A short review of 2017

Now that I’m back from vacation, I should stop procrastinating and do a quick year in review.

My biggest miss

The first week after the 2016 election, I was convinced that the entirety of the ACA minus the Medicare Advantage cuts was dead.  Medicaid expansion gone. Pre-existing conditions gone. Essential Health Benefits gone. Subsidies gone.

I was wrong.  The individual mandate is gone and Cost Sharing Reduction (CSR)subsidies are a mangled mess of ineffective sabotage.

My most important post

CSR and the limited time fuse

I argued that the threat to terminate payments for CSR subsidies was limited in scope and duration.

The CSR threat loses its ability to blow up the market by sometime in the fall.

This post led me to believe that CSR payments required Republican concessions and not the conventional wisdom of Democratic concessions. From there, it led me to believe and argue that there will never by an appropriation for CSR again.

Proudest moment

Every time every one of you picked up the phone and called.  Every time that we stood for our values.  Every time that we looked at our world and tried to figure out how to make it better and not worse.

End Notes

2017 was a huge transition year for me.

I started it as Richard Mayhew and I end it as Dave Anderson. My wife was 150% supportive of us taking a massive leap into the unknown as we moved to North Carolina and Duke instead of staying in the comfortable and familiar of Pittsburgh.  I can not tell her often enough how much I love her, I can only show her that but I am incredibly lucky to share my life with her.  She encourages me to be my best me, and I try to do that for her as well.

I will miss Richard, he was a fascinating character that had lived with me for the first three years I was here at Balloon Juice.  I always envisioned him as Leslie Knope’s second  ex-boyfriend  from college where they split because he was slightly too cynical and brash for her but they remain Facebook friends who can give Leslie a smile when they run into each other.  Speaking as Richard gave me a tremendous amount of space to be wrong or at least incomplete and thus continue to learn and explore.

However he limited what I could do.  Richard Mayhew could not write in the Des Moines Register last week that Iowa should Silver Gap their individual market for 2019.  Richard Mayhew would not argue in the Times that the non-funding of CSR would lead to a quasi-stable equilibrium where almost everyone could proclaim victory.  Richard Mayhew could not sit and participate in the twice a month Friday research seminars that the Margolis Center puts on and have his mind twisted and stretched.  Richard Mayhew could not grab a couple of beers with his fellow jackals.

Dave Anderson is able to do all that, and I love it.

41 replies
  1. 1
    BC in Illinois says:

    Well, I can say that I have always been grateful to have the commentary of Richard/David here at BJuice. Often a bit technical for me, but that gave me the assurance that there were actual details there, on which you were basing your analysis (i.e., not as if I were giving my opinion on something I barely grasp).

    And — unlike a lot of healthcare and economic commentary — you have never lost the focus on the real people who are involved and affected. The value and wonderfulness of this cannot be overstated.

    Have a great 2018. . . . Although, as Mrs. BC has said it, “There’s so much to UNDO!”

  2. 2
    tokyocali (formerly tokyo expat) says:

    Congratulations! You have earned every inch you have gained. It has been a pleasure to see you succeed and to know that in some ways it all started here.

    I have to admit, I don’t always understand the policy wonk. I get medical care under a different system. If you ever have questions about Japanese medical care, give a shout out. As an American living abroad, I do worry whether I will ever have the option to return to the US when I hit retirement or if the healthcare landscape ensures that I must always remain an expat. I hope you’ll still be around Balloon Juice in the future to answer that.

    Best wishes to you and your family for 2018! This is an awesome community. I’m glad you’ve chosen to call it one of your temporary homes.


  3. 3
    SiubhanDuinne says:

    Very nice post. Thank you for your regular and careful analyses of a messy and complicated subject. And thank you for encouraging all of us to call our legislators, even when it seems pointless. Best wishes to both David Anderson and his inner Richard Mayhew for a fine 2018.

  4. 4
    low-tech cyclist says:

    The first week after the 2016 election, I was convinced that the entirety of the ACA minus the Medicare Advantage cuts was dead. Medicaid expansion gone. Pre-existing conditions gone. Essential Health Benefits gone. Subsidies gone.

    I was wrong.

    You had plenty of company. I figured that the GOP Congress would put an ACA repeal on Trump’s desk on the afternoon of January 20.

    I’m far from sure why they didn’t. My best guess is that they hadn’t yet caught on to how little Trump means what he says, so they believed him when he said he was just a couple weeks away from having a bill ready, and stood down and waited for his bill. By the time they caught on, the Women’s March had already happened, people were getting organized and lighting up the Congressional phone lines, so the moment had passed when they could have rushed an ACA repeal through while the potential opposition was still flat on its back.

    Even with an aroused Resistance, it was still a close call, so it’s hard to see how the ACA repeal could have been stopped during the first 19 days of January. We dodged a bullet there.

  5. 5
    Kraux Pas says:

    I’m glad the ACA mostly endured, for the wave of passion that seems to be moving voters, and for your personal success.

    I actually had a question about the end of the individual mandate. Would MA be affected differently because we have a statewide mandate in place? What if additional states were able to pass similar mandates?

  6. 6
    MomSense says:

    You have been a yuuge help to us in our fight to keep our healthcare and in navigating our options on the marketplace.

  7. 7
    Barbara says:

    It’s so nice to see that expertise can still be rewarded. I hope we can do another meet-up if your sojourns bring you to the DC area in the new year.

  8. 8
    satby says:

    We’re just glad you’re here to help us understand this stuff!

  9. 9
    Betty Cracker says:

    We’re lucky to have an expert to walk us through such a complex issue! Thanks for all you do!

  10. 10
    Alternative Fax, a hip hop artist from Idaho says:

    Congratulations on the success of your move(s) and thank you for all of the insight you share. Would you object if I still (internet – fondly) refer to you – as I think of you here – as Mayhew?

  11. 11
    Yutsano says:

    @Kraux Pas: Also a valid question for Hawai’i, as they have their own version of a mandate in place. Theirs, however, is different and didn’t go away with ACA AFAIK.

  12. 12
    Yarrow says:

    Thank you, David, for all you do. Your posts are much appreciated even if comments are often low. I think that’s because your posts are so smart we aren’t always sure how to comment. It’s greatly reassuring that you are here translating what’s happening in the health insurance world for those of us who don’t have your knowledge and experience. You’ve certainly helped me more than once and also allowed me to help my friends understand what’s happening. Thank you.

  13. 13
  14. 14
    Sloane Ranger says:

    Thanks for your insights into what for me is the alien and incomprehensible world of American healthcare.

    It makes me so grateful for the NHS despite its faults.

  15. 15
    mai naem mobile says:

    That the ACA has survived(even though it’s damaged) is testament to it’s designers. I think the designers set it up so that it couldn’t be easily destroyed. They may not have underestimated GOP obstruction but they did anticipate some speed bumps.

  16. 16
    BellyCat says:

    David, didn’t know you were from da ‘Burgh. Regent Square resident here.

    Saw that you worked for UPMC (years ago I did some design work for them — and their aggressive market domination was in the salad days) and imagine that was pretty intense.

    Appreciate your deep analysis of America’s current Wild Wild West.

    Best of luck down in your new locale!

  17. 17
    glory b says:

    I’ve never done anything but read your posts without response, but I want you to know that you helped me A LOT with understanding this stuff.

    Of course, as a Pittsburgher, I wish you were still here, but really appreciated the local analysis.

  18. 18

    As a Canadian, I could never understand why the United States didn’t just do what we had done and expand Medicare to everybody. Simple!
    Your posts helped me understand a little better how complicated the US health care system is and how difficult it is to introduce changes to how it operates.
    Also, as I recall it, it wasn’t actually simple at all to bring in Medicare to Canada — I live in Saskatchewan, where the first medicare system was introduced in 1962. The doctors were so angry they went on strike for three weeks and a baby died before the strike collapsed. And we spent the next 30 years arguing about what medicare should cover, whether there should be co-pays or user fees, how to keep the system basically the same across the country so that everyone had roughly-equivalent access, etc etc.

  19. 19
  20. 20
    sheila in nc says:

    I shared many of your posts from last year on my Facebook page, during the times when Congress was poised to act. (That was pretty much my entire contribution to Facebook.) Your information and analysis make it possible for people to understand enough of the inner workings to be able to see dimly how different proposals are likely to affect them. For most people, the whole subject is a black box, and all they ever have by way of data to make a judgment of success/failure is whether their premium goes up or down, and by how much. Keep posting! We are not at the end of this chain by a long shot. Thanks and HNY

  21. 21
    Waspuppet says:

    @low-tech cyclist: I suspect what happened there was that Republicans still took the “replace” part of repeal and replace semi-seriously. I fear they’ve “learned” from the tax-bill “process” that their cultists don’t care if a bill makes their lives worse; they just wanna yell SUCK IT LIBS WE WON periodically.

  22. 22
    sheila in nc says:

    Also I am so happy that you still have a soft spot for Leslie Knope. She’s the emblem of every public servant who is earnestly trying to make the world better for her fellow citizens.

  23. 23

    @BellyCat: Swissvale near the library for 12+ years for me —Dee’s was the best!

  24. 24
    Emma Anne says:


    href=”#comment-6698549″>low-tech cyclist:

    Yeah I think the Republicans thought Trump meant what he said when he said he insisted on repeal and replace. Now they know better – they just put whatever they can pass in front of him, tell him it was a win and he signs it.@<a

  25. 25
    dmsilev says:

    @Waspuppet: It’d be a lot harder for them to try again this year. They’ve already used up the one reconciliation bill for this fiscal year, so they’d have to either wait until October (ie right before the election…) or convince all of their Senators to nuke the filibuster rules completely. And with Doug Jones joining the Senate tomorrow, their margin of error even on fifty-vote thresholds has just dropped to one.

  26. 26
    dnfree says:

    I agree with everyone who has said how valuable your contributions have been. (Some of them I understood fairly well and others hardly at all, but I enjoyed trying.) Congratulations on your new job and your new visibility to the larger healthcare community. And as someone said above, thanks for always keeping the real people affected in mind.

  27. 27
    Benjamin Mays says:

    I concur with our fellow jackals on the important contributions you have made here. Prior to retirement I was in municipal finance and had benefits admin in my portfolio. It can be tricky to explain the nuances involved, but you do it very well. Thank you!

  28. 28
    BellyCat says:

    @David Anderson: +1 (or +3-4?!?) for D’s.

    Was there on opening day YEARS ago. Dee and Frank (Dino’s lovely parents) ran the joint back then — sans beer, if you can believe it! Just dogs and fries.

  29. 29
    stinger says:

    David, thanks for all your contributions to this site, under any nom de net, on health care insurance, soccer refereeing, and other topics!

  30. 30
    Gelfling 545 says:

    I am very appreciative pf the information and analysis you bring us. I rarely comment as I most often I would only be able to say: Hmmm. As far as I can tell this deep but accessible analysis ihas been unique to this blog. Glad you’ve had the opportunity to make it more available in other venues as well.

  31. 31
    Meyerman says:

    I thought Richard Mayhew was the best. Where else but on Balloon Juice would you get a deep dive into gaming out the results of health insurance regulation, followed by an intricate discussion of the jurisprudence of football.

    I am relieved that John hired this David Anderson guy to replace Richard because he seems almost as smart.

  32. 32
    TEL says:

    Thank you for taking the time writing here. I rarely comment, but I read most of your posts. They’ve been very helpful while I’ve been having to navigate the individual marketplace plans. I was on an unsubsidized silver plan this year, which would have cost nearly twice as much next year (even the off-market silver plan premiums skyrocketed). I’ve ended up with a Bronze plan coupled with 2 secondary insurances to handle the out of pocket costs if necessary for the next year. It turns out this better fits my actual insurance usage for half the cost of a silver plan.

  33. 33
    Origuy says:

    Thanks, David. However, it’s not as funny as Dave Barry’s Year in Review.

    ETA. I didn’t read the whole thing before posting this. I thought there would be more. I miss Dave Barry. He doesn’t write much these days.

  34. 34
    Laura B says:

    David/Richard, thank you so much for your postings here over the years. Because of you, this lurker is able to speak somewhat intelligently on health insurance to my clients and friends/family (I’m a bookkeeper and general business consultant to a couple dozen very small businesses.) Again, thank you thank you thank you!

  35. 35
    cmorenc says:

    Well done David / Richard on your main health-care analysis gig. However, wish your body and situation had facilitated continuing your soccer refereeing avocation down here with us in the Triangle region of NC.

  36. 36
    trollhattan says:

    Even as a good deal of the technical content whizzes past my thick skull I’m grateful to have your deep and relentless parsing of our wacky healthcare system. One needs the former to navigate the latter.

  37. 37
    efgoldman says:

    @David Anderson:

    always, Mayhew is part jackel

    Which part?

  38. 38
    Betsy says:

    David, thank you. Your posts have been very meaningful to me personally as I work toward my next career move: Can I leave my job with benefits? and how much risk will I be taking with the Rs in power re: insurance? has been my question throughout 2017, and you helped me sort it out.

  39. 39
    debg says:

    I miss Richard too, but will always appreciate Dave’s thoughtful analysis. Even when I don’t understand the details, I know where to find an expert. Happy 2018 to you and yours.

  40. 40

    @cmorenc: I gave up soccer this fall. I had another minor injury that put me on the sidelines for a month and I grew to enjoy answering my son’s Saturday morning question:

    “Are you going to work all day today, Daddy?”

    “Nope, just getting coffee”

  41. 41
    rikyrah says:

    Mayhew is still the Man.He educated us so much 😄

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