptians to vote yes, but on my visit to Cairo last week I did not witness a single one urging them to vote no. The reason for this emerges from a very worrying report from Human Rights Watch out today. Campaigners against the constitution are being arrested and charged with “attempting to overthrow the regime”. The main opposition party, the Muslim Brotherhood, has been declared (on no evidence) a terrorist organisation. There are reports today that the political party Strong Egypt, which claims to be liberal, has been forced to suspend its no campaign because of the recent arrests. Meanwhile, General Sisi says that a successful vote this week will license him to run for the presidency in a poll later this year. This is very sinister. As Bruce Riedel powerfully points out here, the coup d’état which restored military rule in Egypt is being seen by al Qaeda as validation of their murderous ideology.