Auto-enrollment trade-offs

Sarah Kliff at Vox highlights one area of plausible discussion among liberals and some conservative Senators on health care. She looks at the idea of automatic enrollment with opt-outs from a catastrophic plan. This idea is part of Cassidy-Collins state option.

Republican legislators and policy experts are kicking around a novel way to increase health coverage: automatically enrolling millions of uninsured Americans into low-cost insurance plans….

And unlike Republicans’ other ideas, automatic enrollment is the rare health proposal that doesn’t reflexively alienate liberals. They are generally enthusiastic about policies that would lead to greater coverage.

“It’s a viable idea,” says Andy Slavitt, who ran Medicare under President Obama and is an ardent Affordable Care Act advocate. “What’s appealing about it to Republicans and to Democrats is you want people to have free choice but not be free riders.”

There is a major operational challenge of assignment. I don’t think it is as big of a deal as others make it out to be as I conceptualize it as effectively similar to Medicaid presumptive eligibility with retroactive payments. A region could be set up and insurers could bid on providing coverage to effectively the uninsured for an estimated pot of money. We don’t need an ugly database tracking enrollment.

But that is a detail.

The key thing is to look at the trade-offs between an opt-in and out-out auto-enrollment program.

The ACA is an opt-in program. People have to sign up for an Exchange plan, they have to sign up for Medicaid. Not everyone signs up. Auto-enrollment basically has everyone sign up.

We need to hold money constant for a minute to see the implications. The first pass will not be an ACA vs AHCA analysis. It will be an illustration. We’ll get a little more complicated in the second iteration of analysis. Read more

Market power strikes again

An interesting paper in Health Services Research by Dr. Seidu Dauda* looks at market power between payers and providers to tease out the effects of increasing concentration on prices. The effect that is actually being measured is how does the changing relationship of market power between payers and providers change prices.

The results aren’t surprising. Concentrated providers lead to price increases. Increasingly concentrated payers lead to price decreases. This is expected.

A hypothetical merger between two of five equally sized hospitals is estimated to increase hospital prices by about 9 percent (p < .001). A similar merger of insurers would depress prices by about 15.3 percent (p < .001). Over the 2003–2008 periods, the estimates imply that hospital consolidation likely raised prices by about 2.6 percent, while insurer consolidation depressed prices by about 10.8 percent....

What does this mean for policy? Read more

Tuesday Morning Open Thread: The Kleptocracy

It used to be third-world shiteholes and banana republics where the ruling autocrat was brought low by the thieving ways of his inept relatives. Thanks, GOP, for making this comic trope AMERICAN!

Within the warped internal logic of the Trump presidency — where it is taken as a given by essentially everybody around him that the president is impulsive and grotesquely ignorant — his shocking actions and statements have a more understandable basis.

A week ago, it appeared that the probe would center around the activities of a handful of figures who are now marginal within Trumpworld: former campaign manager Paul Manafort, foreign policy adviser Carter Page, and deposed National Security Adviser Michael Flynn. That has changed. The Washington Post reported Friday that investigators have identified a current White House official as a person of interest in its financial probe. (The story hinted, and New York Magazine contributor Yashar Ali confirmed, that the person is Jared Kushner.)…

All this implies that the probe is scrutinizing the financial aspects of Trump’s business, which is a family operation. While some Trump advisers opposed the firing of Comey, Kushner reportedly advocated for it. That fact may seem strange if one thinks of Kushner as a voice of pragmatism. But it is easier to understand if you think of him as a figure sitting near the heart of a financial scandal, who harbors a strong interest in suppressing the investigation…
The official White House line maintains — or has tried to maintain — that the administration welcomes special prosecutor Robert Mueller and sees his work as a chance to dispel the cloud of suspicion needlessly hanging over the presidency. Their actions suggest a very different calculation. From Trump’s campaign to ensure the loyalty of his FBI director, to his subsequent firing of him, to his tweet-rages against the special prosecutor as an unfair witch hunt — all of this indicates high levels of panic in the Oval Office. Trump has almost certainly engaged in obstruction of justice for the simple reason that there is a lot of justice to obstruct.

Of course, like every other aging crime family capo, the old man can’t resist going back to his known accomplices…

On The Road

Good Morning All,

This weekday feature 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. By concentrating travel updates here, it’s easier for all to keep up-to-date on the adventures of our fellow Commentariat. And it makes finding some travel tips or ideas from 6 months ago so much easier to find…

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

Should you have any pictures (tasteful, relevant, etc….) you can email them to or just use this nifty link to start an email: Start an Email to send a Picture to Post on Balloon Juice

We’re working on a better system for submitting photos and accompanying text. It will allow you to attach text to pictures and submit them so that I don’t scramble the description or leave out an important detail. Plus less time needed for the mechanics on my end, so all-around better, I’d say.

Read more

New Orleans Mayor Landrieu Speaks Out On Confederate Monuments

Amplifying Jim, Foolish Literalist’s, posts. This is an important speech. Read the whole thing, but here is a sample.

You see: New Orleans is truly a city of many nations, a melting pot, a bubbling cauldron of many cultures.

There is no other place quite like it in the world that so eloquently exemplifies the uniquely American motto: e pluribus unum — out of many we are one.

But there are also other truths about our city that we must confront. New Orleans was America’s largest slave market: a port where hundreds of thousands of souls were brought, sold and shipped up the Mississippi River to lives of forced labor of misery of rape, of torture.

America was the place where nearly 4,000 of our fellow citizens were lynched, 540 alone in Louisiana; where the courts enshrined ‘separate but equal’; where Freedom riders coming to New Orleans were beaten to a bloody pulp.

So when people say to me that the monuments in question are history, well what I just described is real history as well, and it is the searing truth.

And it immediately begs the questions: why there are no slave ship monuments, no prominent markers on public land to remember the lynchings or the slave blocks; nothing to remember this long chapter of our lives; the pain, the sacrifice, the shame … all of it happening on the soil of New Orleans.

There are good people in this country, politicians who understand they represent all the people. Remember that.

Medicaid in the President’s budget request

The Department of Health and Human Services accidentally leaked their own budget this evening. Bob Herman at Axios saved a copy. The biggest aspect of the budget is it laid out another $600 billion dollars in cuts to Medicaid and CHIP over ten years in addition to the $820 billion in Medicaid cuts in the AHCA.

Between these two documents Medicaid would lose 47% of its federal funding over a decade.

Loren Adler at Brookings thinks the cuts would be to tie the AHCA block grants to no more than inflation rate growth without regard to population or case mixture. As the Baby Boomers retire, more of them will require nursing home care that is currently paid for by Medicaid but there would be no federal money.

This is a budget wishlist that pits old people versus kids, the disabled against the pregnant and state budgets against upper income tax cuts in the federal budget.

Call Congress and give them an earful.

Pet Bleg II: Sending Out the Signal

Commenter BL wrote and asked if I’d re-up the request for assistance.

Look at that face! You know you want to help that face!

BL writes:

The dog has been lost since at least Friday morning and we have had several bouts of rain. He only had an Invisible Fence collar, and no other tags or tattooes. He is not microchipped and his collar is not registered with Invisible Fence. I have posted on several lost pet sites, facebook, a local neighborhood social media site, and Craigs List. I’ve notified the county animal control and the community HOA. I filed a found dog report with the county shelter.
I have had only one response and that was not the right dog.
Today, the president of the HOA of my development (who is a big dog lover and just took in a puppy today or would help take in Buddy for the next 3 days) drove around our neighborhood and the next development over, and asked everyone she saw if they knew where Buddy belonged with no luck. I also drove around neighborhoods this weekend and saw no signs or anyone looking for a dog.
In my county, if you turn the dog into the county, you have 5 days to pick up your dog and then they start to look at adoption.
Tomorrow will be the 5th day.
I would like to go ahead and ask the Balloon Juice community to help place the dog for adoption somewhere.
Here is what I know:
He is an older, intact, black lab mix and weighs 69lb. The vet said everything looked good except for his heart (he may have an arrhythmia). He is stiff, and had trouble walking for me on Friday, but the vet says his hips and knees seemed good (at least as much as he could tell without an xray). The walking/stiffness may be more back related. He can go up and down stairs, but it is difficult for him. His teeth are in great shape. He is very friendly with people and ok with my dogs. He is a little protective of his food with my dogs, he is ok with me taking food from him. He, unfortunately, wants to chase cats, and so, I cant keep him in the house while I travel since I have cats.
However, he likes to mark – including in the house. I have started trying to correct that, but I expect that is going to take awhile as he is old and has years of habit to undo. But I doubt he is an outside dog, since I had trouble getting him to go out into the rain. Maybe the marking is due to some level of anxiety in a new setting, although he seems calm.
I had him vaccinated for rabies while at the vet this weekend to keep everyone safe. I can arrange for the rest of the vaccines later this week, when I get back. I am postponing my travel to WV until tomorrow evening, so I can take Buddy somewhere tomorrow. If I have no other option, I will ask my daughter (but she is pregnant, in that stage where you feel nauseous all the time, and is dealing with her own dog emergency – one of her dogs is going through chemo and had to be rushed to the emergency vet this morning, plus she also has cats). I suppose the last resort is the county shelter, but they do euthanize animals they cant place. They told me they have a 60% placement rate.
Let me know if you need anything else from me. I have been reading Balloon Juice for a couple of years and I’ve seen how the group rallies for pets.
If you can help BL and this fine fellow out, let us know in comments or email me and I’ll put you in touch.
Open thread!

Open Thread: When Someone Tells You What They Are…

Explosions in the UK

Apparently something horrible has happened at an Ariana Grande concert in Manchester.

Fire on the mountain, run boys run

Jon Ossoff is up SEVEN POINTS in today’s Survey USA poll. If he wins this race at all, great Democratic candidates are going to come out of the woodwork to challenge Republican incumbents everywhere. The Montana special with Rob Quist on Thursday is looking tight too, though it’s tough terrain (Trump won by 20 points).

I’m not raising money for either of those two races anymore, since all the money will probably go to advertising of dubious efficacy.

I just emailed ActBlue about setting something up where we donate and money goes equally to all Democratic challengers. In the meantime, we’re still raising money against the asshole in NJ-6 (Rodney Frelinghuysen) who sent the letter that made the woman have to resign her job at a bank.

Goal Thermometer

Open Thread: “Peach” in Our Times

Didn’t “peach” used to be thieves’ cant for “incriminate one’s associates to the authorities”?

Open Thread: Now, the Happy Part Is Over…

Okay, the Secretary of Commerce thinks criminalizing protests isn’t such a bad thing, since he got ‘two gigantic bushels of dates’ from his security detail. One look at Wilbur Ross’s face, you can understand why dietary fiber is so valuable to him!

My New T-Shirt Came

I always hate the “Not my President” nonsense because that’s not how it works- yes, he is my President, unfortunately and god damnit. But I made an exception for this t-shirt.

The nice thing about this shirt is that even if Trump is impeached, it works for Pence, too! So its got good shelf life.

Site Tweaks and Suchlike

note: I pulled this and scheduled it for a later publish to not stomp on Betty’s post.  Sorry for the brief stomp, Betty!

Just a quick update:

The video as is back – yay more site revenue for good causes.

The video ad is back – boo, it makes the page refresh.

Well folks, we’re working on it. We’re seeing what we can do to make the best of both worlds.

Please don’t block all the ads on the site, they’re the lifeblood that a) keeps the community going, and b) ensure that good pet causes are supported. And, should you ignore this plea, once the refresh issue is past, please consider white-listing the site so that we get more ad revenue!

For today, perhaps tomorrow, as we experiment with some settings, the ad may go away, make the page refresh, or show an error message. Please be patient while we try to get it right.

This wouldn’t even be seen by you if we had a test server, but which we don’t…yet. I just started setting it up today, and expect to have it fully functional by the end of the week. When ready, it will be an almost clone of the full site, with a few configuration differences. It will be a full-time dedicated server for experimenting with new or changed features, etc. So less bumps in the future as we return to the ideal of a full-time test/development server!

Alongside this will be a proper Issues tracker so that problems, ideas, complaints, etc. about the technical side of the site can be put in one central, public place. No more spreadsheets, to-do lists, emails, comments, phone calls, etc. – just a simple, organized list of Issues.

More details will be forthcoming, but it is my sincere hope that we’ll be able to improve this site, smooth over rough patches, and hopefully add a feature or two here and there that makes your reader/commenter life better.

As a final piece of news, you may have noticed that there is an In Memoriam widget at the top of the sidebar. It’s temporary, just there for a few weeks, but please do keep greennotGreen’s family in your thoughts and prayers, and if you have a bit to spare, consider a donation to honor her, and to thank her and her family for sharing her journey. I know that I am changed from going through this; I suspect many of us are.

I don’t expect to be in the comments much, but feel free to post tech issues, ideas, etc. I am taking good ideas and adding them to the list. That won’t mean they all get done, but once they’re official issues, at least there’s a process and explanations if an issue is closed without resolution.

ETA: Please give feedback below if the desktop site is working better for you than earlier today or yesterday, or if it’s the same, or worse. If it is the same as before, also let me know.  I made some changes that seemed to fix things but then I just saw what I think was the partial reload, so now I’m not sure what to think.

Rewind the timer to 90 days

The Cost Sharing Reduction suit, House vs Price, had a status meeting this morning in front of the DC Court of Appeals. Nothing much happened. Both parties asked for another ninety day extension.

States are trying to become intervenors with the argument that the House does not have standing. Nicholas Bagley explains:

If the states are allowed to intervene, however, they could pursue the appeal even if Trump decides to drop it. With the appeal in place, the injunction couldn’t take effect until the case is heard and decided.

What’s more, the states are very likely to prevail. Not on the merits: as I’ve written before, the House is right that there’s no appropriation to make the cost-sharing payments. But the D.C. Circuit is likely to be skeptical of the district court’s conclusion that the House of Representatives has standing to sue. That’s why the states want to court to decide the case quickly: they hope to get rid of the lawsuit once and for all…
Courts try to strike a balance. They insist that third parties intervene as early as possible. They also don’t allow intervention if someone who’s already a party can be counted on to represent the third party’s interest.

That’s why the states couldn’t have intervened when the case was before the district court. The Obama administration was vigorously defending the constitutionality of the cost-sharing reductions, much as the states would have done. Their interests were aligned. Even after Trump’s election, it looked like the Justice Department would keep defending the payments—which is perhaps why an earlier effort to intervene in House v. Price was rebuffed.

Matters are very different today. Cementing his reputation as the world’s worst client, President Trump has publicly toyed with the idea of cutting off the cost-sharing reductions in an effort to force concessions from Democrats….

At this point, it’s nuts to think the states can count on the Trump administration to represent their interests.

A key reminder. The short cut fuse of the CSR bomb is limited. If it does not explode by early Fall, carriers can survive paying increased benefits without corresponding revenue if they jack up their rates in 2018 to compensate.

We have one more CSR court cycle to go through before it is resolved one way or another.