I’m gonna keep on loving you

Believe it or not, I do buy into the idea that it’s possible someday, maybe not today, maybe not tomorrow, the GOP Congress will turn on Trump. But I don’t think it’s likely, and the idea that once the tax cut giveaway to millionaires takes place, the GOP Congress will turn on Trump because they don’t need him anymore, well….that’s just stupid:

The reason the tax cut bill is a danger to Trump is that it’s the one last thing keeping the bulk of his own party in line behind him.

[…]

ith a tax bill behind them, the bigger the better, you will see more Republican members of Congress publicly denouncing the president, and showing far less patience for time-consuming fights with a celebrity sports figure who rubs Trump the wrong way or attacks on the president’s disfavored Republican of the moment. You won’t see leaders watching quietly as Trump encourages divisive primary challenges against incumbents. What you will likely see is real movement toward a well-funded alternative in 2020, should the president even make it that far. And if Mueller does show any evidence of malfeasance on the part of Trump or his team, don’t look for a crowd of Republicans to jump to the president’s defense.

Republicans in Congress are afraid of Trump’s brownshirts. They’re afraid of being primaried in particular, but it goes deeper than that. They don’t want Fox and Breitbart to go after them. I’m not making a value judgement here, just describing their mindset.

If the pee pee tape drops along with “Apprentice” tapes where Trump uses the n-word plus the economy tanks, then maybe the GOP Congress will turn on Trump. Until then, they won’t, and they’re even less likely to if Trump signs a bill giving their Galtian overlords trillions of dollars.








Bronze to Catastrophic Price Spreads

I believe that the Catastrophic coverage eligibility expansion in Alexander-Murray is a risk adjustment play. I want to estimate what the potential risk adjustment related pricing increment could be using 2017 Healthcare.gov public data.

My data is here. I used the Healthcare.gov PUF Landscape file to identify all counties with both a Bronze and Catastrophic plan. I used the pricing for a single 40 year old non-smoker. I took the least expensive on-Exchange Bronze and Catastrophic plan by county/state dyad and calculated the difference in premium (Bronze-Catastrophic). Positive numbers means Catastrophic has a lower premium than Bronze. I did not adjust for the actuarial value of Bronze (allowable range 58%-62% AV in 2017 and Catastrophic has an AV of 57.5%) so I may be biasing the premium spread to be higher than a true apples to apples comparison.

Bronze plans are part of the Metal risk adjustment process. A portion of Bronze premiums are sent to cover the expenses of Platinum, Gold and Silver buyers. Catastrophic plans are risk adjusted only against themselves. Catastrophic dollars within a state only need to cover Catastrophic buyers.

This leads to a pricing delta which can be significant.

There are a few things to note.

1) Not every state nor every county within a state has a Catastrophic plan
2) Not every county has a Bronze plan
3) Something strange is happening in Texas and Oklahoma as BCBS-Tx and BCBS-OK Catastrophic plans are often more expensive than BCBS Bronzes in the same county.
4) Most other county/state combinations where there is a Bronze plan less expensive than the least expensive Catastrophic plan is because one insurer offers the low price Bronze but does not offer a Catastrophic plan.

However, out of the 2,362 county-state combinations with a 2017 Bronze and Catastrophic plan on Healthcare.gov, 1,847 have a lower priced Catastrophic plan than Bronze plan. Of that 1,847 counties with a less expensive Catastrophic plan, 1,170 counties see the same insurer issue the least expensive Bronze and least expensive Catastrophic plan.

Within this subset of 1,170 counties, there is an average of $73 pricing spread between these plans in these counties. I am making the strong assumption that the catastrophic and Bronze plans are sharing the same network and the same underlying administrative expense models. Most of the delta is due to the lack of risk adjustment transfers from Catastrophic to the higher AV metal bands.

This is the play that is being made in Murray-Alexander.








Morning thoughts on Alexander-Murray

Caitlin Owens at Axios was able to get the text of Alexander-Murray and we’ll go through it. Analytically, the most critical thing in the bill is that the Copper/Catastrophic expansion is a risk adjustment play. Before we dive into the details, I want to make a couple of general points.

First, I still think that the relative balance of leverage could have made CSR payments a non-issue. Insurers (except in North Dakota) had been able to price the costs into their premiums and this would have led to much lower net of subsidy premiums for a lot of buyers. Secondly, this is a bill for 2019 not 2018. Finally it is nice to read a bill that actually grapples with health financing and health insurance.

Let’s get into this:
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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!

More tech issues, sorry Bill. I’ve got Thursday and Friday set, do don’t worry folks!

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Wednesday Morning Open Thread: Happy Diwali !


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Lights, sweets, firecrackers — what’s not to love about such a celebration?

Okay, maybe not quite so many fireworks, per NPR:

Once illuminated with clay lamps, the festival of lights has morphed into a festival of sound and fury.

It’s estimated some 50,000 tons of fireworks are exploded during Diwali, which marks the homecoming of the Hindu god Lord Ram from exile. But a public health alarm was sounded in Delhi after Diwali last year, when a toxic haze blanketed the city for days.

Delhi’s air quality is extremely poor: A 2015 study found that half of the city’s 4.4 million schoolchildren have diminished lung capacity.

To control the escalating pollution, the Supreme Court banned the sale of fireworks during this year’s Diwali. (The use of fireworks, though, was not banned.) The ban on sales extends until Nov. 1 to allow the court to fully monitor its impact in the wake of the festival…

Merchant Praveen Kumar complains that his livelihood is going up in smoke.

“It’s 100 percent correct that we are adding to pollution. But the government says it’s only three percent of the total — the other 97 percent isn’t addressed,” he says. “Besides, what do we tell the kids on Diwali: ‘Go pray, eat your food and go to bed?’ How will they enjoy that?”…

Given enough sweets, I think the kids’ll make their own fun. One way or another, folks will find a way:


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Apart from remembering to light some lights, what’s on the agenda for the day?



Late Night Horrorshow Open Thread: Is There Nothing Trump Can’t Make Worse?

Who says stuff like that? (An elderly spoilt man-child who’s always lived in his own bubble, that’s who.)

“Yes, he said it,” Wilson said. “It’s so insensitive. He should have not have said that. He shouldn’t have said it.”

The president called about 4:45 p.m. and spoke to Johnson’s pregnant widow, Myeshia Johnson, for about five minutes. She is a mother to Johnson’s surviving 2-year-old son and 6-year-old daughter. The conversation happened before Johnson’s remains arrived at Miami International Airport on a commercial Delta Airlines flight…

Wilson watched as the widow, who is expecting their third baby in January, leaned over the U.S. flag that was draping Johnson’s casket. Her pregnant belly was shaking against the casket as she sobbed uncontrollably. Their daughter stood next to her stoically. Their toddler waited in the arms of a relative.

There was silence.

Local politicians, police officers and firefighters lined up to honor Johnson for his service and for the efforts and discipline that got the former Walmart employee to defy all odds and become a 25-year-old member of the 3rd Special Forces Group at Fort Bragg, North Carolina.

Johnson, who participated in a mentorship program Wilson founded in 1993, died during a mission fighting alongside Green Berets. Islamic militants ambushed them on Oct. 4 with rocket-propelled grenades and machine guns. The team reportedly didn’t have overhead armed air cover and was in unarmored pickup trucks. Reuters reported the lack of planning upset the French…

Wilson criticized Trump for failing to acknowledge Johnson’s death after he was left behind during the evacuation. It took nearly two days to find his body in the Republic of Niger’s desert. Johnson’s body made it to the U.S. on Oct. 7 when Trump was playing golf with Sen. Lindsey Graham…

From the Sargeant’s local paper, the Miami Herald:

Sgt. La David T. Johnson of Miami Gardens, the soldier and father who was killed in Niger, returned home Tuesday afternoon.

The fallen American soldier who wore the name of his wife and mother of his two children, Myeshia Johnson, tattooed across his chest under his U.S. Army uniform, was saluted with a ceremonial homecoming at Miami International Airport.

His family, including his widow, along with dignitaries and law enforcement officers, saluted Johnson as his casket, draped in the American flag, wheeled out of a Delta Airlines plane en route to Fred Hunter’s Funeral Home in Hollywood.
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Twitter Games

This has been fun.








Sportsball Open Thread: There Is Power In A Union?

I am given to understand that Roger Goodell is an aggregation of marketing slogans made flesh and slapped in a jacket, but it seems that the players still have some pushback here:

The NFL did not seek commitments from its players to stop kneeling during pregame renditions of the U.S. national anthem but rather focused on helping them in their political activism.

“We spent today talking about the issues that our players have been trying to bring attention to. About issues in our communities to make our communities better,” NFL Commissioner Roger Goodell told reporters.

Trump’s repeated denunciation of the players as unpatriotic for kneeling during the national anthem, which he reiterated as recently as Monday, has only made the practice more widespread…

The small but growing number of players who have taken to kneeling during the national anthem are protesting the killing by police of unarmed black men and boys across the United States, as well as racial disparities in the criminal justice system. More than half of all NFL players are black.

Goodell appeared less interested in stifling the silent protests, despite Trump’s wishes, and instead praised players’ character, saying he wanted to help their political activism.

“Today’s discussion with our players was very productive and very important. It reflected our commitment to work together with our players on issues of social justice,” said Goodell…

Along those lines, team owners and 13 players had a “productive meeting” of their own earlier on Tuesday at the league offices about how to collaborate on positive social change and addressing inequality, according to a statement by the NFL and the players’ union, the NFL Players Association…

Malcolm Jenkins, a player for the Philadelphia Eagles, told reporters that the two sides discussed how to amplify players’ voices and make what he called “long, sustainable changes.”

“We all have mutual interests. … We want to make sure that the quality of product that we put out on the field is great, but at the same time we have a responsibility to the communities that we live in and the communities that we come from,” Jenkins said…

Players and their union have bristled at Trump’s assertion they are unpatriotic. Though still a minority, more players have begun kneeling since the new football season began, and some sympathetic teammates have linked arms with the kneelers while standing themselves…

The NYTimes:

The league’s rule book never required players to stand for the anthem but says they must be on the sideline during the song and “should” stand for it.

The ambiguity in the rule has made it difficult for the league to fine players who have either sat or knelt for the anthem, and the owners had discussed clarifying the wording to make standing for the anthem mandatory.

By leaving the rule alone, the league has chosen to avoid more internal strife with its players and to potentially weather more criticism from fans and President Trump, who has repeatedly ridiculed the league for not firing players who demonstrate during the anthem.

“We need to be above petty attacks from anybody, because racial and socioeconomic inequality has existed in this country for too long,” Jed York, the chief executive and co-owner of the San Francisco 49ers, said when asked about the president’s criticism of the league. “You got to block out the noise and go do your job, and that’s what we need to focus on.”…

We fully understand that nobody’s gonna pay NFL dollars to watch a bunch of Trump interns in full gear attempt not to injure themselves running around the field every Sunday, Monday, and Thursday evening, Mr. I-Killed-Arena-Football.

…Jenkins said there had been no discussion during the meeting about prohibiting players from kneeling during the national anthem; whether players continue to do so, he said, would be an individual decision.

He also said that Kaepernick had been invited to the meeting but chose not to attend. Kaepernick’s lawyer, Mark Geragos, later said it was possible that Kaepernick would attend future meetings…

The league also continues to grapple with Kaepernick, who filed a grievance accusing the owners of colluding to keep him from joining a team. Kaepernick, who led the 49ers to the Super Bowl in 2013, has remained unsigned since leaving the team in March.

What say the sports fans?



Who Dis? (Open Thread)

Name this actor and the 1970s horror film in which he stars below:

God lord, that movie is a giant slab of Velveeta. No more hints! Open thread!



You know something is happening here but you don’t know what it is

A poll, albeit a Fox News one, has the race for Alabama Senate tied. You can give to the Democrat Doug Jones below.

Goal Thermometer








Tuesday Evening Open Thread: Why the Election Was Close Enough to Steal


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Imagine you were an idiot, and imagine you were a Trump voter. But I repeat myself!
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Apart from [all the facepalms], what’s on the agenda for the evening?



Expanded Catastrophic plans

It seems that Senators Alexander (R-TN) and Murray (D-WA) have most of an agreement together on appropriating CSR funds and tweaking elements of the ACA.

One of the tweaks is expanding access to Catastrophic plans. Catastrophic plans can not currently receive premium subsidies. I had been scratching my head on this for a couple of days as Catastrophic plans are currently sold to people under 30 or have a hardship exemption. It has a similar to Bronze actuarial value. A standard Catastrophic plan has $7,150 deductible with 3 PCP visits covered before the deductible has to be paid.

This is a risk adjustment play to lower premiums.

Rebecca Stob, a health insurance actuary who wrestles with risk adjustment every day lays out the mechanical implications:

Right now in the ACA there are two distinct risk adjustment pools. The catastrophic pool shifts money between catastrophic insurers. The money is mostly covering healthy and young people. The other risk adjustment pool is the Metal pool. Bronze, Silver, Gold and Platinum buyers are all shifting money amongst the plans. Typically Bronze plans will send a significant proportion of total premiums into the risk adjustment pool while Gold and Platinum plans will be net recipients of risk adjustment funds.

IF the Catastrophic concession is to open up Catastrophic plans to all ages and includes APTC subsidies while not integrating Catastrophic into the common risk adjustment pool, we get a quasi-split risk pool. Very few people will buy Bronze plans as Catastrophic will be cheaper as the Catastrophic plans won’t be sending money to the Silver-Gold-Platinum plans while Bronze plans have to cover their own medical costs plus kick money into risk adjustment outflows. Few Bronze buyers means the Silver-Gold-Platinum plans all get more expensive as they will be receiving far less risk adjustment money coming from Bronze plans.

The Catastrophic pool will still be fairly healthy as the $7,150 deductible is scary to anyone with a chronic condition but premiums will be low as the pool just needs to cover their own costs without funding risk adjustment outflows to cover sick people in Silver-Gold-Platinum.

From a distributional point of view, this is good for healthy subsidized and non-subsidized buyers, no significant change for subsidized CSR buyers, slightly worse off for subsidized Gold and Platinum buyers as the relative price spreads will increase, and bad for non-subsidized metal buyers. It might be a net improvement for non-subsidized but very high cost buyers with severe medical conditions as they were always guaranteed to hit the Out of Pocket Max in any scheme but premiums might drop enough.

Update 1 If I had to vote on this legislation, based on the reporting of the past couple of hours, and with the proviso that I actually need to see the text, I would be a yes with at most modest grumbling.








Calling Bullshit on the BS Artist

We bitch about the Beltway media a lot around here, and God knows they deserve it. But sometimes, talking heads say something worth hearing. Such was the case on AC 360 last night, when the panel was discussing Trump’s shameless, infuriating lies about how President Obama and other predecessors interacted with the families of soldiers killed in action.

In the clip below, Ryan Lizza of the New Yorker (at left in the screen grab) wonders why Trump “makes shit up” and “lies all the time.” The melon-headed butt-munch seated at right who’s failing to hide his chinlessness behind a goatee — co-panelist and former Trump flack Jason Miller — lamely tries to defend Trump’s staggering and unprecedented mendaciousness. But Lizza is having none of it, repeatedly calling Trump out for lying constantly.

Lizza is getting high-fives all over the Twitters for it, but IMO, the real hero of the clip is Tara Setmayer, who comes in at the 1:40 mark and drops the following truth bomb about why Trump is such a lying piece of shit (transcribed below the clip for those who can’t / don’t want to watch the video):

SETMAYER: Because he’s done this his entire career and never been held accountable for it. Now he’s in front of the entire world, where he has people who will actually hold him accountable for the things he says, and he does not know how to process that, because its not in his character to do so. He’s been a liar his entire life! He’s a BS artist! And when he gets backed into a corner, then his default is to lie, make something up, deflect and divert, and when people call him on it, he says “fake news.”

Exactly right, and well said, Ms. Setmayer.



CSR from your point of view

Yesterday, MAK in comments raised a very good and pragmatic implicit question; WHAT THE HELL DOES THIS MEAN TO ME AND MY FAMILY

Does this mean that the September payment covered the rest of the year? Because I’ve been looking (apparently in all the wrong places) for an answer to this simple question: when do the subsidies end?
We receive a substantial subsidy which makes our family policy affordable. If the subsidy goes away, so does our insurance. So perhaps a better question, in my case, is: when does my insurance end?
ETA: We’re in Pennsylvania, fwiw.

Everything that I have been writing about regarding CSR is happening behind the scenes. It will have future in front of the scene implications, but let’s keep things simple.

1) If you currently have an ACA plan, the CSR drama has no immediate impact on whether or not you are covered today, tomorrow or next month.

2) If you have an ACA plan with premium tax credits helping you pay the monthly premium, the CSR drama has no immediate impact on whether or not you are covered today, tomorrow or next month.

3) If you have an ACA Silver plan with premium tax credits and CSR assistance, the CSR drama has no immediate impact on whether or not you are covered today, tomorrow or next month.

So what about 2018?

1) If you qualify for premium tax credits, those will be paid normally.
2) If you qualify for CSR and choose to buy a Silver plan, you still will get the extra reductions in out of pocket expenses.

There will be strange things happening in relative pricing as we saw when we looked at Pennsylvania’s pricing this morning, but everything is going to function normally once you choose a plan for 2018.

This is a really good, pragmatic question.

Open thread for insurance questions!



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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