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Hi all,

It feels great to be back with new episodes for you all after our month away, and I think we kicked things off with two really important and difficult topics:

Learning As We Go: I sent my kids back to school this week ... from their bedrooms. My sons started 7th and 9th grades, respectively, remotely, as did millions of other kids around the country. We talked with Brown University economist Emily Oster about the tough decisions facing schools and families this fall. Emily has spent her career helping people, often parents, make better decisions with data, and now she's hoping to do the same with schools and COVID-19. (Listen on Apple Podcasts and learn more on our website.)

An Unpleasant Surprise: One of the biggest health policy stories of the year before the pandemic was surprise billing. Repeated stories of patients with insurance getting stuck with hundreds or thousands of dollars in unexpected charges after going to an in-network hospital provoked outrage across the political spectrum. But Congress has still not passed any legislation to rein in the unpopular practice. We checked in with University of Michigan law professor Nicholas Bagley to find out why this happens and why Congress has yet to act. (Listen on Apple Podcasts and learn more on our website.)

Next week, we'll explore the toll the pandemic is taking on the mental health of health care workers and what is being done to support them. Make sure you're subscribed to the show on Apple Podcasts or wherever you listen, so you don't miss an episode.

Until then, enjoy this week's newsletter.


Research Corner: Larry Levitt

This week's contributor is Larry Levitt, the Executive Vice President for Health Policy at the Kaiser Family Foundation.

For the first time in an economic downturn, the Affordable Care Act (ACA) exists as a health care safety net for people losing their jobs and employer-provided health insurance. A new study provides some clues as to how well the health care law works for people who lose their jobs and insurance.
The study – by Sumit Agarwal and Benjamin Sommers, published in the New England Journal of Medicine – compares people who lost their jobs before and after the ACA went into effect in 2014 to see if there is a difference in how many people retained health insurance. During the pre-ACA period (2011-2013), there was about a 5% increase in the uninsured rate for people following a job loss. After the ACA went into effect (2014-2016), no such increase occurred. Instead, Medicaid and the marketplaces saw large increases in utilization.

Credit: The New England Journal of Medicine ©2020

With millions of Americans losing their jobs during the pandemic, the number of people without health coverage has undoubtedly risen. However, by how much is unknown, since we don’t track insurance coverage in real-time like we do employment. Many who have lost jobs may not have had employer-sponsored insurance in the first place, if they worked an industry like food service or retail. And the vast majority of people who are unemployed are classified as on temporary layoff, with employers who may be continuing health benefits for their furloughed workers, at least for now. However, the share of unemployed workers who have permanently lost their jobs is growing.
If the economic crisis persists, the number of people losing job-based health insurance will climb, making the ACA’s role as a safety net more relevant than ever.

Staff Picks: Intern Sabrina Emms

BEHIND THE SCENES: It can get a bit lonely working from home. I’ve never met any of the Tradeoffs team in person (we're a remote team already and I started after the pandemic), and although they are amazing and supportive coworkers, it can be weird. I can’t tell you who snacks while they work, who makes loud phone calls, or who keeps a really tidy desk. But while I was working on producing this week’s episode on school reopenings, I had one of my favorite Tradeoffs moments. Dan and I were going through a script, and he had cut this phrase I really liked: “combustible cauldron.” I argued we should keep it, and Dan very candidly told me he thought it sounded silly, that he sounded silly, and could we just cut it. I’ve gotten to work with Dan a lot — he’s a wonderful reporter, a delightful host, and my boss — but I have never felt more like we were coworkers than in that moment.

EVERYTOWN, USA: I've been binge listening to the podcast Everytown. Set in Hamptons Bay, a town just kissing the edge of the Hamptons, Everytown looks at the racial and economic divides that are ripping the town apart. It isn’t exactly escapism, but it’s a very good podcast. Part of the reason I love it is that it paints a very full picture of what is going on — there are no villains, only little tragedies and big structural problems.  

SOME TIRAMISU FOR YOU: My partner and I had a socially distanced dinner with some of our friends recently. They have a garden, so we had the (admittedly humid) privilege of sitting outside for a fresh pesto and homegrown tomato salad. For dessert, I made a tiramisu. I opted to make my own ladyfingers, and it was very easy — the ladyfingers only use three ingredients, and I soaked them liberally in Kahlúa. My partner thought the dessert could have had more chocolate, but it was a lovely, summer-y thing to eat. Although I made mine in a dish, the recipe is really for individual tiramisus, so there’s nothing stopping you.

Reporting on complex health policy issues is no easy task. It takes time and money. When you support Tradeoffs, you are making our ambitious storytelling, dogged reporting and rigorous research possible.
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