Hopefully they’ll swarm all over this in California

We haven’t talked about this yet, but it was big news last week on Obamacare and the California exchange:

Yesterday, we got the real numbers. And they’re lower than anyone thought.
California is a particularly important test for Obamacare. It’s not just the largest state in the nation. It’s also one of the states most committed to implementing Obamacare effectively. Under Gov. Arnold Schwarzenegger — remember how that really happened? — California was the first state to begin building its insurance exchanges. The state’s outreach efforts are unparalleled. Its insurance regulators are working hard to bring in good plans and make sure they’re playing fair. If California can’t make the law work, perhaps no one can. But if California can make the law work, it shows that others can, too.
Imagine it’s the end of 2014. California now boasts a working, near-universal health-care system. Nothing perfect, but clearly a a success after the first year of implementation. Texas, meanwhile, is a bit of a mess. They didn’t allow the Medicaid expansion so the state’s poorest residents got nothing. They didn’t help with the exchanges, or the outreach, so there aren’t many choices, and premiums aren’t as low one might hope.
Viewed in isolation, Texas’s problems would be deadly for the law. But viewed next to California, they might mainly be a problem for the political class in Texas, which has failed to implement a clearly workable law.

For the actual breakdown of the rates after subsidies, look here:

These premiums really underscore the big role that the tax subsidies play. Available to Americans who earn less than 400 percent of the poverty line ($45,960 for an individual), these federal payments limit an individual’s premiums to a specific percent of their income. An individual earning 150 percent of the poverty line, for example, won’t be expected to spend more than 4 percent of his or her income on a health plan.
That means that the individual earning $17,235 (150 percent of the poverty line) only ends up paying a fraction of the $230 premium. The federal government picks up the rest of the tab.
For a less robust “bronze” plan, which covers 60 percent of the average beneficiary’s costs, the tax credit could actually cover the entire premium for low-income twenty-somethings. That’s what you see in the upper-left corner of the chart below, which shows how much it would cost a 21-year-old earning $17,000 to buy the most affordable bronze plan: Nothing.

For that all-important balance, here’s one or another paid group of grifters, ranting about something or other:

Ezra Klein, the White House’s personal ObamaCare flak, refuses to write about anything but a positive spin on ObamaCare or, in the alternative to silence, will attack those who are scoring points against ObamaCare.His latest piece has in it’s title, “Very Good News for ObamaCare,” since “very good news” and ObamaCare don’t usually go together in a newspaper or online headline.He is touting the prices for the California exchange, not mentioning that three of the largest insurers have decided not to participate in the California exchange.Here is the reality about the California prices, every insurer who will participate using these prices will lose so much money that they will pull out within two years.The announced prices are just like the ObamaCare law, they assume the young and healthy will out number the less healthy that swarm ObamaCare.

How great is it that they use the word “swarm” to describe the “less healthy”? It’s a battle for resources between the “young and healthy” and the “less healthy.” Winners and losers, baby. Pick a side. You say you have BOTH “young and healthy” AND “less healthy” within your immediate family? CHOOSE.

They’re just all love all the time, aren’t they?

* Every time I write about this someone asks about co-pays and deductibles for preventive care. This is the link for that.

Under the Affordable Care Act, you and your family may be eligible for some important preventive services — which can help you avoid illness and improve your health — at no additional cost to you.

96 replies
  1. 1
    kindness says:

    I thought it was great. I was disappointed that only 3 HMO’s opted to cover these folk. The other big 2 in the state said they would sit on the sidelines for a year or more.

    Conservatives are livid though. Seems the pricing puts their talking points in the crapper.

  2. 2
    Mnemosyne says:

    Another thing I would say about California is that we already have a very prominent non-profit healthcare provider in the state: Kaiser Permanente. It has some weird management problems that mean you usually get very good care from Kaiser Southern California but very shitty care from Kaiser Northern California, but I’m guessing it helps implement Obamacare when there’s already a large, influential nonprofit in place.

  3. 3
    Marmot says:

    Awesome as always, Kay. I didn’t get outta the boat, but that link to the HSA Coalition–it goes to a group that supports health savings accounts, right? Who’s backing it? Brokers and investment firms?

  4. 4
    Kay says:


    I don’t know. They’re pretty mad, though! I really don’t get this stark division between young and “less healthy”, honestly. I know Justice Scalia was ranting about it, and it’s always brought up, but do these “young and healthy” people not live among us? Are they on some kind of island without family or friends who may be (gasp!) less healthy? I don’t really look at it that way.

  5. 5
    Belafon (formerly anonevent) says:

    “Hey, young people!! Destroy ObamaCare! Do your part by eating a quart of ice cream every day.”

  6. 6
    Forum Transmitted Disease says:

    the less healthy that swarm ObamaCare.

    That dogwhistle is ringing in my ears. Why just come right out and say “illegals” or “Mexicans”?

  7. 7
    JoyfulA says:

    Like my “young and healthy” niece who’s 6 months pregnant?

  8. 8
    patroclus says:

    I hope Illinois is as good as California looks at present. I don’t have health insurance currently and really don’t want to buy something I don’t really need because I rarely, if ever, go to the doctor. But I might be willing to swarm all over this if the premiums are as low as projected. We’ve got a Democratic governor (Quinn) and a Democratic legislature and Obama is from here, so I’m hoping we’re going to be the “model” for the rest of the country too.

  9. 9
    Aimai says:

    So: the rates are low despite the fact that a few major companies stayed out if the mix? So it’s not the magical invisible hand if the market at work at all. You can bring down rates by rationalizing the system and through government intervention.

  10. 10

    Oh I’m sure McMegan is preparing a screed detailing how this is all crap.

    OT: Daily Caller tries to use the lingo in describing Rinse Pubis’ ability to “rap”. https://twitter.com/bmorrett/status/340195092696559616/photo/1

  11. 11
    khead says:

    Here’s my response to each of the last six of the last seven paragraphs from the HSA link.

    “Ok. Get back to me when it happens”.

    Of course, I’m the type of jackass that prefers “I told you so” over “we are all DOOOMED”.

  12. 12
    Forum Transmitted Disease says:

    not mentioning that three of the largest insurers have decided not to participate in the California exchange.

    Cigna’s one, UHC is another and I can’t remember the name of the third. True, they are the largest insurers in the country. But combined, they only cover 8% of the California market.

    I’m on Kaiser SoCal. I’m quite pleased with them. I for one would like to see them be given the single-payer contract for the entire country and be done with this so-called “debate”.

  13. 13
    Turgidson says:

    I think Ezra’s forecast that Texas will be embarrassed by being compared with California is a wee bit pollyannaish. There are enough red states deliberately sabotaging the ACA that the knuckledraggers will be able to stick to talking points about how widespread the ACA’s failures are, while ignoring or shouting down anyone mentioning the fact that it works when it is implemented as designed.

    And really, you think a state that elected Rick Perry…not once, not twice, but THRICE…will be shamed into doing a better job? If so, I have a Texas business regulation to sell ya.

  14. 14
    Belafon (formerly anonevent) says:


    I don’t have health insurance currently and really don’t want to buy something I don’t really need because I rarely, if ever, go to the doctor.

    I have three healthy boys, and we rarely need to go to the doctor. I pay for the insurance specifically because I worry about that one time we will really need to be at the doctor.

    And everyone wonders why the ACA mandated buying insurance.

  15. 15
    Tone In DC says:

    I frequently notice how much of g00per rhetoric includes social Darwinism. In my humble opinion, Erick von Erick, Flushed Limburger, Chris Wallace, Michael Savage and Michele Bachmann don’t strike me as particularly “survival of the fittest” examples of humanity.

    Just sayin’.

  16. 16
    e.a.f. says:

    Seniors might be a higher risk/cost group to insure because they frequently don’t get health care until they are seniors. If people had health care from womb to tomb, society/business may find the general cost would go down. If people have no health care until they are 65 or older, then of course the costs will be through the roof. All those problems, if dealt with when they began, would have saved everyone a bundle.

    decent health care would also reduce the number of people suffering from mental illness. that alone would result in a huge savings in the criminal justice system, which is frequently the first responder for mental illness.

    The Vancouver Police Dept. in Vancouver, B.C., Canada, examined their calls for service. A full 40% of calls for police assistance were the result of mental health issues. That is a huge use of police resources. And we have much better health services in Canada than in the U.S.A. Yes, we have wait lists, but you will get care. So if you have cancer, you may have to wait 4 weeks to see the cancer specialist but then all surgery, hospital care is free. Our medical plan also covers all prescriptions over $800 a yr.

    It is hoped the California experience is positive. The Texas might want to get it together. There is nothing worse than sick children never getting health care. They grow up to be sick adults and frequently are not able to participate in society.

  17. 17
    khead says:

    Yikes I need an edit.

  18. 18
    👽 Martin says:

    @Forum Transmitted Disease: The ones that didn’t participate are the for-profits because, well, there’s no profit for them.

    The rates on the exchange are pretty much in line with what a group rate will cost for similar coverage. The coverage is a bit worse than a lot of the group policies because employers buying coverage are usually doing so as an employment incentive – it needs to be perceived as generous to work. The exchanges don’t. They just need to be perceived as a good value.

    And I agree regarding Kaiser SoCal. They’re really the gold standard in HMOs.

  19. 19
    Kay says:


    I think the conservative crowing about that was a little deceptive/uninformed. It’s my understanding that those companies are big because they are primarily insurers for companies (insurance one would get through an employer) so they wouldn’t be “big” in an (initial) individual exchange like this one, because they don’t have to be. It’s not really their market.

  20. 20
    Emma says:

    @e.a.f.: Our dirty little secret is that we wait too, except it’s the insurance set up that make us wait. My father was having dizzy spells and it was recommended he go see an eye doctor to determine if his diabetes was affecting his eyesight. Next possible appointment: September. So he was supposed to wait 4 months falling down on a regular basis like a drunk.

    Thanks whoever it didn’t turn out to be that.

  21. 21
    IowaOldLady says:

    These people’s hatred for Obamacare echoes their hatred for Obama. They have tiny little racist brains and hearts.

  22. 22
    Kay says:


    I wonder a little about this, because we’ve really expanded low income childrens health care coverage since the late 1990s thru 2009, with Medicaid + SCHIP. It won’t “pay off” with current older people, but if children get better health care hopefully it will pay off in 30 years, right? I’ve never seen it addressed, but one would hope better access for children might mean healthier people when those children are older.

  23. 23
    Mr Stagger Lee says:

    @Tone In DC: Yeah but think of it this way, they got the money to buy replacement organs that us po folk will be forced to sell, in the new world order.

  24. 24
    belieber says:

    Now all we need are some stories of companies moving from Texas to Cal because of the healthcare and wingnuts heads will be exploding all over the place.

  25. 25
    Calouste says:


    IMO Health Savings Accounts are a scam on par with privatizing Social Security.

  26. 26
    👽 Martin says:


    It’s my understanding that those companies are big because they are primarily insurers for companies (insurance one would get through an employer) so they wouldn’t be “big” in an (initial) individual exchange like this one, because they don’t have to be. It’s not really their market.

    The insurers in question cater to a specific market – multistate policies. If you look at damn near every other insurer, they cover relative to state lines – either one state, or maybe 2-3. Their efficiency comes from having economies of scale, which matters when the moment you step over a new state line you have a whole raft of new insurance laws to deal with, need to redo all of your policies to be certified in that market, build out a whole new network of care providers, pharmacies, and so on – and do all of that before you sell a single policy. That’s really damn expensive, particularly if you have little hope of getting a large market penetration in the new state.

    The big for-profits then cater to large employers that need policies that work in many different states. Rather than them having to negotiate with dozens of different insurers and wind up with policies that don’t match (and leave employees upset that their counterpart a state over has a better policy than them) and having to move employees across policies every time they get relocated, the big for-profits have national networks, policies that work in every state, and most importantly cost a fucking fortune for the convenience.

    Anyone who thought they’d sign onto the exchanges were fucking delirious.

  27. 27
    kindness says:


    but very shitty care from Kaiser Northern California

    I have Kaiser here in N. Cal and I love them. So I’m not sure what your issue is.

  28. 28
    RoonieRoo says:

    @Calouste: Curious why you think they are a scam? We have HSA’s and I think they are fantastic. It’s lowered my taxes, I have my deductible covered if something happens and my husband has had matching from a few of his employers in the HSA.

  29. 29
    KG says:

    Question… is young and healthy a permanent state? I was under the impression that you could become unhealthy fairly easily – eat too much of the wrong food, forget to look both ways before crossing the street, exert too much force while working out and snap a bone/tendon/muscle, get a job that doesn’t give you enough time to go to the gym. I mean, that (the food and job thing) happened to me, so if young and healthy is a permanent state, I’m more than willing to be the class action rep for whoever we sue for this injustice.

  30. 30
    elaine benis says:

    My husband and I own a business and just yesterday we met with our broker to review our company health insurance options for the next FY. It was excellent news, Better coverage (preventative covered 100%!) and our premiums are increasing only 3%.

    There was some discussion regarding Obamacare implementation and our conservative employee was asking pointed questions, desperately – and I mean DESPERATELY – , trying to find something somewhere where the new laws negatively impact the company.

    There was nothing. Dude has been brainwashed for years now that Obamacare would be a costly burden and the death knell of many businesses. It was sort of hilarious to watch his brain stuggle with the fact that Obamacare is hardly even a blip on the radar for us.

    I did take the opportunity to voice my relief that the days of 18%-27% annual premium increases seem to be over. You know, 2002-2007. The Bush years. :)

  31. 31
    Suffern ACE says:

    But which states have competing non-profit payors? California does have a large BCBS, plus Kaiser, but in some states the BCBS’s went for profit.

  32. 32
    IowaOldLady says:

    Young and healthy can go away in a minute. The sister of a friend of mine lives in CA. She’s in her 30s and had insurance through her employer, a small company that was short of cash and stopped paying the premiums. (Think about that one for a minute.) She found out about it and my friend, her sister, urged her to get at least a catastrophic care policy, but the employer said they’d have their insurance back soon, so she decided to take a chance.

    She lost the gamble via emergency gall bladder surgery. The hospital and doctor lowered their fees, but she still has to pay a whopping amount out of pocket. They see up a payment schedule and she’ll spend years paying an amount that would have bought her insurance on the exchange.

  33. 33
    Bubblegum Tate says:

    The wingnut feedback loop on this is going to be amazing, but it’s also going to seep into non-wingnut coverage:

    1) Wingnut state governments will do everything they can to sandbag implementation.

    2) Wingnuts will trumpet the resulting shitty rollout/coverage as “proof that Obamacare is a failure!”

    3) MSM coverage: “Obamacare has failed in [Texas/Alabama/Mississippi/whatever]. Republicans say this failure is evidence that the law is fatally flawed and must be repealed; some Democrats disagree.”

  34. 34
    Mnemosyne says:


    Yep. I love my PayFlex account through work, but that’s an FSA and is meant for incidentals not otherwise covered by insurance (like copays, etc.) It’s not supposed to cover my entire healthcare budget, just the annoying bits on the edges.

  35. 35
    Trollhattan says:


    Was with Kaiser n NoCal for quite awhile and the care was fine, and relatively easy because of the everything-under-one-roof model. There’s a lot of Kaiser hate though, including my spouse, which is why I no longer have Kaiser.

  36. 36
    Suffern ACE says:

    @RoonieRoo: Maybe they have changed, but I stopped using mine 15 years ago because ours was a use it or lose it plan. It wasn’t really a savings account at all, but more like an expense account. The reimbursement process was worse than the insurance company and I ended up losing a few hundred the two years I was in it. They don’t seem to be worth the hassle. I would use mine if there was a carryforward and a cap. I can understand the government not wanting to give out another middle class shelter where someone could park a few hundred thousand dollars tax free. But they don’t allow one to save for that day one might need to cover expenses. Untill one has regular medical expenses (eg is sick and needs something), is there really a point in having an HSA?

  37. 37
    👽 Martin says:

    @Calouste: They have a very, very specific utility – if you have a known schedule of health care costs, they work great. But that’s not insurance – that’s a payment plan. Outside of that utility, they’re an utter disaster and fuck people over.

  38. 38
    Trollhattan says:

    HSAs are great but the ACA scaled them way back, which would present a reason for HSA companies to dislike ACA.

  39. 39
    Mnemosyne says:


    I have Kaiser here in N. Cal and I love them. So I’m not sure what your issue is.

    It’s partly anecdotal from friends who had Kaiser NorCal and partly stories like this one. Kaiser NorCal lost their kidney transplant program altogether through serious mismanagement.

  40. 40
    Mnemosyne says:


    I loved Kaiser until they decided to stop covering any prescription that did not have a generic, so I would have to pay out-of-pocket for something that is still under patent. I ended up having to switch to Cigna just so I could have decent prescription coverage. Until then, I loved Kaiser.

  41. 41
    Mnemosyne says:

    @Suffern ACE:

    BCBS in California is for-profit, so I think our only large non-profit is Kaiser.

  42. 42
    Trollhattan says:


    Ugh. IIUC my current plan has similar shenanigans but luckily I’ve not run into a problem…yet. (They call me Mister Generic.)

  43. 43
    NickT says:

    @Tone In DC:

    They exemplify survival of the dickest. It’s the creationist version of evolution.

  44. 44
    Forum Transmitted Disease says:

    I have Kaiser here in N. Cal and I love them. So I’m not sure what your issue is.

    @kindness: Lucky you. I have issues with them.

    One woman, good friend of mine, who’s never going to be able to have kids because of a simple mistake that they made, and then doubled down on repeatedly.

    And then I helped nurse my girlfriend’s mother through a stroke and the aftermath thereof: Kaiser’s NorCal’s idea of rehabilitative therapy and nursing home care ought to land every member of their board of directors in jail.

    I wouldn’t go so far as to call Kaiser SoCal “the gold standard” but they are good enough. Kaiser NorCal is another animal entirely, one I’d call “worst case scenario” for someone having to go to the exchanges.

  45. 45
    Trollhattan says:

    @elaine benis:

    Great story and even better experience! Folks do so cling to their narratives, I think because they invest so much energy constructing them. Best friend’s wife is convinced we’re headed to heck in a handcart because of her experience volunteering at their kids’ grade school. “Kids are more disrespectful and rude than ever.” I think she’s literally expecting every day to be Rodney King day and won’t, for example, take time to note that crime rates are at their lowest in decades. It’s why they moved out of town and into the hills.

    Me, I’m holed up every night waiting for those citified zombie skateboarders.

  46. 46
    Dolly Llama says:

    Holy shit, way OT but too damn funny.

    McCain poses for a snapshot with a notorious fucking Syrian kidnapper.

    Oh, yes, he’s just the man to “find the right people” to arm.

  47. 47
    Kay says:

    @elaine benis:

    We sometimes walk people who don’t have internet through it at the law office.

    I love the FOX news watchers: “is this OBAMACARE?”

    Yeah, but you have no health insurance and you’re 53. I suggest you get over it.

  48. 48
    kindness says:

    And Kaiser is Not for Profit, not non-profit. But so are the other companies that accepted the California option. What that means is that they do generate profits but they all have to be plowed back into the business either through bonuses or upgrading the facilities.

  49. 49
    WereBear says:


    This is why we can settle for half a loaf. Because it means somebody eats!

    I am extraordinarily happy with the way Obamacare is going, and I figured that if we didn’t get a public option right away, we would get one down the road, because health insurance companies want to keep making their obscene profits on human suffering… and with Obamacare, they cannot.

    Though it would remove a talking point, wherein a wingnut whines that private enterprise works better than government, and I say, “Oh, your mother has turned down Medicare?” But I’ll take it!

  50. 50
    scav says:

    OT But is he clean?

    Former President George W. Bush had some pretty non-descript praise for Sen. Marco Rubio Thursday:

    “Rubio’s articulate. I met him once, maybe twice. My brother likes him, so I like him,” Bush said, according to the Huffington Post, at his third annual Warrior 100K, a three-day mountain bike ride that he hosts every year.

    TPM. PS bonus points for outsourced thought there, C+.

  51. 51
    Kay says:

    @👽 Martin:

    I looked up Jerry Brown’s age the other day because I want him to run for President.
    I’m aware of all the obstacles, including that he doesn’t win primaries and is 75, but I was just shopping around :)

  52. 52
    Susan K of the tech support says:

    I’m glad to hear these recommendations of Kaiser (esp here in SoCal). I’ll hafta look into em. I’ve currently got a policy that’s just a money drain. These days, it’s a choice between paying for individual insurance premiums against catastropic stuff, or pay $ for ongoing preventative care. These days, that’s been either/or, not both/and. Razzum, Frazzum. Am so glad to be in CA, 2014 can’t come soon enough.

    Those of you who’re The Kaiser’s Boys and Girls (wait, what?) — what’s the arrangement for basic wellness visits on your plan?

    Edited to add: Now I’ve read the whole thread, so it’s not as hunky dory gold standard as all that. But still, would appreciate more info.

  53. 53
    Roger Moore says:

    they assume the young and healthy will out number the less healthy that swarm ObamaCare.

    That’s what the mandate is for. The young and healthy will buy insurance because they’re required to buy insurance or pay a fine, and with the subsidy the fine will be more expensive than the insurance. It doesn’t take a rocket surgeon to figure this one out.

  54. 54
    IowaOldLady says:

    @Roger Moore: I’ve heard the fine is very low. $95 maybe? That worries me because the success of any insurance depends on spreading the risk.

  55. 55
    Forum Transmitted Disease says:

    I looked up Jerry Brown’s age the other day because I want him to run for President.

    @Kay: NO. NO NO NO NO NO.

    You can’t have him. I’m just praying he runs for one more term as governor; for the first time since the 1980s Californians aren’t wondering what vital state service is going to get cut next year. We’re not cringing waiting for the news to trumpet just how far in the shitter our state budget is. We finally have our state’s ruined legislative system working for the first time in a very long time and sorry, but you’re not taking that away from us.

  56. 56
    gelfling545 says:

    @e.a.f.: My wait to see a dermatologist in NY – 6 months. Not life threatening but really uncomfortable. To see anybody in any specialist capacity you’re going to wait unless you came in through the ER. I’m now trying (and have been since April) to find a rheumatologist who can see me before my next primary appointment in late July. This is in an area with a large number of doctors & health care facilities. No luck & it has nothing to do with my insurance.

  57. 57
    JCJ says:


    The problem is if you ever need it – wow, watch out. Try pricing out the care needed for a tib-fib (lower leg) fracture or perhaps treatment for lymphoma. I treated a lady a few yew years ago for a brain tumor – the charges for the radiation from the hospital where I practice were over $30,000.00. My wife has been hospitalized for bipolar disorder – the bill for woefully inadequate care was $14,000.00 ten years ago. My daughter has lupus at age 21 and the bills are ongoing and will never end. I wish you luck and good health, but reality can be a bitch.

  58. 58
    Trollhattan says:

    @Susan K of the tech support:

    Mine’s dated information but my last plan (through a cheapskate corporation) included annual physicals with no copayment, while other visits had a ten-buck copayment and ER visits (the occasional bike wreck) had a twenty-five buck copayment. IIRC prescriptions were a ten-buck copayment. Also included an annual eye exam and annual lenses, biennial glasses frames.

  59. 59
    👽 Martin says:

    @Kay: He’s already run for president 3 times. Not sure he’s interested in taking another swing at that.

  60. 60
    👽 Martin says:

    @gelfling545: I think that’s why a lot of us like outfits like Kaiser. We see our doctor same day. Specialists might take a week. Ms Martin had a procedure done this morning that she booked 2 weeks ago.

  61. 61
    Kay says:

    @Forum Transmitted Disease:

    He wrote this letter vetoing a lobbyist-written standardized testing scheme that was passed around public school supporter circles it was so great.

    He asks: “when do we reach testing nirvana?”

    I’m jealous.

  62. 62
    Higgs Boson's Mate says:

    OT: A letter addressed to President Obama that may have been contaminated with the deadly toxin ricin is similar to two ricin-laced letters recently sent to New York City Mayor Michael Bloomberg, the U.S. Secret Service said Thursday.

  63. 63
    Trollhattan says:

    It must really, really bug Michelle Rhee to live within a mile of Our Jerry.

  64. 64
    Violet says:

    @Turgidson: I don’t think Texas will be “shamed” into doing anything. But I do think that businesses will look at states that have implemented Obamacare and states that haven’t and realize that those that have are much better environments for them. And then they’ll lean on those Republican governors and get them to change things.

  65. 65
    Tone In DC says:


    “Survival of the dickest”. Gotta like that.

  66. 66
    RoonieRoo says:

    @Suffern ACE: Your describing an FSA which is a scam. We have HSA’s which carry forward, you don’t lose if you change employers and are a savings account, in essence. There are no claims. I have a debit card that is tied to the account and I use that to pay for all our deductibles, prescriptions and whatever. I’ll have to look up what the ACA might have changed. I had not heard that it had made an HSA worse.

  67. 67
    Higgs Boson's Mate says:

    Has anyone considered that Republicans oppose ACA because having large numbers of people get mental health treatment means they’ll lose their base?

  68. 68
    Trollhattan says:


    Blowing up a dozen firefighters sure hasn’t brought in the golden age of TOSHA. They’re gonna do what they’re gonna do–“they” being a relative handful of wealthy folks who run everything from the legislature to the supreme court, and install the governor.

  69. 69
    Mnemosyne says:


    No, you really don’t. He’s good here in California, but he can be an asshole about things he doesn’t like or understand (he’s vetoed a LOT of bicycle-related legislation that would make it easier and safer for bicyclists and pedestrians to get around).

    Honestly, from what I’ve heard he kinda sucked as a governor back when he had national ambitions. Now that he knows his main legacy is going to be saving the state from what the Republicans did to it when he was governor last time, he’s settled down to work.

  70. 70
    Violet says:

    @Trollhattan: I never thought that it would. But when businesses start letting the Republican-governed states know that it’s a lot more expensive to operate in their states because of the cost of health care, then that very well could cause things to change.

  71. 71
    Mnemosyne says:

    @Susan K of the tech support:

    Kaiser can be really, really good for people with chronic conditions, because everything is in-house and it’s easy to get your care coordinated between the different doctors (and they all take the same insurance!) It’s if you need something unusual or develop an uncommon condition then people can run into trouble.

  72. 72
    JT says:

    Forbes has decided to take the gloom and doom route. I haven’t had a chance to reconcile the two articles yet.


  73. 73
    kindness says:

    @Trollhattan: Jerry Brown lives in the Oakland hills. Rhee is married to the mayor of Sacramento. Doesn’t Rhee live in Sac?

  74. 74
    Higgs Boson's Mate says:


    Jerry was elected governor the first go round because Pat Brown was actually beloved by the state. Jerry became known as Governor Moonbeam.

  75. 75
    Enhanced Voting Techniques says:

    @Forum Transmitted Disease: That dogwhistle is ringing in my ears. Why just come right out and say “illegals” or “Mexicans”?
    Don’t forget to add gays (’cause ALL gays have teh aids) and poor whites (cause they worship Charles Darwin) to the less than healthy list.

  76. 76
    kindness says:

    @Mnemosyne: I voted for Jerry Brown back in the 70’s & 80’s. He did not suck then.

    The political arena sucked with Reagan running high then and Howard Jarvis pushing through Prop 13 which wrecked the state budget. I will give you that Jerry is much more grounded now than he was back then. Now days Jerry is openly contemptuous of the ‘political game’. I actually like that. And really as a N. Cal guy I appreciate that he’s trying to fix our water problems in a balanced manner. I don’t think the current plan will win but it’s a whole bunch better than anything previously submitted.

  77. 77
    Jeremy says:

    The red state governors are stupid for not setting up exchanges. Because of their action the federal government will set up and run the exchanges for them. If you support “state’s rights” then you wouldn’t want the federal government to exert more power and influence.

  78. 78
    Trollhattan says:


    Both have places (lofts) in downtown Sac. Jerry’s not doing the bachelor-pad-with-mattress-on-da-floor thing this time, since he’s now married and has a corgi. Kevin and Michelle (see, we’re really just good friends) live within blocks of Jerry, Anne and Sutter.

    Sac’s really just a town, posing as a city.

  79. 79
    Susan K of the tech support says:

    @Trollhattan: Thank you for that.

  80. 80
    Kay says:


    I like the skeptical tone he took. This stuff is just swallowed whole. He’s been looking at education “miracles” for 30 years. He knows there are none.

    It’s just a relief to see some governors reining it in. Using an actual THOUGHT process.

  81. 81
    MattR says:


    The red state governors are stupid for not setting up exchanges. Because of their action the federal government will set up and run the exchanges for them. If you support “state’s rights” then you wouldn’t want the federal government to exert more power and influence.

    But if you really just want to complain about the overreach of the federal government, then it is advantageous to force the federal government into taking over the exchanges.

  82. 82
    Trollhattan says:


    Prop 13 passed when he was gov the first go-round so he observed the massive impact it had on education budgets and loss of local control of school funds, first-hand. He’s also every bit the wonk the Big Dog is and can certainly sniff out a grift.

  83. 83
    gene108 says:


    Deductibles under Obamacare have been capped. Not sure how this would effect HSA contributions as theIRS has annual maximums you can contribute, independent of your deductible. Maybe people will just contribute to the deductible for the year?

  84. 84
    Jay C says:

    @Violet: @Trollhattan:

    True this. I had a WTF? moment when I read this bit from the WaPo’s piece:

    Viewed in isolation, Texas’s problems would be deadly for the law. But viewed next to California, they might mainly be a problem for the political class in Texas, which has failed to implement a clearly workable law.

    Does anyone at the Post (or anyone with a working brain) really think that the “political class in Texas” give a good flying about “workable laws” – or any laws in general? Except those that (further) enrich the backers of their “political class”, of course…..

  85. 85
    Kay says:


    They have a plan. It has to do with challenging the premise of the penalty for large employers.
    I’m sort of getting the broad outlines, but I haven’t read the legal theory yet.

    There is a legal theory, though. It’s from our good friends the libertarians.

  86. 86
    feebog says:

    I attended a meeting about implementation of the AHCA last night. The speaker was the Regional Director for Health Services, a direct report to the Secretary of HHR. California is doing it right, and that will become apparent in two or three years. What was amazing to me was the number of “business owners” and “health care experts” who don’t the first fucking thing about economics. They didn’t get that an overall healthier general population will have a tremendous effect on holding down health care costs overall. Nor did some get that making health care insurance affordable for several million people, as well as adding up to two million on to Medi-cal rolls will cut hospital costs dramatically. Hospitals will be reimbursed for billions of new insured that they are currently absorbing and passing on the now insured.

  87. 87
    daverave says:

    Jerry’s loft is in a building I helped design downtown (above a PF Chang’s Restaurant and the offices of one of the developers behind the new Kings arena.) I think KJ and Rhee have a huge place out in the 40’s but on the wrong side of Folsom Blvd, closer to the freeway.

  88. 88
    Trollhattan says:


    Very cool, nice work on that space! It could well be Johnson moved after getting hitched. The two Kevins–Johnson and Martin, used to live in the L Street lofts.

  89. 89
    terraformer says:

    Perhaps one day, people will look back on the past 30 years or so around right now, and wonder how any of us contemplated much less empowered health care to be in thrall of the profit motive. Boggles the mind, especially when all you have to do is look around at other first-world countries. But our media and professional shiny-object-slingers ensure that people only look inward, not outward.

  90. 90
    jl says:


    From my experience, the medical directors and actuaries understand the economics of our current health insurance system and how it is slowly falling apart.

    A lot of self-described “health policy experts” and supply chain management, cost and revenue optimizing case mix mavens and contract negotiation and chiseling in an opaque oligopolistic market sharks.

    And, regarding HSAs, if better preventive care and management of hidden chronic disease (like high blood pressure or borderline diabetes) is big part of health reform strategy, they pose problems especially in older adults and with kids. Regular and cheap care from a health professional is key to preventing progression of those diseases. That was one of the findings of the RAND health insurance experiment. And one of the reasons health ethics people tell me that type of experiment will never be done again, since there was too much evidence of mortality effects in the subjects who had to pay out of pocket for regular care. Anybody tried to do it, they wouldn’t get a proposal past human subjects review.

    You can’t see the gradual increase in cumulative damage done by not seeing health professional regularly (from high blood pressure, for example), but you can see the full cost of visits coming out of your pocket.

  91. 91
    pseudonymous in nc says:


    We have HSA’s and I think they are fantastic.

    Everything associated with the HSA industry smacks of grifters and snake-oil merchants. Perhaps it works for some people, but I tend to file that industry with those who explicitly prey on the old and sick.

    The most important structural point about HSAs is that you can’t build a system on them. There’s this glibertarian fantasy that if everyone were on a HSA-HDHP, the magic market fairy would work its magic, but that’s basically asking the entire population to gamble with its health, and the aim of a healthcare system is to remove the element of gambling.

  92. 92
    CaseyL says:

    I can’t remember who it was, but some national-profile numbnuts did proposed HSAs as instead-of healthcare reform: obviously did not know what an HSA is.

    I haven’t signed up for one, due to the use-it-or-lose-it factor. But if you have regular, known expenses (such as office visit co-pays, or the employee’s share of the monthly premium, if the employer doesn’t pay it all) then they’re useful, or so I’m told.

    Insurers’ biggest beefs with ObamaCare are the cap on administrative expenses and the end of the annual and lifetime caps on benefits. The admin expenses cannot account for more 20% of the premium, and that impinges directly on the profit margin. (20% is a very generous cap, BTW). The end of caps on annual or lifetime benefits may affect the enormous funds set aside for claim payments that insurance companies are required by law to have, to certify they can pay claims.

    It’s good to hear how well the Exchanges are working in California and Massachusetts. We in Washington State are anxiously looking forward to the roll-out of our Exchange in October (giving people time to enroll in policies that will be effective as of Jan 1, 2014.) I work for an insurer, and the big thing we’re wondering is how well the actual mechanism will work; implementing policies which the state will administer.

  93. 93
    RoonieRoo says:

    @pseudonymous in nc: That makes no sense at all. An HSA, Health Savings Account, is an account that you can put part of your paycheck into that reduces your tax burden. You can use this savings to pay any medical bills at all. Prescription, Deductibles, medical equipment. What the hell is snakeoil about that? It is NOT an FSA. You do not lose your money at the end of the year. You don’t ever lose your money. You lose your job with the company that set it up and all that means is that you are no longer able to contribute to THAT account via your paycheck. Big whoop. How are we being preyed on that we stick money into a HSA, some companies actually MATCH your contribution and we pay medical bills/deductibles with it. How is that possibly a scam?

  94. 94
    RoonieRoo says:

    @CaseyL: It sounds like you don’t know what a HSA is either. HSA’s are not use it or lose it. That is a FSA. Two different things. I keep seeing the confusion of these two different savings accounts in this thread.

  95. 95
    Elie says:

    @Bubblegum Tate:

    The wingnuts have to be at least a little careful. Remember, the payment of providers of services who would not get any payment if they block the exchanges and Medicaid expansion — would not be warmly received by said providers. At the state level, the providers are pretty powerful but we will see

  96. 96

    California’s too low to be real prices for Obamacare

    That sums up American conservatism in a nutshell: It can’t be true because I don’t want it to be true.

    Now wonder we found weapons of mass destruction in Iraq, the swine flu broke out when Jimmy Carter was president and Congressional Democrats passed Hoot-Smalley when Franklin Roosevelt was president.

    Liberals have a real problem here, which is that we try to argue with conservatives using facts. Facts don’t mean anything to conservatives. All they care about is truthiness. After all, as Stephen Colbert says, there are more nerve endings in your gut than in your brain. Democrats have to learn to make two pitches: a factual, intellectual one to liberals, and a visceral, emotional (but truthful) one to everybody else. This shouldn’t be too hard; you can get a lot of mileage out of hundreds of children slaughtered by guns each year. Maybe it’s crass, but what the hell, why should we give a shit about that? Half the people in this country only react to news emotionally. Our policies are good enough to reach people emotionally, if only the Democratic Party can find it in itself to get over this feeling that emotional pitches are somehow unseemly.

    I can’t really prove that this is what Democrats think as a rule, but it sure seems that way. Look at John Kerry. The guy was running for president, but he was unwilling to make any kind of pitch to voters that wasn’t an unemotional, clinical pitch. President Obama sometimes has this trouble, too, talking more like a teacher than a, well, I don’t know, a friend, almost. Franklin Roosevelt could do this. Truman, too, from what I know. Joe Biden can do it. John Edwards did it; he was a trial lawyer, and that makes sense that he was good at that; reaching juries is as much about playing on their feelings as it is about appealing to their intellect.

    And it’s funny; lots of Democrats hated Edwards. They always said there was something phony about him, and I wonder how much of that had to do with his ability to emotionally appeal to people. A lot of Democrats seem to be wary of Biden, I think for the same reason; it just doesn’t feel right somehow to lot of Democrats to make the emotional pitch. I think it seems manipulative to many Democrats. Only it isn’t. We’re social beings, after all. Feelings are at least as important to our understanding of the world as intellect is. We need to find a way to get our candidates to let themselves sway voters with emotions, with stories, with fables and parables. They need to be more openly visceral and emotional.

Comments are closed.