Pennsylvania’s 2018 Exchange market

Pennsylvania released their 2018 ACA rates on Monday afternoon. Their data is here (XLSM file) and the press release is here. They are explicitly Silver Switching the entire state to accommodate the CSR cut-off.

Because cost-sharing reductions are only available on silver plans, rate increases necessitated by the non-payment of these cost-reductions will be limited to silver plans. On-exchange bronze, gold, and platinum plans and off-exchange silver plans will not be impacted by these disproportionate increases.

Premium subsidies are calculated based on the cost of silver plans in each rating area, and subsidies increase in connection with rate increases. Because rates are rising on silver plans due to cost-sharing reduction non-payment, premium subsidies may be generous enough to allow an individual who qualifies to purchase a gold-level plan that has more favorable cost-sharing at a lower price than previous years.

Acting Commissioner Altman strongly encouraged individuals who do not qualify for premium subsidies to consider off-exchange options. The department worked with each of Pennsylvania’s five marketplace health insurers to ensure they would offer an off-exchange only option that is not impacted by the disproportionate rate increases for on-exchange silver plans. Off-exchange plans must be purchased directly through one of Pennsylvania’s five marketplace insurers or through an agent or broker licensed by the department to sell on behalf of these companies.

This is a really good short explainer of how people should shop in 2018. If you make more than 400% FPL, don’t even look at the exchanges. Use a broker or go direct to the websites of the insurers in your county and buy directly from them. If you make between 200% and 400% FPL, take a very hard look at Gold plans. In most counties, there will be at least one Gold plan that is less expensive than the Benchmark Silver plan.

Below is a Tableau that has most of the details of the entire Pennsylvania insurance market. My data is here as a .txt file. I started with the state data, stripped out the small group plan-county combinations. After that, I identified the APTC eligible plans. From there, I flagged the county level benchmark. I then calculated the distance from each plan-county combination from the benchmark plan for that county. A negative number means that Plan X is cheaper than the benchmark. All premiums are based on a 21 year old non-smoker who does not receive a subsidy. As people get older and families get larger, the spreads between Plan X and the benchmark will increase by a fixed ratio.

I have a few observations below the fold.

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Tuesday Morning Open Thread: Rare Sincerity

Not an elegant solution, stripping the individual tweets like this, but I hope y’all will overcome your aesthetic instincts to read the whole thing anyways:

2/ I watched the segment @chrislhayes did tonight RE whether Trump called or sent letters to the families of the 4 soldiers KIA in Niger
3/ it kinda unexpectedly wrecked me. I heard about it earlier, & like w much that he does, my response was sarcastic humor. But watching…
4/…it overwhelmed me, & I ended up in tears. It was one of those moments where it was devastating to think about the defective human…
5/…now with power to make some of the most consequential decisions w the most catastrophic effects in human history. Specifically…
6/…it reminded me of my role in bringing a dog from Iraq to the United States. In 2006 I managed a Congressional campaign vs a Repub…
7….incumbent who–like nearly every one of them-voted for the Iraq War. As late as early 2006 there were still a lot of Dems afraid of…
9/…opposing the Iraq War & making the campaign centered on it. Like many Dems unafraid of opposing the war, he won. He asked me to be…
10/…his chief of staff. And in 2007 I took on the job of setting up his operation & positioning him for reelection.
*****

14/…BUT, he was not elected to represent only people opposed to or not involved in the war. He was elected to represent all +700,000 people in his district…
*****

19/ Fast forward a few months. We get word the family had tried to get help from one of the state’s 2 Repub…
20/…senators but we’re getting ignored. They reached out to us. The last photo of their son was him holding a puppy. The next day…
21/…he was killed. They wanted to know if we could he them bring them the puppy. From Iraq. To the US. From the start, I made it clear..
22/…I would likely fire anyone on our staff who should do any of the following: A. Guarantee we could get the dog B. Request anything…
23/…that could get anyone else wounded or killed C. Mention anything about what we were doing to anyone in the press. This was…
24/…something the family wanted. We were doing it for them, & because their son had made the ultimate sacrifice for his nation. Remember
25/…the man we worked for was elected for opposing the war in which their son was killed. I assumed they voted for the Repub incumbent…
26/…but _it didn’t matter. We had a duty to act in the interests of everyone in the district. And we took that duty seriously. So, for…

27/…the next several months, in addition to all out normal work, & helping a guardswoman who’d gone AWOL to attend a custody hearing…
28/… for her son, & a soldier who wanted to donate a kidney to his mom, we worked to find a street dog in Iraq, get it quarantined…
29/…in Iraq, transported through three countries, & delivered to a family in the US, & keep it secret from the press. The help we got…
30/…still makes me choke up; the soldier’ squad, the commander of the 82nd Airborne, DHL, customs officials in three countries…
31…and especially the 20-somethings on our staff who took on this task as professional, as public servsnts, as patriots, and as…
32…this connects to today–as serious people doing serious work. When I saw the tape of Trump today, I wanted to punch the screen…


***********

Apart from resolving to NEVER STOP RESISTING, what’s on the agenda for the day?



On the Road and In Your Backyard

Good Morning All,

This weekday feature is for Juicers who are are on the road, traveling, or just want to share a little bit of their world via stories and pictures. So many of us rise each morning, eager for something beautiful, inspiring, amazing, subtle, of note, and our community delivers – a view into their world, whether they’re far away or close to home – pictures with a story, with context, with meaning, sometimes just beauty. By concentrating travel updates and tips here, it’s easier for all of us to keep up or find them later.

So please, speak up and share some of your adventures and travel news here, and submit your pictures using our speedy, secure form. You can submit up to 7 pictures at a time, with an overall description and one for each picture.

You can, of course, send an email with pictures if the form gives you trouble, or if you are trying to submit something special, like a zipped archive or a movie. If your pictures are already hosted online, then please email the links with your descriptions.

For each picture, it’s best to provide your commenter screenname, description, where it was taken, and date. It’s tough to keep everyone’s email address and screenname straight, so don’t assume that I remember it “from last time”. More and more, the first photo before the fold will be from a commenter, so making it easy to locate the screenname when I’ve found a compelling photo is crucial.

Have a wonderful day, and enjoy the pictures!

Sorry to all who I tried to publish for today, I encountered lots of errors and have little mental “pow” to deal with more than the path of least resistance.

Thank you JR – I think I stomped something else of yours, but I’ll try to solve  that another day.

Mom is doing ok, not good. I’m now here all the time (only son, no other family outside of Texas) so I’ve not paid the attention I should to this feature. I will, soon.

Until then, let me share with you a picture I took nearby. This is the view from where we (me and then-best-friend Brian) dropped off a stolen quarter-full keg of beer from some stupid Georgetown University frat boys our junior HS year, 30 years ago. Unfortunately, it didn’t have a tap, and no store would rent underage boys a tap without a credit card and deposit. So it sat outside until it was reported to police officers and then returned to the store from whence it came. Ah, the good old days, and getting away with stupid shit without digital evidence of all shapes and sorts!

This is looking over the (former) train bridge over Canal Road/Arizona Avenue in Washington, D.C. In the distance you can see forested cliffs; that is Virginia, across a deep, rapid stretch of the Potomac. During the Civil War, there were Rebels there – in view.

In my neighborhood is a former Battery a hundred or so feet higher in elevation than my family home where cannon were emplaced to shell across the river and defend against any efforts to cross the river up to Chain Bridge or down to Fletcher’s Cove. Gettysburg may be a two hour drive, and Bull Run much less, but it’s crazy how literally close the enemy was here, in our Nation’s Capital – within view, within hearing, but not effective rifle range.

It reminds me of visiting Bogota in 1996 – you could not believe that “los guerillas” were just over the mountain, and were likely viewing you in their scopes. Crazy that rebellion can be so physically close to the seat of power and yet not destroyable. Perhaps the best, most unheralded change of the past few years is the conclusion of the civil war in Colombia, and the beginning of repatriation of FARC. Finally a great people can work together to forge a better future for their children.

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Late Night Schadenfreude Open Thread: Alas, Young Jared!

Their partner, Vornado Realty Trust, is telling brokers to plan for a much more mundane renovation that would leave the property as an office building, according to three people familiar with the matter. Vornado Chairman and Chief Executive Officer Steve Roth was never enthusiastic about the Kushner plan although until now he hadn’t stood in its way.

Putting an end to the Kushner effort — to salvage their overpriced investment by turning it into a Midtown jewel with expensive condos, a hotel and five-floor mall — could have profound ramifications for the family. Vornado, which owns 49.5 percent of 666 Fifth Ave., is unlikely to invest further in the property without first being reassured of its future, said three people familiar with Roth’s thinking. That means returning to the negotiating table with lenders — a battle that could result in Kushner Cos.’ losing control of the building, said the people, who asked not to be named discussing private deals…

Roth is famously press shy and private and has instilled that ethos in other company executives. When he suffered a minor heart attack in August — something that many publicly-traded companies would immediately disclose to investors — it took more than a month for the news to break. So Vornado’s switch of directions for 666 Fifth is probably leaking out for a reason, according to three people familiar with him: he’s signaling to any lenders or investors who may still be interested in the Kushner effort to back off, the people said.

It’s a sharp reversal. As recently as March, both Vornado and Kushner were looking at a massive windfall from Anbang Insurance Group. The Kushner family stood to gain a $400 million cash payout from a deal being discussed with the Chinese insurer, while realizing their dreams of building a glamorous skyscraper. But Anbang, which had previously bought up several major U.S. properties, including the Waldorf Astoria hotel, pulled out of the negotiations amid a public outcry in the U.S. over conflict-of-interest concerns and a crackdown by the Chinese government on overseas investments…

Pressure is mounting because a $1.2 billion mortgage is due in February 2019, while losses make it unattractive to lenders who might refinance the debt. The building lost $14.5 million in 2016 and is on track to lose $24 million this year after a boost in the loan’s interest rate, according to data compiled by Bloomberg. A 30 percent vacancy rate, as of June, has deepened the losses as Kushner Cos. prepared to demolish the property and replace it — a process that would have required buying out existing leases. Vornado’s plans are designed to fill the building at market-rate rents and stanch the bleeding, three people said…

For entertainment purposes only (since there’s not much that hasn’t already been chewed over here), Kyle Pope in CJR on “The Jared Bubble: What my 18 months as Jared Kushner’s first editor taught me about the Trump family and the press”:

“You can’t say ‘hit job’ in here.”

I was six months into my tenure as the editor of the New York Observer, and I was schooling my publisher, Jared Kushner, on why ordering up a slam of someone who had crossed his family in business didn’t pass the journalistic smell test.
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Open Thread: Trump Lies About Fallen Soldiers & Actual Presidents

There is nothing this person will not lie about. THANKS, REPUBLICANS!

Trump was responding to a question about why he has not yet made remarks about the four special operations servicemen killed in Niger almost two weeks ago. Trump, speaking from the Rose Garden in a surprise press conference with Senate Majority Leader Mitch McConnell, R-Ky., said he plans on contacting the families soon.

“If you look at President [Barack] Obama and other presidents, most of them didn’t make calls. A lot of them didn’t make calls. I like to call when it’s appropriate, when I think I am able to do it,” said Trump. “They have made the ultimate sacrifice. So generally I would say that I like to call. I’m going to be calling them. I want a little time to pass. I’m going to be calling them.”…

The office staff is having a little trouble finding those phone numbers, y’see. And they tore the place up looking for the roll of stamps, but how often do letters get sent, these days?

Look, those soldiers will be just as dead during the off-season, but there’s only so many days suitable for a few rounds of golf. The man has his priorities.

“President Trump’s claim is unequivocally wrong,” a former Obama official said in a statement to ABC News. “President Obama engaged families of the fallen and wounded warriors throughout his presidency through calls, letters, visits to Section 60 at Arlington, visits to Walter Reed, visits to Dover, and regular meetings with Gold Star Families at the White House and across the country.”

“President Bush wrote all the families of the fallen, and called and/or met privately with hundreds if not thousands,” a spokesperson to former President George W. Bush told ABC News.

An aide to President Bill Clinton also called the claim false. “He did call the families of fallen soldiers while in office,” the official told ABC News.

Alyssa Mastromonaco, former White House deputy chief of staff and a longtime scheduler for Obama, told ABC News, “It is unconscionable that a president would dare to ever portray another as unpatriotic, which is essentially what he was doing.” …

He may be squatting in the Oval Office, but Donald Trump will never be “a president”.

(Also, too, if glum-faced Mitch McConnell had the political sense of my little dog, he’ve tried to distract his “leader” before he dug that trench any deeper — by faking a heart attack, if necessary. Nobody outside the 27% believes your ‘No True Republican’ bullshit, McConnell.)

ETA:


(Trump would probably explain that he prefers soldiers who don’t get wounded and suck up money that could better be spent on tax cuts shiny new weapons.)



Open Thread: Everything’s Bolder in This (Mal)Administration…

In a terse letter to Reps. Trey Gowdy (R-S.C.) and Elijah Cummings (D-Md.) — leaders of the House oversight committee — President Donald Trump’s congressional liaison Marc Short declined to indicate whether any administration officials had used personal email accounts or messaging services, despite reports suggesting such communications were common in the West Wing.

“The White House and covered employees endeavor to comply with all relevant laws,” Short wrote in a two-page reply delivered late last week and obtained Monday by POLITICO.

Short’s statement comes despite recent revelations that several senior aides to President Donald Trump routinely used private email addresses and personal devices for government business. Among the current and former aides who POLITICO found at least occasionally relied on private email addresses were Jared Kushner, Steve Bannon, Gary Cohn and Reince Priebus.

In a similarly brief letter, Short also declined to provide records in response to a separate inquiry by Gowdy and Cummings into the use of costly private air travel by top administration officials.

The White House’s limited responses set up a potential confrontation with Gowdy, a hard-nosed prosecutor with subpoena power and a track record that includes sharp criticism of Hillary Clinton’s use of private email as secretary of state. Cummings said last week that he hoped the committee would subpoena any information that the White House declined to provide, as have other Democrats…

Anybody want to bet that Witchfinder Gowdy will take more than a token interest in Lawyer Short’s curt dismissal of his mighty prosecutorial powers?

At least now we know why so many high-ranking Repubs have suddenly started wringing their pale plump hands over the reckless, out-of-control Trump cartel’s totally unprecedented “takeover” of the GOP — suddenly it’s in the Party’s interests to pretend they had nothing to do with this gang of thieves and con artists. Shocked! they are shocked! that there might be gambling going on in their personal branded casino!…



Reefer Madness- Not Only Insane, But Literally Killing People

This should surprise NO ONE:

Marijuana legalization in Colorado led to a “reversal” of opiate overdose deaths in that state, according to new research published in the American Journal of Public Health.

“After Colorado’s legalization of recreational cannabis sale and use, opioid-related deaths decreased more than 6% in the following 2 years,” write authors Melvin D. Livingston, Tracey E. Barnett, Chris Delcher and Alexander C. Wagenaar.

The authors stress that their results are preliminary, given that their study encompasses only two years of data after the state’s first recreational marijuana shops opened in 2014.

While numerous studies have shown an association between medical marijuana legalization and opioid overdose deaths, this report is one of the first to look at the impact of recreational marijuana laws on opioid deaths.

Marijuana is often highly effective at treating the same types of chronic pain that patients are often prescribed opiates for. Given the choice between marijuana and opiates, many patients appear to be opting for the former.

From a public health standpoint, this is a positive development, considering that relative to opiates, marijuana carries essentially zero risk of fatal overdose.

The reason it is important to separate “medical” marijuana and recreational marijuana usage is that “medical” marijuana is a lot of the time shit, and second, those being perscribed medical marijuana are probably a small subset of the population and in such bad shape they are probably also on other pain pill regimens.

Regardless, this is a good thing, and why the lying murderous fucks in big Pharma and the people they have paid off oppose legal marijuana.








Proof of Life: Pics from the Seattle Meet-Up

From first-class party promoter Casey L:

The Seattle BJ Meetup was terrific, except that the Guest of Honor, Yutsano, apparently went to the wrong Elliott Bay Brewery. There is more than one, and we were at the one in Burien; possibly our Absent Host went to the one in Lake City :(

We did have a good turnout- 12 people! – and I’ve attached some photos. Maybe you’ll get more from other attendees.

In the first photo, from right to left:

Beautifulplummage, Bonnie, Filbert, Lurker1, Lurker2, HG Wolf (Heidi), Connie (Bonnie’s twin sister), and part of MikeJ’s face

Left to Right: HG Wolf, Connie, MikeJ, and Bumper

That’s me, CaseyL, on the left.

A couple latecomers, Susan and Roger (The Lodger).

We had a great time, but are really sad Yutsano wasn’t there. Hopefully next time!

Good-looking crew — thanks, Casey!



Bergdahl Pleads Guilty

Closure in the Bergdahl case:

The Latest on the court-martial of Army Sgt. Bowe Bergdahl, who walked off his post in Afghanistan (all times local):

11:20 a.m.

A military prosecutor says he has made no agreement to limit punishment for Army Sgt. Bowe Bergdahl in return for the soldier’s guilty pleas to charges that he endangered comrades by walking off his post in Afghanistan in 2009.

After Bergdahl entered guilty pleas to desertion and misbehavior before the enemy, the prosecutor, Maj. Justin Oshana, told the judge that there’s no pretrial agreement between the two sides.

The judge, Army Col. Judge Jeffery R. Nance, spent Monday morning asking Bergdahl questions to make sure he understands what he’s pleading guilty to, and that his offenses carry a maximum punishment of life in prison. The judge asked him one last time if he wanted to plead guilty, and Bergdahl replied, “yes.”

This is the system working. I still maintain that all the people screaming “fuck him” or “leave him” are wrong, as I have said all along. You bring your men back, and if they have done something wrong, the military will deal with it.








Reluctantly the panic begins to catch

It’s not often that I say this but good for Joe Manchin:

One Democratic senator called on Trump to withdraw the nomination of Rep. Tom Marino (R-Pa.) to lead the Office of National Drug Control Policy, a position requiring Senate confirmation. Another quickly introduced legislation to undo the law that Marino championed and that passed Congress with little opposition.

In a statement, Sen. Joe Manchin III (D-W.Va.) said he was “horrified” to read details of an investigation by The Washington Post and “60 Minutes” that detailed how a targeted lobbying effort helped weaken the Drug Enforcement Administration’s ability to go after drug distributors, even as opioid-related deaths continue to rise. He called on Trump to withdraw Marino’s nomination.

I assume the nomination will go through anyway.

And as opioids 100 people a day, Trump will do nothing. Eventually, there will be some symbolic bullshit that he’ll do that, that will make Fareed and Van Jones declare that he’s become presidential, but that’s about it.








Monday Midday Open Thread

Feeling kinda stuck today, not unlike Batman and Robin:

The photo is from the @BatLabels Twitter feed, which, as its name suggests, primarily features things that are labeled from the old Batman TV series, e.g., “UNDETACHABLE GLUE PAD.”

Besides that, I got nothing. Open thread!








Misunderstanding the No CSR World

I want to highlight a story that I think has a fundamental mis-analysis of the individual health insurance policy world where there are no more Cost Sharing Reduction subsidies being paid.

Now the piece that has me scratching my head is from the Washington Examiner and a story about Senator Johnson (R-WI) willingness to appropriate CSR in exchange for policy concessions from Democrats:

Johnson told the Washington Examiner Friday he hopes to put out legislative text sometime next week on a proposal that funds insurer payments in exchange for reforms to Obamacare. His proposal includes expanding the duration of short-term plans and expanding health savings accounts….

Johnson said he is talking with some House Republicans to get their support for a deal. This is key because Republicans have derided the CSR payments as “bailouts.”…”I hope this would inform them what type of deal the Senate would have to come to with any hope of passing the House,” he said. “People need to realize there is a strong resistance to doing this among conservatives.”

Johnson also wants to let all Americans buy catastrophic plans, not just those under 30 years old as is the practice now.

He seems to think that Democrats need to offer policy concessions to protect the individual market. I think he is wrong.

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Plan Types aren’t everything

There are four basic plan design types. They are based on two elements. Is there a Primary Care Provider (PCP) gatekeeper requirement? Is there an out of network benefit for non-emergency changes?

That is it. There is nothing inherent to a Preferred Provider Organization (PPO) that makes it immediately superior to an Health Management Organization (HMO) or an Exclusive Provider Organization (EPO) plan design. Plan type does not drive network.  So when you have to choose a plan during open enrollment, don’t automatically choose a PPO until you look at the trade-offs.

If we hold everything else equal, PPO plans will be more expensive than anything else.  They are the most permissive. They don’t require referrals from PCPs for services, and they will give some money to any provider anywhere in the country when they perform a service.  There is a lot of leakage from the contracted network.

EPO’s don’t pay out of network benefits.  They also don’t require primary care referrals for in-network specialists.  They tend to be a middle ground on the hassle factor.  HMO and Point of Service (POS) plans require PCP referrals for complex and specialty care.  Some plans will have stringent gatekeeper requirements.  Other insurers will have loose requirements.  That will vary.  HMO plans will not pay non-emergency out of network benefits.  POS plans will pay out of network charges to some degree.

Network size is independent of plan type.  Some HMO networks are massive and some PPO networks are tiny.  Some insurers will have one basic network that they use for multiple plan types.  It will all vary.

The top 20 plans in the country according to NCQA in 2015 were a mix of plan types.   Not all PPOs are great, not all HMO’s are bad.

When you are choosing your plan during open enrollment, please be ready to think through the trade-offs.








On the Road and In Your Backyard

Good Morning All,

This weekday feature is for Juicers who are are on the road, traveling, or just want to share a little bit of their world via stories and pictures. So many of us rise each morning, eager for something beautiful, inspiring, amazing, subtle, of note, and our community delivers – a view into their world, whether they’re far away or close to home – pictures with a story, with context, with meaning, sometimes just beauty. By concentrating travel updates and tips here, it’s easier for all of us to keep up or find them later.

So please, speak up and share some of your adventures and travel news here, and submit your pictures using our speedy, secure form. You can submit up to 7 pictures at a time, with an overall description and one for each picture.

You can, of course, send an email with pictures if the form gives you trouble, or if you are trying to submit something special, like a zipped archive or a movie. If your pictures are already hosted online, then please email the links with your descriptions.

For each picture, it’s best to provide your commenter screenname, description, where it was taken, and date. It’s tough to keep everyone’s email address and screenname straight, so don’t assume that I remember it “from last time”. More and more, the first photo before the fold will be from a commenter, so making it easy to locate the screenname when I’ve found a compelling photo is crucial.

Have a wonderful day, and enjoy the pictures!

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Monday Morning Open Thread: Break Out the Light Therapy Boxes

(Drew Sheneman via GoComics.com)
.

Something this weekend about the quality of the light, or the lack thereof, reminded me it’s probably time to start using my light therapy box again. If the turning season makes you SAD, remember that self-care is especially important as the days get shorter here in the northern hemisphere.

Apart from turning inward with the season, what’s on the agenda as we start another week?

***********
It’s not just us sensitive left-wing snowflakes — even the robust denizens of MAGAmurka are feeling abused and misunderstood these days. Eric Levitz, in NYMag, says “Trump Keeps Getting Mad When He Finds Out What His Policies Actually Do”:

[T]here is one sense in which Trump is genuinely a man of the people — or, more precisely, of a certain subsegment of said people: Like millions of ordinary Americans, Donald Trump watches a lot of Fox News, but isn’t really interested in politics.

No occupant of the Oval Office has ever shared the average person’s disinterest in policy, parliamentary procedure, and the rudiments of American civics to the extent that Trump does. He is America’s first “low-information voter” president.

This was surely one source of his appeal on the campaign trail. The candidate spoke about politics like a regular Joe. Which is to say, like someone who doesn’t know much about politics but heard (or misheard) an outrageous thing about “Obummer” on Hannity last night. Jeb Bush read white papers, gave speeches at D.C. think tanks. Donald Trump watched Fox & Friends and shouted at his television. The billionaire might live in material conditions more opulent than his supporters could ever imagine. But unlike every other candidate in the GOP primary, in one small — but real and visceral — sense, Trump and the Republican base lived in the same world.

But if blithe ignorance about politics and mindless faith in the claims of right-wing pundits worked for Trump as a candidate, they’ve proven less effective for him as a president.
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