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Saved by Medicaid: New Evidence on Health Insurance and Mortality from the Universe of Low-Income Adults
Saved by Medicaid: New Evidence on Health Insurance and Mortality from the Universe of Low-Income Adults

We examine the causal effect of health insurance on mortality using the universe of low-income adults, a dataset of 37 million individuals identified by linking the 2010 Census to administrative tax data. Our methodology leverages state-level variation in the timing and adoption of Medicaid expansions under the Affordable Care Act (ACA) and earlier waivers and adheres to a preregistered analysis plan, a rarely used approach in observational studies in economics. We find that expansions increased Medicaid enrollment by 12 percentage points and reduced the mortality of the low-income adult population by 2.5 percent, suggesting a 21 percent reduction in the mortality hazard of new enrollees. Mortality reductions accrued not only to older age cohorts, but also to younger adults, who accounted for nearly half of life-years saved due to their longer remaining lifespans and large share of the low-income adult population. These expansions appear to be cost-effective, with direct budgetary costs of $5.4 million per life saved and $179,000 per life-year saved falling well below valuations commonly found in the literature. Our findings suggest that lack of health insurance explains about five to twenty percent of the mortality disparity between high- and low-income Americans. We contribute to a growing body of evidence that health insurance improves health and demonstrate that Medicaid’s life-saving effects extend across a broader swath of the low-income population than previously understood.

·nber.org·
Saved by Medicaid: New Evidence on Health Insurance and Mortality from the Universe of Low-Income Adults
Family Values
Family Values
Many complex products often present all features at once, including crypto wallets. Everything is right there, all the time, whether you need it or not. We wanted to take a different approach where the fundamentals would be at your fingertips, but everything else would appear as it became most relevant to you.
We decided to focus on fluidity after observing how static transitions can disrupt the user’s sense of flow and orientation. Staticity can also leave a product feeling lifeless, which we didn’t want. A lifeless product feels like a dead product, and a dead product feels uncared for.
Family's dynamic tray system comprises components housed within trays that can effortlessly expand, contract, and adapt in response to a user’s actions. Trays can appear on the fly and function as a condensed version of the app, with a specific set of constraints and capabilities.
The tray system follows certain rules to function in a way that feels natural. Trays are initiated by the user by tapping buttons, icons, or opening push notifications. They can manifest either as standalone entities on top of any app content, or emerge from within other components like buttons.
To prevent any confusion during transitions, each subsequent tray is designed to vary in height. This makes the progression or change unmistakably clear. This constraint occasionally requires us to rewrite content or tweak the design of a tray slightly to make a transition apparent.
Every tray is equipped with a title that succinctly captures its function or contents, alongside an icon. This icon serves a dual purpose: it allows users to dismiss the tray if it's the initial one shown, or navigate back through a sequence of trays that have been presented one-by-one.
Each tray displayed is typically dedicated to a singular piece of content — like educational text explaining a feature — or a primary action, such as completing a checklist before a transaction.
When deciding whether to implement a tray or full screen flow, we decided to utilise trays for transient actions that don't need to be permanently on display within the app. This can be especially helpful for confirmation steps and warnings, which appear in the right place at the right time.
Trays can also function as the starting point for more elaborate flows that ultimately transition to a full screen format.
One advantage of leveraging trays over full screen flows is the preservation of context. Unlike full screen transitions that can displace users from where they just were, trays overlay content directly onto the current interface.
The compact nature of trays signals to users that each task is approachable. It encourages engagement without the intimidation of a full screen commitment.
Users are guided through actions with the reassurance that they're not veering off course, but rather diving deeper into their current context. This simplifies the user's journey and reinforces the fluidity and coherence of the overall experience.
Imagine seeing parts of a room through an open doorway. From a few metres away, you’re able to catch a glimpse of what’s inside. As you approach and enter, the space and its contents are gradually revealed. Each action by the user makes the interface unfold and evolve, much like walking through a series of interconnected rooms. As a user, I get to see where I’m going as I go there. It’s this dynamic that allows Family to remain simple and keep complexity out of sight and out of mind until required.
Our second principle builds upon similar themes to our dynamic tray system and pushes the concept even further. It envisions the entire app as a constantly evolving space, where any element can theoretically transform into another, given there's a strong enough rationale for the transition.
Similar to our tray system, we aim for a sense of dimensionality throughout the app. Our goal is to create a coherent journey that users are able to follow easily. Every movement feels like a logical step forward to resemble what we experience in physical spaces.
For example, switching tabs in Family includes a flash of directional motion. If you tap on a tab on the left, the transition moves left, and vice versa for the right. This creates a subtle yet helpful sense of space and movement. We fly instead of teleport.
Let’s take the transformation of a chevron in a multi-step flow; something that would typically be static. In Family, we saw an opportunity when transitioning between screens for a simple but effective animation — from an to a . This tiny detail, coupled with the broader view transition, clarifies the navigation action taken. Details such as this contribute to a sense of fluidity throughout the app and quickly compound over time. 1x 0.5x
A pet peeve of mine is when a component already visible on the screen unnecessarily duplicates itself during an animation. If a component occupies a space and will persist in the next phase of the user's journey, it should remain consistent.
This concept of fluidity goes hand in hand with our dynamic tray system. We’re able to create interactions of trays morphing into full screen views, buttons gliding across trays, buttons morphing into trays and back again, and so on. Every interaction feeds into the next.
These interactions aren't easy to create, but the seamless transitions within Family are more than just technical achievements. They're a manifestation of our respect for the user's sense of space and movement within the app.
In contrast, when my banking app displays a glitchy animation while accessing my checking account, it erodes my trust. It makes me question whether the app truly understands what I'm trying to do or if it can execute my actions accurately. With Family, the consistent, smooth interactions communicate a clear message: "I know exactly what you need — let me get that for you…"
Mastering delight is mastering selective emphasis. It’s about knowing where, when, and how to apply magical moments intentionally across a product.
We don’t intentionally diminish moments of delight in our less common features — we try to insert delight with varying degrees of ‘intensity’.
We leverage the element of surprise in a few places, such as on the QR code screen in Family. The feature is used just enough to make an easter egg placed here enjoyable rather than annoying. In this instance, the magical moment is hidden in plain sight. When the user taps on the QR code, it triggers a gentle ripple effect.
For features encountered less often, the opportunity to inject delight significantly enhances the user experience. For frequently used features, the value of adding further delight gradually diminishes. While our frequently used features are always crafted to be inherently delightful, it's often the delight in the less utilised features that leave a more lasting impression.
No matter the context, the ‘specialness of a moment' generally decreases with repeated encounters. Eating your favourite candy will get progressively less enjoyable with each piece, etc. (unless they are Nerds Gummy Clusters) Let’s take a very commonly used feature as an example of where doing too much would quickly diminish potential delight. As mentioned earlier, sending tokens is a core feature and something many users do daily. It’s therefore important for it to be efficient and enjoyable, without being overbearing. Our approach here was to focus on the little things. In this case, the commas when inputting a number shift visually from place to place as the number is inputted.
When adding tokens or collectibles to the trash, they visually tumble into a skeuomorphic trash can. Completing the action plays a satisfying sound effect.
Activating stealth mode is accompanied by a gentle shimmer effect when active. This effect signals that although your holdings' values are concealed, they continue to update discreetly in the background.
In all of these features, we're not just trying to entertain the user4. These moments are our way of valuing and rewarding the user's time and emotional investment in Family. They transform something mundane into something memorable.
The true value of Family lies in making every day interactions with the wallet a little easier, a little more seamless, and a lot more enjoyable. This philosophy shapes every aspect of the product.
·benji.org·
Family Values
May 2025 | Maggie Appleton
May 2025 | Maggie Appleton
Being on the other side, I now realise there was no calculation or algorithm or pro/con list or financial spreadsheet that could have helped me understand what it would feel like. Nothing that would do justice to the emotional weight of holding your sleeping baby that you made with your own body. Of watching them grin back at you with uncomplicated joy. Of realising you’ll get to watch them grow into a full person; one that is – at least genetically – half you and half the person you love most in the world. Of watching them trip out as they realise they have hands.
I can now say with certainty I am evolutionarily wired for this. Perhaps not everyone is. But everything in me is designed to feel existential delight at each little fart, squeak, grunt, and sneeze that comes out of this child. Delight that is unrivalled by any successful day at work, fully shipped feature, long cathartic run, or Sunday morning buttery croissant – the banal highlights of my past life. When I think back to my pre-baby self, trying to calculate herself into a clear decision, I wish I could let her feel for one minute what it’s like to hold him. And tell her I can’t believe I ever considered depriving myself of this.
·maggieappleton.com·
May 2025 | Maggie Appleton
Giannandrea Downplays The Significance Of AI Chatbots — Benjamin Mayo
Giannandrea Downplays The Significance Of AI Chatbots — Benjamin Mayo
Chatbots present an open-ended textbox and leave everything else up to you. Until we get to the era of mind-reading, user interface elements are going to win out over textboxes. It doesn’t necessarily mean human curation. Maybe AI models will end up building the perfect custom UI for each situation. However, the technology behind chatbots does not feel antecedent. It feels like the future. And a text field lets real people access that futuristic technology (the underlying power of the LLM) right now.
The term chatbot implies ideas of para-social conversations and pleasantries with robots. ChatGPT will certainly confabulate to infinity and simulate human-like interactions, if you approach it that way, but it isn’t really where most users are finding value in the product.
It makes Apple seem way behind on AI — even more behind than they are — when in lieu of a chatbot, they seemingly employ that argument to justify shipping nothing at all. Apple exacerbated this issue further by shipping UI that looked an awful lot like a chatbot app, with the new Type to Siri UI under the Apple Intelligence umbrella, despite not actually shipping anything like that.
·bzamayo.com·
Giannandrea Downplays The Significance Of AI Chatbots — Benjamin Mayo
Paul Graham on Good Writing
Paul Graham on Good Writing
I think if you pointed to a random paragraph in anything written by anyone and told them to make it slightly shorter (or longer), they'd probably be able to come up with something better. The best analogy for this phenomenon is when you shake a bin full of different objects. The shakes are arbitrary motions. Or more precisely, they're not calculated to make any two specific objects fit more closely together. And yet repeated shaking inevitably makes the objects discover brilliantly clever ways of packing themselves. Gravity won't let them become less tightly packed, so any change has to be a change for the better.
If you have to rewrite an awkward passage, you'll never do it in a way that makes it less true. You couldn't bear it, any more than gravity could bear things floating upward. So any change in the ideas has to be a change for the better.
Writing that sounds good is more likely to be right for the same reason that a well-shaken bin is more likely to be tightly packed. But there's something else going on as well. Sounding good isn't just a random external force that leaves the ideas in an essay better off. It actually helps you to get them right.
the easier the essay is to read, the easier it is to notice if something catches
the rhythm of good writing has to match the ideas in it, and ideas have all kinds of different shapes. Sometimes they're simple and you just state them. But other times they're more subtle, and you need longer, more complicated sentences to tease out all the implications
when an essay sounds good, it's not merely because it has a pleasing rhythm, but because it has its natural one. Which means you can use getting the rhythm right as a heuristic for getting the ideas right. And not just in principle: good writers do both simultaneously as a matter of course. Often I don't even distinguish between the two problems. I just think Ugh, this doesn't sound right; what do I mean to say here?
The sound of writing turns out to be more like the shape of a plane than the color of a car. If it looks good, as Kelly Johnson used to say, it will fly well.
It's only when you're writing to develop ideas that there's such a close connection between the two senses of doing it well
The way to write something beautiful and false is to begin by making yourself almost believe it. So just like someone writing something beautiful and true, you're presenting a perfectly-formed train of thought. The difference is the point where it attaches to the world. You're saying something that would be true if certain false premises were.
So it's not quite right to say that better sounding writing is more likely to be true. Better sounding writing is more likely to be internally consistent. If the writer is honest, internal consistency and truth converge.
ideas are tree-shaped and essays are linear. You inevitably run into difficulties when you try to cram the former into the latter. Frankly it's suprising how much you can get away with. But even so you sometimes have to resort to an endnote.
Obviously if you shake the bin hard enough the objects in it can become less tightly packed. And similarly, if you imposed some huge external constraint on your writing, like using alternating one and two syllable words, the ideas would start to suffer
There are two senses in which writing can be good: it can sound good, and the ideas can be right. It can have nice, flowing sentences, and it can draw correct conclusions about important things. It might seem as if these two kinds of good would be unrelated, like the speed of a car and the color it's painted. And yet I don't think they are. I think writing that sounds good is more likely to be right. So here we have the most exciting kind of idea: one that seems both preposterous and true. Let's examine it. How can this possibly be true?
You can't simultaneously optimize two unrelated things; when you push one far enough, you always end up sacrificing the other. And yet no matter how hard I push, I never find myself having to choose between the sentence that sounds best and the one that expresses an idea best. If I did, it would be frivolous to care how sentences sound. But in practice it feels the opposite of frivolous. Fixing sentences that sound bad seems to help get the ideas right.
·paulgraham.com·
Paul Graham on Good Writing
How am I supposed to improve my life as a 5w4? : r/Enneagram
How am I supposed to improve my life as a 5w4? : r/Enneagram
Realize that competent mental control is only useful when it is used to enhance real, vivid experience and not simulated reality.
You know how to lose things over and over without losing sight of what you still have, so use that nonattached insight and permanence and accept the part of yourself that was cut off when you decided to make yourself smaller again.
the 4 wing likes self expression. I spent 20+ mins a day dancing alone with headphones for months and it really changed something in me for the better.
Endeavor to engage rather than to avoid, and work on improving your physical strength and well-being.
5w4s have a tendency to be independent, aloof, and (if you're like me) greedy with time. Overall this is fine, but after a point it becomes unhealthy. Everyone needs connection and connection often comes by sharing. Find a person or an activity group that you can semi-consistently share your time, thoughts, and/or interests with.
More in control of what? Your free time? Your thoughts or mindset? Your emotions? All of the above? Sounds like you’re spinning your wheels a bit on a few fronts. As others have mentioned, sure, tapping into the 8-traits of in-the-moment decisiveness sounds like a quick fix but it isn’t. To get to that point, you likely need to process some messy emotional shit first.
·reddit.com·
How am I supposed to improve my life as a 5w4? : r/Enneagram
Hamas' iron grip on Gaza is slowly slipping as residents protest
Hamas' iron grip on Gaza is slowly slipping as residents protest
"The world is deceived by the situation in the Gaza Strip," says Moumen al-Natour, a Gaza lawyer and former organiser of the 2019 anti-Hamas "We Want to Live" movement. Al-Natour spoke to us from the shattered remains of his city, the flimsy canvas side of the tent which now forms part of his house billowing behind him. "The world thinks that Gaza is Hamas and Hamas is Gaza," he said. "We didn't choose Hamas and now Hamas is determined to rule Gaza and tie our fate to its own. Hamas must retreat. "
With little to lose and hopes of an end to the war dashed once more, some Gazans direct their fury equally at Israel and Hamas. Asked which side he blamed most for Gaza's catastrophe, Amin Abed said it was "a choice between cholera and the plague".
·bbc.com·
Hamas' iron grip on Gaza is slowly slipping as residents protest
Former Israeli defense minister Yaalon warns of ethnic cleansing in Gaza
Former Israeli defense minister Yaalon warns of ethnic cleansing in Gaza
"I am compelled to warn about what is happening there and is being concealed from us," Yaalon told Israel's public broadcaster Kan on Sunday. "At the end of the day, war crimes are being committed." Yaalon is a former army chief of staff who served as defence minister under Netanyahu from 2013-16, and has been a fierce critic of the prime minister ever since. Netanyahu's Likud party accused him of spreading "slanderous lies", while Foreign Minister Gideon Sa'ar, head of a small rightist party, said his accusations were baseless. "Everything Israel does is in accordance with international law and it is a pity that former minister Ya'alon does not realise the damage that he has done and retract his remarks," he told a conference hosted by Israel Today newspaper. The International Criminal Court (ICC) last month issued arrest warrants for Netanyahu and his former defence chief Yoav Gallant for alleged war crimes and crimes against humanity in the Gaza conflict.
·reuters.com·
Former Israeli defense minister Yaalon warns of ethnic cleansing in Gaza