Why we need to fight

First a story from Jacy:

I had a catastrophic plan the first year — which was the year I was diagnosed with ovarian cancer that July. Living in Louisiana, I fell into the “Jindal Hole,” where I made too much money for Medicaid but not enough money to qualify for a subsidy. It was a nightmare. Out-of-pocket cap was supposed to be $6,300 after a $4,200 deductible (which was a fortune that I couldn’t afford anyway…), but having a major diagnosis meant that I racked up bills so fast that they couldn’t even process the claims to figure out when the insurance would kick in. Fast forward to October, where I was standing at the reception desk of the oncologist’s office, crying, because I couldn’t pay the $5,000 copay to get the chemotherapy I was scheduled for that day. I was paying almost $500 a month for insurance, had spent borrowed and spent nearly $7,000 in copays and deposits to meet my deductible and and out-of-pocket cap, but none of that mattered. I had to postpone chemotherapy and spent the next several days on the phone trying to get someone to authorize treatment or find some way to come up with thousands of more dollars on the spot.

The next year, I made enough money to get a silver plan, and I was paying $128 a month in premiums, with a $200 deductible, after which everything was totally covered. I would not have survived another year on the catastrophic plan.

And then a story from the truly bad old days as written in the LA Times:

When Steve and Leslie Shaeffer’s daughter, Selah, was diagnosed at age 4 with a potentially fatal tumor in her jaw, they figured their health insurance would cover the bulk of her treatment costs.

Instead, almost two years later, the Murrieta, Calif., couple face more than $60,000 in medical bills and fear the loss of their dream home. They struggle to stave off creditors as they try to figure out how Selah can keep seeing the physician they credit with saving her life.

“We’re in big trouble,” Leslie said.

Shortly after Selah’s medical bills hit $20,000, Blue Cross stopped covering them and eventually canceled her coverage retroactively, refusing to pay for treatment, including surgery the insurer had authorized in advance.

The company accused the Shaeffers of failing to disclose in their coverage application an undiagnosed bump on Selah’s chin and physician visits for croup. Had that been disclosed, the company said in a letter, it would not have insured Selah.

(h/t Charles Gaba)

Let’s avoid the bad old days.

Brand new cadillac

This sounds like a real winner politically:

A draft House Republican repeal bill would dismantle Obamacare subsidies and scrap its Medicaid expansion, according to a copy of the proposal obtained by POLITICO.

The legislation would take down the foundation of Obamacare, including the unpopular individual mandate, subsidies based on people’s income, and all of the law’s taxes. It would significantly roll back Medicaid spending and give states money to create high-risk pools for some people with pre-existing conditions. Some elements would be effective right away; others not until 2020.

The replacement would be paid for by limiting tax breaks on generous health plans people get at work — an idea that is similar to the Obamacare “Cadillac tax” that Republicans have fought to repeal.

Age based subsidies and geographic disparities

I am reading through the leaked Republican Reconciliation bill at Politico.  

P.66 has the replacement subsidies that are determined solely by age and do not reflect either income or local cost of coverage:

  • 18 to 29 — $2,000 year
  • 30-39 — $2,500 year
  • 40-49 — $3,000 year (note mid-40s is when the cost curve which is incresing from a 3:1 band to a 5:1 band starts getting expensive)
  • 50-59 — $3,500 year
  • 60+ — $4,000 year

There are major distributional impacts that will kick the Republican base voters in the teeth.  Most notably the increase of the age premium band from 3:1 to 5:1 will make insurance much more expensive for older insured individuals.  The subsidy band is only 2:1.

In Pittsburgh under the 3:1 band, a 29 year old can buy a catastrophic policy today for less than their monthly subsidy. A Bronze plan would cost $20 out of pocket every month and a Silver plan $47 per month.  Under the same banding, a 64 year old with their $333 non-income adjusted subsidy will be able to buy a catastrophic policy for $89 per month, a Bronze plan for $152 per month and a Silver plan for $211 per month.  This is a favorable set of assumptions for the 64 year old as the age banding is 3:1 instead of 5:1.  Less favorable assumptions would make the Silver policy cost $600 or more after subsidy for a 64 year old.  The only person who will buy that policy is someone who is already getting extremely expensive treatment in the hospital.

That appeals to liberal moral interest and a bit of schradenfreude.  A more useful angle of attack is to look at what that 29 year old and 64 year old can buy after the subsidy in Alaska (zip code 99501).  There a 64 year old under 3:1 band would see a Bronze plan cost them $1,300 a month and a Silver plan cost them $1,700 a month after the flat age based subsidy is applied.  These numbers will get even larger once a 5:1 premium band is applied.  This will death spiral the individual market.

Apply the same analysis to Arizona which also has two Republican Senators that count on an older supporting voter base and there are stories to tell which will inflict significant political risk to Republican Senators.

Revisiting the three legged stool

Paul Krugman has used the three legged stool analogy to describe the ACA several times.  It is an analogy that is vivid in its description and useful in its implications:

Yes! The Court (minus the three stooges) understood that the ACA is designed to work via the “three-legged stool” of guaranteed issue and community rating, the individual mandate, and subsidies. All three elements are needed to make it work, which is why it was obvious to anyone who paid any attention that the lawsuit was nonsense.

There is a problem with this analogy.  It is too specific.

There are three legs of the stool.  Two can stand without modification.  Guarantee issue with community rating stands as a firm leg.  It means that anyone can get a policy at a standard rate.  In the ACA, that standard rate is based on the county or zip code of residence and age of the applicant.  Subsidies also are a firm leg.  They help people who can not afford the standard rate pay for the standard rate.

The third leg of the stool is a pool participation mechanism.  The individual mandate is a specific type of the third leg.  There are other mechanical techniques that can fundamentally perform the same needed function of getting people who think that they will be relatively healthy and low utilizers into the insured risk pool.  100% subsidy for the premium and auto-enrollment with an opt-out performs the same function as the mandate in getting healthy people in the pool.  It would force a lot more healthy people into the pool at a higher expenditure for a given level of actuarial value coverage.  Late enrollment penalties like those used in Medicare that are long lasting and significant are another approach to get healthy people in the current period into the pool.  Multi-year contracts that extend the zone of uncertainty and risk theoretically perform the same function.

All of these techniques are ways to minimize the cost gap between not being covered at all and being covered at a minimal level while participating in the pool.  They attack the same problem from a variety of angles but they are functionally similar to each other.

So the actual three legged stool of the ACA is community-rated guarantee issue, subsidies and pool participation mechanism.  Keep this in mind as we again talk health reform over the next year.

Something Nice

Here’s an urban animal rescuer in Germany removing a hook from a swan’s leg and releasing a rehabilitated fox:

Did you notice the little fuzzy cygnets paddling around the pair of adult swans before Stefan Bröckling so deftly captured the injured party? So cute!

My daughter and I rescued an injured seagull from a supermarket parking lot several years ago. It had been hit by a car (I think) and lost the use of a wing.

I called a local seabird rescue place to report it, and they said they couldn’t send anyone to capture it, but told me if we brought it to them, they’d give it medical attention.

The thing about seagulls? They’re FAST! It took us the better part of an hour to corral the critter, which we chased between parked cars, under shopping carts and over median strips. We finally cornered it in a flower bed, threw a towel over it and placed it gently in a cardboard box for the hour-plus trip to the seabird rescue.

My daughter sat in the backseat cradling the box, with the gull shrieking and raising hell inside. At one point, as we neared the top of a very tall bridge, it nearly escaped. I pictured it leaping over the seat and pecking at my eyes, causing me to lose control of the car and plummet over the guardrail into the bay 400-plus feet below.

But luckily, my daughter was able to contain it, and we delivered it to the rescue place without further incident.

Anyhoo, hope your Friday is going well.

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 premiums and a healthier risk pool.  

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.