An open letter to insurance commissioners regarding baseline maximization

To any Insurance Commissioner:

This is an open letter to insurance commissioners who believe it is their legal and moral duty to protect the citizens of their state in the face of increasing policy uncertainty.  I strongly urge that the following actuarial guidance be sent to all carriers that are considering submitting rates for the individual market for the 2018 rate year as this will provide significant protection for subsidized individuals in 2018 and potential long term insulation from several of the policy changes that are currently being debated in Washington.

“All carriers that wish to submit rates for qualified health plans for the 2018 shall use the assumption for all on-Exchange plans that the individual mandate will not be enforced.  An alternative secondary submission shall be prepared with the assumption that there is no material change in the enforcement of the individual mandate.”

Furthermore, states should seek to reduce the number of plans that are offered, approved and authorized for sale on Exchange, specifically on the Silver metal band.  Increasing the difference in price between the least expensive Silver plan on the Exchange and the second least expensive Silver plan will lead to far lower post-subsidy.

These strategies will help protect residents and citizens of your state in 2018 within the current uncertain political and policy environment.  This protection emerges from two directions.  First it will give permission to carriers to realistically budget and plan for the next plan year which should increase the probability that carriers will offer plans in all markets even if there are significant rate increases needed to counteract any potential off-Exchange death spirals in the non-subsidized portion of the individual common risk pool.

Secondly, there are several bills that are being mooted about that seek to block grant future health insurance subsidies on a state by state basis where the baseline for the funding will be CBO projected subsidy spending under PPACA as it is currently written and implemented.  If the law is changed to reflect this, it is in the best interest of your state to have as high of a baseline as possible in order to guarantee the best coverage for as many of your citizens as possible.  If your department determines that the individual mandate enforcement is not certain and authorizes very large premium increases for on and off Exchange plans this summer, the baseline spending allocation will be significantly higher for your state than if you authorize very low rate increases which could lead to carriers withdrawing en masse which would be a human tragedy in 2018 with decades of repercussions.

Aggressively asking for actuarial sound scenarios will further your charge to protect your state’s insurance market and citizens.  

On The Road


We’re trying a new feature here, so let’s see how it goes for the next week or so before it’s fully automated.

This post is for Balloon Juicers who are on the road, travelling, etc. and wish to share notes, links, pictures, stories, etc. from their escapades. As the US mainland begins the end of the Earth day as we measure it, many of us rise to read about our friends and their transient locales.

So, please, speak up and share some of your adventures, observations, and sights as you explore, no matter where you are.

Have at ’em, and have a safe day of travels!

Friday Morning Open Thread: Barkus! Barkus! Barkus!

Thought about saving these for next (Shrove) Tuesday, but we’ve all earned a break this week. Thank you, Ozark Hillbilly, for these fine canine candids from the 22nd annual St. Louis Pet Parade!

Apart from checking the pancake supplies, what’s on the agenda for the end of another insane week?

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Nightmare Open Thread: Overgrown Toddlers with Weapons of Mass Destruction

A-B-C! One spoilt princeling with Chemical weapons, trumped by another with Atomic fantasies…

Thanks for breaking the world, Repubs!

Late Night Horrorshow Open Thread: Look, See CPAC 2017 — See CPAC Run!

Yes, the American Conservative Union’s combination trade show and meat market is cheesy and ludicrous when it’s not revolting, but on the other hand, the President-Asterisk and the people actually running his administration are in attendance

Jennifer Jacobs, at Bloomberg, “Bannon Rallies Conservatives for ‘Economic Nationalist Agenda’“:

President Donald Trump’s top advisers girded conservative activists for battle with the nation’s political and media establishments to deliver his campaign agenda of trade protection, immigration limits and a shrinking of government regulation.

“Every day is going to be a fight,” Trump’s chief strategist, Steve Bannon, said. “We want you to have our back.” He warned that “the corporatist, globalist media” are “adamantly opposed to an economic nationalist agenda like Donald Trump has.”…

Vice President Mike Pence reinforced Bannon’s us-against-them rhetoric when he took the stage Thursday evening.

“The media, the elites, the insiders, everybody else who profits off of preserving the status quo, they dismissed our president every step of the way,” Pence said. “And in dismissing him, they also dismissed millions of the hard-working, forgotten men and women who make this country great. And worse yet, they’re still trying to dismiss him. They’re still trying to dismiss all of us.”

Bannon, Priebus and Pence assured the thousands of activists that Trump wouldn’t back down from his campaign promises. Pence said, “We’re in the promise-keeping business these days.” Bannon said he’s proud that Trump has refused to moderate his message or to give any ground on delivering on his campaign commitments…

Although Trump was ridiculed at last year’s CPAC conference by rival presidential candidates and skipped the gathering to campaign elsewhere, prominent members of his administration this year dominate program…

Trump adviser Kellyanne Conway also talked to the group Thursday. Other Trump administration officials scheduled to speak include Scott Pruitt, the head of the Environmental Protection Agency; deputy assistant Sebastian Gorka; and Andrew Bremberg, director of Trump’s Domestic Policy Council. Trump is set to address the gathering on Friday…

Rosie Gray, at the Atlantic, on “The Bannon-Priebus Buddy Act“:

While a suit-clad Priebus offered standard fare about taxes and regulation, Bannon, in khakis and no tie, went in a different direction. His appearance was a reminder of how unusual it is that Bannon, whose career in politics thus far had consisted of aggressive opposition not just to the left but to establishment Republicans in Priebus’s mold, has ascended in such a short period of time to the highest levels of power in the White House.
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House Update

Thought I would share some of the lovely pictures that the lady friend took of the dining room and kitchen after she spent a significant amount of time organizing and hanging pictures and forcing me to throw out and give away a lot of stuff. She’s got a lot of talent:

I’m picking up a corner cupboard off craiglist on the other side of Pittsburgh, and we picked out a 9’x 7′ rug.

For my part, I ordered this for her as a thank you:

Finally, as a bonus, here’s our boy Walter cleaning his bestest friend’s ears:

Open Thread: GOP Attempting to Buff Away the KGB Fingerprints

The Washington Post has a new subhed: Democracy Dies in Darkness. The GOP would dearly love to make it so:

House Republicans next week plan to derail a Democratic resolution that would have forced disclosure of President Donald Trump’s potential ties with Russia and any possible business conflicts of interest, according to multiple House sources.

Seeking to avoid a full House vote on the so-called “resolution of inquiry” — a roll call that would be particularly embarrassing and divisive for the right — Republicans will send proposal by Rep. Jerry Nadler (D-N.Y.) to the House Judiciary Committee for a panel vote on Tuesday, two Democratic sources said. The GOP-controlled committee is expected to kill the resolution…

The markup has yet to be noticed by the panel. But the Tuesday vote will come just a few hours before Trump will give his first address to Congress. Indeed, Democrats are fuming that Republicans are trying to bury the panel vote by scheduling it on a busy news day.

Resolutions of inquiry are rare in Congress and privileged, meaning lawmakers can circumvent leadership and force action on the floor if they’re ignored for 14 legislative days.

The resolutions can force presidents and agencies to give Congress private records. Nadler’s, for example, demands that Attorney General Jeff Sessions hand over to the Hill “any document, record, memo, correspondence or other communication” pertaining to “criminal or counterintelligence investigations” related to Trump, White House staff or his business…

The mark-up will likely prove awkward for Judiciary Committee Republicans who will have to block the resolution. Judiciary member and Oversight Committee Chairman Jason Chaffetz (R-Utah) just last week, for instance, faced sharp questions from constituents who accused him of steering the Oversight panel’s agenda to protect Trump…

Well, since #JasonintheHouse already whined that town hall protests in his district were meant to “bully and intimidate” him, here’s hoping he’s ready for a whole new onslaught…

Yesterday in Domestic Terrorism and Stochastic Violence: Exceedingly Pale Edition Part II

Last night Adam Purinton of Olathe, KS decided he needed to take his 1st and 2nd Amendment rights out for some exercise at the local sports bar. Purinton killed one patron of the bar and wounded two.

A man opened fire at a crowded Olathe bar, killing one man and wounding two others before he was arrested across state lines hours later, police said Thursday about an attack that some witnesses suggested had racial overtones.

Adam Purinton, 51, of Olathe, was arrested in Henry County, MO after the shooting Wednesday evening at Austins Bar and Grill in Olathe. He waived extradition from Henry County Thursday and was expected to be returned to Kansas, said Maj. Rob Hills of the Henry County Sheriff’s Office.

He has been charged with murder and attempted murder.

The Kansas City Star reports that Purinton provided his own explanation for his actions at the time of the attack:

At least one witness reportedly heard the suspect yell “get out of my country” shortly before shooting men he thought were Middle Eastern. Both men, engineers at Garmin, appear to be originally from India.

Like the fine, brave, upstanding citizen that he is, he fled across state lines to a near by Applebees where he asked the bartender “he needed a place to hide out” and that “he had killed two Middle Eastern men”.

The victims are Srinivas Kuchibhotla, Alok Madasani, and Ian Grillot. Kuchibotla died of a result of his injuries, while Madasani and Grillot were wounded. Grillot is reported to have stood up to the shooter in defense of Kuchibhotla and Madasani.

This is Purinton.

Which reminds us to post this obligatory page from the Preacher comic book:

I’m addressing the realpolitik

My therapist said I have to stop reading and writing about Putin’s useful idiots on “the left”. It’s hard to top this from LG&M and anyway:

Watching Glenn Greenwald desperately fling his hands and talk VERY LOUD to dissemble from his role in electing Donald Trump through funneling everything about Hillary Clinton the Russian propaganda arm known as Wikileaks gave him throughout the election is pathetic. Only Greenwald and Katrina vanden Heuvel know the real truth–that by focusing on Russian interference in American elections, that we are engaging in a NEW COLD WAR that makes any criticism of Glenn NEO-MCCARTHYISM! If you don’t believe this YOU ARE A DESPICABLE LIAR!!!! AND A REDBAITER YOU JOE MCCARTHY YOU!!

Prophecy Fulfilled

Remember James O’Keefe and Project Veritas, the Keystone Kops of Wingnut Sting? O’Keefe was instrumental in shutting down ACORN, which is a feather in his Huggy Bear pimp-cap. But he was later successfully sued for $100K by an ACORN employee he smeared with deceptively edited tapes.

As a follow-up own-goal, O’Keefe and crew dressed like telecom employees to try to bug the office of Louisiana Senator Mary Landrieu but ended up arrested, fined and sentenced to probation and community service instead. In another bizarre incident, O’Keefe tried to lure CNN correspondent Abbie Boudreau onto a boat with a cargo of dildos to…embarrass her somehow? But he was outed by a female colleague, becoming the object of ridicule himself.

Oh, and who can forget when O’Keefe tried to set up a sting on a foundation funded by wingnut nemesis George Soros? His plan was foiled when O’Keefe failed to hang up the phone after leaving a voice mail under an assumed name at the foundation as bait, then regaled his comrades with a detailed account of the planned sting, all recorded on the foundation’s phone message system.

I mean, this guy is just a bumbling idiot. Only rank Republican cynicism and blue dog cowardice enabled the ACORN scam to gain any traction at all, and he’s done nothing but step on his own pee-pee ever since. Anyhoo, with that background in mind, when I saw an announcement on Twitter this morning that O’Keefe planned to reveal “hours of undercover audio recordings of employees at CNN” and read O’Keefe’s tweets squeeing that he even had Trump on tenterhooks for the big reveal, I was skeptical:

Okay, that didn’t happen, but what did was almost as dumb. Via Politico:

For a few days, Project Veritas founder and conservative activist James O’Keefe has been hyping the release of what he said where hundreds of hours of undercover audio recordings of employees at CNN.. Before releasing the tapes Thursday, O’Keefe was featured on The Drudge Report and on Sean Hannity’s radio show, where he previewed their release.

Instead, what O’Keefe released on Thursday landed with a dud in the media world… What got the most attention on social media though was the unusual highlighting of a well-known journalism quote about how journalism is about ‘aiding the afflicted and afflicting the comforted.’ But Project Veritas portrayed the situation as Richard Griffiths, now Vice President and Senior Editorial Director, being “caught explaining” the role of a journalist.

Here is Griffiths’ quote, as ‘caught’ by Project Veritas:

“If we are journalists, what is our role as a journalist? What is the fundamental role as a journalist, for us to do? Tell a story. Tell what’s going on. There’s a secondary corollary to that, right? Aid the afflicted and afflict the comfortable. To a degree, right? Is that not part of the traditional role of a journalist. It’s actually one of the things I can be most proud of as a journalist. You know we try to show the ugly side of humanity so we can do something about it. It’s hard, very hard.”

O’Keefe suggested in a video that CNN is now working on afflicting President Donald Trump. The phrase “comfort the afflicted and afflict the comfortable,” though sometimes attributed to H.L. Mencken, is best known for its use in the 1960 film “Inherit The Wind.”

Oh, and it turns out the audio is from 2009. And the other “bombshells” from the tape are a polling director slagging on Rasmussen, an assignment desk editor saying “Fox News is unbearable,” and a news desk editor saying “there’s no debate” about climate change. I’m sure CNN is rocked to its very foundations by these earth-shattering revelations. Or not.

But the right is never one to hold moronitude against someone who has successfully aided the defunding of an organization that helped poor people. So O’Keefe will remain what passes for a star in the conservative firmament: a dim, gaseous object that appears to shine only in contrast to the void around it. The end.

Oh, I wish I was in the land of Cotton

But you’re going to repeal it anyway because you don’t give a fuck about your state.

Don’t Stop Bludgeoning Them

Well, no shit, really:

Former House Speaker John Boehner predicted on Thursday that a full repeal and replace of Obamacare is “not going to happen.”

Boehner, who resigned in 2015 amid unrest among conservatives, said at an Orlando health care conference that the idea that a repeal-and-replace plan would blitz through Congress is just “happy talk.”

Instead, he said changes to former President Barack Obama’s signature legislative achievement would likely be relatively modest.


On Thursday, Boehner said the talk in November about lightning-fast passage of a new health care framework was wildly optimistic.

“I started laughing,” he said. “Republicans never ever agree on health care.”

“Most of the framework of the Affordable Care Act … that’s going to be there,” Boehner concluded.

I don’t care if he and I think it isn’t going to happen, it could, and that is what matters. Keep beating them up. Keep showing up at town halls and jeering them. Keep talking to cardboard cutouts when they are too chickenshit to show up to town halls. Keep organizing, keep yelling, keep beating them about the head and neck. They need to pay an even higher political price for trying to take away your health care than the Democrats did trying to help you gain access to health insurance and health care.

Fuck these people. They’re running scared, and instead of letting up, keep the pressure on and keep nipping at their heels as they try to escape. Sherman didn’t say “well, we’re close to Atlanta, that’s good enough. I think they know we’re serious.” He knew the only thing the confederates would understand was brute force. And these descendants of those assholes are the same god damned way. Keep throwing molotov cocktails and burn the shit down. No one ever told me in basic training it was a bad thing to shoot the people who are trying to kill you in the back as they run. Fuck ’em. Let’s take back the House, the Senate, and the statehouses.

Communication, a telephonic invasion

Nothing to see here, folks:

A purported cyber hack of the daughter of political consultant Paul Manafort suggests that he was the victim of a blackmail attempt while he was serving as Donald Trump’s presidential campaign chairman last summer.

The undated communications, which are allegedly from the iPhone of Manafort’s daughter, include a text that appears to come from a Ukrainian parliamentarian named Serhiy Leshchenko, seeking to reach her father, in which he claims to have politically damaging information about both Manafort and Trump.

Attached to the text is a note to Paul Manafort referring to “bulletproof” evidence related to Manafort’s financial arrangement with Ukraine’s former president, the pro-Russian strongman Viktor Yanukovych, as well as an alleged 2012 meeting between Trump and a close Yanukovych associate named Serhiy Tulub.

What’s going on in Kansas

Some very interesting news in Kansas that I don’t know how to interpret:

The argument that is being advanced is that even at a 90% Federal match, there is a Medicaid expansion package that will reduce Kansas state expenditures so it helps the state legislature dig out of the Brownback inspired fiscal hole without raising taxes and without being heartless bastards. And that argument seems to have worked in at least the House.

Here is what I don’t know yet:

  • Will this pass the Senate?
  • Will it pass with a Senate super-majority that is veto-proof?
  • Is it straight up expansion/state plan amendment or a 1115 waiver application?
  • What the hell is going on?

So what the hell is going on in Kansas as this seems slightly unbelievable in a good way.  And who do we need to call to encourage good votes in the Senate?

High deductible plans, IBNR and non-patient centered care

My wife had scheduled an elective but needed surgery for late December, 2016 (just days before I left her with the kids to go to North Carolina**). We had good insurance through my former employer.  The individual deductible after the health incentive bonus is $600 and then there is a 20% co-insurance for the next $10,000 in expenses.  By a rough estimate it is 83% to 85% actuarial value coverage.  It is somewhere between a Gold and a Platinum plan.  Up to the surgery, she had spent less than $50 in deductible so she still had a lot of deductible to satisfy before the co-insurance kicked in.

Any an-patient surgery for a non-bundled case will produce at least three sets of claims. The first claim is the surgeon’s professional claim.  It compensates the surgeon for their skill and time.  The second claim is the anesthesiologist for their skill and time as well as the good drugs.  The third claim is the facility fee from the hospital.  It is the rent for the operating room, recovery room and then room and board.  This is the simplest billing situation.  There are numerous situations where the claim situation will be far more complex.

And now let’s see where this split system produces a very patient unfriendly experience that has a root cause of increasing cost sharing obligations.

The week before the surgery, the surgeon’s office pre-authorized the diagnosis and procedure codes.  They also received an estimate of how much cost sharing my wife was subject to and the split between deductible and co-insurance.  Before the operating room reservation would be confirmed, the billing manager told my wife that she would have to pay her estimated cost-sharing for the surgeon’s professional claim.  This was deductible plus some co-insurance.  My wife was surprised and asked why.  She was told that with increasing deductibles the surgeon’s office does not want to chase patients for co-pays and deductibles that they won’t see.  My wife pulled out a credit card and made the payment.

A week later, she checks into the hospital, gets her surgery and is released the next afternoon.

All is good and then we get into claim processing cycle heck.

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