insurance – Between Hell and High Water

Republicans Aren’t Cutting Health Care Costs—They’re Just Shifting Them

By Mike Koetting September 1, 2026

As various cuts to Medicaid and the Affordable Care Act (ACA) take effect, it becomes clear that they will substantially reduce the health care options available to millions of Americans.

This is awful.

But this note is not focused on the harm it does people impacted directly, rather on the fact that the entire premise of these cuts is fundamentally a lie. Despite any rationalizations by Republicans, the cuts in Medicaid and the ACA included in the Republicans’ budget bill are less reductions in health care costs and more shifts in who pays. In this case, it moves costs from the most wealthy (by reducing their taxes) to the rest of us (who pick up the pieces in various ways.) It is a stealth “tax” increase on those not specifically benefited from Republican Budget Bill.

If the country is ever going to have an honest discussion about health care, we need to understand the actual dynamics.

Numbers and Conversations in the Fires’ Aftermath

By Mike Koetting February 11, 2025

The thing about numbers is they are objective. You can fudge them for a while, but eventually their concreteness wins out.

So when the insurance actuaries mull over the Los Angeles wildfires, they will issue verdicts not based on rhetoric or hope or blame, but gimlet-eyed assessments of what makes sense for insurance companies—increase rates, leave or what.

We already have a preview. In the year leading up to the fires, State Farm, the largest homeowners insurance company in California, anticipating the risk, refused to renew thousands of policies there. They had already stopped selling new policies in the state. Other insurers are similarly trimming their sails.

Property Insurance: An Environmentally Endangered Species

By Mike Koetting April 9, 2024

I believe one of the reasons that people discount the threats to our environment is that they imagine them as some really catastrophic events resulting in the kind of dystopian science fiction scenario portrayed in a Mad Max movie. Since that is, literally, unthinkable, it gives license to lower the immediate threat level.

However, it is not likely it will happen like that. It is much, much more likely that things will come apart gradually, one problem after another, each compounding the previous. It has already started to happen, poking successive holes in the fabric of our life. Today’s conversations are no longer just about the future.

This post addresses one of these clear and present problems—the retreat of home owners’ insurance in the face of environmental threats.