Zero premium plans are a red county thing

Yesterday, the White House budget was released. Health care and health financing made up quite a bit of the document. There are tons of little details. One of which was sussed out by Larry Leavitt:

I saw this tweet and I hit my head on my desk. I was in the process of submitting a manuscript on precisely the enrollment impact of a zero premium plan offering. I can’t be more specific as I can’t scoop myself.

I do want to make one point though, it is a geographic point. The counties that are most likely to offer a zero premium plan to most/all adult buyers (At least a $350 gap between benchmark and a Metal plan for a single 40 year old non-smoker ) are in Trump voting states. Eyeballing it even further, most of those counties are likely to be Trump voting counties.

This makes sense. Big premium spreads are likely in monopoly counties. Big spreads are likely in states that did not expand Medicaid. Big spreads are likely in rural areas. All of those correlate fairly well with Trump voting regions. And this policy will kick them in the butt.

Trump’s actual health policy has been to shovel a ton of new money to the 100-400% FPL populations while trying to squeeze the Medicaid population and budget. This policy preference would take some money out of counties that are likely to vote for him in 2020. It is an interesting quirk of the plan.

16 replies
  1. 1
    Baud says:

    Every time his voters get hit, they blame Dems. So win-win for them.

  2. 2
    dr. bloor says:

    It will all be AOC’s fault, and his margin of victory in those counties will be bigger than it was in 2016.

  3. 3
    Mathguy says:

    I have to laugh as a Nebraskan–some of those Nebraska counties went 90% for the shitgibbon.

  4. 4
    SRW1 says:

    OT, Paul Ryan apparently has pronounced on Trump’s personality as a ‘non-winning’ issue wrt to T’s re-election. I feel a ‘whacky nut job’ Trump tweet coming Paul’s way.

  5. 5

    @Mathguy: Conditional on being 100-400% FPL ANd conditional on actually being willing to buy insurance on Healthcare.gov Trump has been great for rural individual market health insurance buyers.

  6. 6
    Snarki, child of Loki says:

    Those brain-dead Trumper’s can’t stop twitching soon enough, methinks. And taking them off of life-support should help.

    Lots of powerful firearms and opioids also, too.

  7. 7
    Mathguy says:

    @David Anderson: A lot of those counties have large percentages below the FPL. I’m hoping that Governor Cueball (aka Pete Ricketts) and some of his pet legislators don’t sabotage the Medicaid expansion. I’ll also be wishing for a unicorn….

  8. 8
    Gin & Tonic says:

    @Snarki, child of Loki: In re the opioids, I was reading an article in The Economist yesterday about the rise in meth overdoses, in which they said the data showed that opioids were mainly an Eastern-state issue and meth was mainly a Western-state issue – except for one state which was #1 in both opioid overdos deaths and meth overdose deaths. Drumroll, please…. West Virginia, of course.

  9. 9
    eldorado says:

    oh hai guise. it me.

  10. 10
    jonas says:

    This is certainly interesting, but of course Trump voters don’t give a shit if the administration’s policies hurt them or not. They do. Not. Care. Soybean farmers who were wiped out this year still love the guy even though he personally destroyed their businesses with his tariffs. They’re in it for punching down on brown people and owning the libs. Full stop.

  11. 11
    Vhh says:

    Empty Trump counties. Faster, please.

  12. 12
    Tall Tom says:

    I agree that this will not change the way these counties vote. They would have to admit to themselves that they made a mistake in voting for Cheeto-head. And that just won’t do. Not at all.

  13. 13

    @Tall Tom: The budget proposal requires legislative change to rewrite the subsidy formula. Not going to happen. So this is a two-for — slam the ACA while not harming the ACA functions that benefit likely Trump voters. Dumb policy, smart politics.

  14. 14
  15. 15
    Just One More Canuck says:

    completely off topic, but there’s a breaking story on CNN about mail fraud in college entrance exams (Felicity Huffman and Lori Laughlin are among those being charged – over 40 in total). I know there’s some Juicers who work in this area (geg6? others?) – it would be interesting to get their insight into this

    From the CNN story:

    Dozens of people, many affiliated with prestigious American universities, face racketeering charges over allegedly facilitating cheating on ACT and SAT tests and bribing college coaches, according to an indictment in US District Court in Massachusetts.
    The purpose of the alleged scam was to help student athletes get into college, regardless of their athletic ability, according to the indictment.
    It alleges that a third party took the ACT and SAT college entrance exams in place of students. The documents also allege that some defendants created fake athletic profiles for students to make them appear to be successful athletes and get them into college.
    Of the defendants, several are employed as sports coaches or administrators at the University of Southern California, UCLA and Yale and Wake Forest universities. The indictment accuses defendants of committing crimes between 2011 and 2019.

  16. 16
    Gin & Tonic says:

    @Just One More Canuck: Back when ID requirements were a lot looser, I knew a guy who made pretty good money taking SAT’s for other people. He went on to become a professor at an Ivy.

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