Friday Morning Open Thread: Medically Necessary

NYMag, at of 3:30am today:

[F]ollowing a 90-minute meeting in House Speaker Paul Ryan’s office on Thursday night, Republicans announced that they still can’t find a way to pass the health care overhaul they’ve been promising for seven years. House Majority Leader Kevin McCarthy said there would be no vote on Friday, and denied that GOP leaders had ever wanted to vote this week.

“We’re still educating members,” McCarthy said. “We’ve been making great progress. As soon as we have the votes, we’ll vote on it.”

The speaker can only afford 22 GOP defections, and according to Politico, he still doesn’t have the votes: “At least 15 House Republicans remain solidly opposed to the bill, with another 20 leaning no or still undecided, according to GOP lawmakers and aides.”

The lack of progress on the health care bill does have a silver lining for the GOP. Democrats had threatened to force a shutdown if Republicans tried to hold a health care vote this week, but now it looks like Congress will pass a weeklong spending bill before the midnight Friday deadline, giving themselves time to negotiate a deal to keep the government funded through September.

Though, House Minority Leader Nancy Pelosi suggested that even if Republicans had voted on the wildly unpopular health care legislation, the outcome wouldn’t have be pretty.

“If they vote on it, the minute they cast that vote, they put doo-doo on their shoe,” she said.

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

Let’s see what joy awaits…

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First Things First

Thanks to John and Adam for asking me to join the distinguished group of key-holders. I feel at home already, having had John step on one of my guest posts and having enjoyed all your animals since John slipped on the ice with Lily. That’s about when I found Balloon Juice.

I understand that a placating offering is required for a smooth relationship, hence this post. I’m a morning person and not good at smart stuff at night. I’ll do another introductory post tomorrow or on the weekend. But let’s get to the important stuff.

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Open Thread

I just wanted to let all of you know that Cheryl Rofer has been given a set of keys. Be nice.

Also, discovered that the fan on my air conditioning unit outside is dead. Wonder how much that will cost. Home ownership is a kick in the dick.

It Was a One Eyed One Horned Flying Purple People Eater

This is great:

The Trump administration this week launched a new hotline called the Victims of Immigration Crime Engagement (VOICE) for people to learn more information about crimes that have been committed by undocumented immigrants.

However, the hotline was quickly flooded by pranksters who called up to report their close encounters with a different kind of “illegal alien” — namely, space aliens who fly around in saucer-shaped ships.

Fusion on Thursday asked Immigration and Customs Enforcement for a response to the people who called them to talk about space aliens, and an agency spokesperson angrily lashed out by calling everyone who participated in the prank “despicable.”

“I hope you won’t dignify this group with the attention they are seeking,” the spokesperson told Fusion. “But if you choose to do so… this group’s cheap publicity stunt is beyond the pale of legitimate public discourse. Their actions seek to obstruct and do harm to crime victims; that’s objectively despicable regardless of one’s views on immigration policy.”

Fuck you, Nazi scum. The next President is going to have to resurrect the Allied Control Council and engage in denazification of these fucking brownshirts at ICE.

Beach Dogs (Open Thread)

A pair of boxers face the sea:

Open thread!

Fixer Upper

There was some discussion at the tail-end of the wee-hours thread about how the efforts to rebuild the Democratic Party are going so far. The Perez-Sanders unity roadshow is widely seen as a flop since there hasn’t been a whole lotta…unity. But was the purpose to display unity or try to get there by airing differences?

I dunno. As I mentioned in that thread, Perez has successfully run large, focused organizations, so I’m giving him the benefit of the doubt. As for the next phase, rebuilding, Kay said something in that thread that resonated with me:

I haven’t witnessed this finely-tuned Democratic machine that effectively excludes progressive candidates and slots in centrist candidates. It is NOTHING like that. In some ways I wish it were like that because that’s a defined problem that could be fixed or changed.

I have been involved with House candidates ranging from a former minister who was anti-abortion to an out and out labor candidate- he was basically “the candidate the Steelworkers gave us”. I didn’t discern the slightest bit of difference in how these two people were “supported” by the “national Party”. I put “national Party” in quotes because I feel like it’s almost an exaggeration to give them that much influence in these races.

It doesn’t matter because as I said I’m not in Bernie’s “movement” and even if I were I hate visioning sessions, but looking at it from the outside I think it operates from a flawed assumption- that The Problem is a command and control centrist Democratic Party. I have never seen evidence of this coordinated effort to hold down progressives. I don’t think it exists. They’re organized around a problem that isn’t the problem, doesn’t exist. For some reason Bernie people LIKE this problem, this is the one they want to solve, but you don’t get to settle on the problem you want to have and then pretend it’s the central issue and solve that.

It’s easy for Perez to accommodate them on the problem they’re presenting him with because it doesn’t exist so he doesn’t have to change anything.

Kay’s description of how the party functions tracks with my experience as an extremely insignificant local-level party member. I know some of y’all are meeting-attending Democrats as well. What have you seen on the ground?

Anyhoo, we need to figure this shit out, and fast. Something valued commenter Kindness said in that thread rang true to me as well:

As a nation I propose we don’t do what Maine did twice in electing LaPage.

Yep. I’ll add Florida’s example to the mix as well since this purplish state twice elected ambulatory dildo / obvious crook Rick Scott with less than 50% of the vote total. We’ve got to be up to the job — us, not some vague, faceless “them.”

Still I’m gonna miss you

Not sure why Dems are trying to stop Republicans from voting on health care tomorrow. I don’t always wish a motherfucker would hold a vote on destroying millions of people’s health care but there’s no way on earth this thing passes the Senate. I mean, look at these poll numbers:

Public sentiment is particularly lopsided in favor of an aspect of the current health-care law that blocks insurers from charging more or denying coverage to customers with medical conditions. About 8 in 10 Democrats, 7 in 10 independents and even a slight majority of Republicans say that should continue to be a national mandate, rather than an option for states to retain or drop.

These Tuesday group moderates, or whatever they’re calling themselves these days, are correct:

The latest changes, hammered out by Freedom Caucus Chair Mark Meadows (R-NC), and one of the moderates’ own, Tuesday Group co-chair Tom MacArthur (R-NJ), allows states to opt out of ACA insurer mandates in a way that would essentially gut its pre-existing conditions protections, the Holy Grail of the promises many Republicans made about their replacement.

“I spent the whole work period hearing from people pissed about pre-existing conditions,” one moderate lawmaker told CNN on Wednesday. “This isn’t helpful.”

Another moderate was overheard by the Hill telling a staffer: “If I vote for this healthcare bill it will be the end of my career.”

If these idiots walk the plank on this unpopular piece of shit…

Odds and Odds Without End

I miss the good old days (2008-2016) when a person could unplug for 12 hours and not find evidence of traitorous behavior in the highest levels of government and multiple instances of chief executive buffoonery upon reentering the media stream. Here are a few things that caught my eye:

This seems significant:

Former national security adviser Michael Flynn was warned by the Defense Intelligence Agency in 2014 against accepting foreign payments as he entered retirement, according to new documents obtained by the House oversight committee…

“These documents raise grave questions about why General Flynn concealed the payments he received from foreign sources after he was warned explicitly by the Pentagon,” said Rep. Elijah Cummings, the top Democrat on the House oversight committee, in a statement. “Our next step is to get the documents we are seeking from the White House so we can complete our investigation.

This stinks to high heaven, y’all. This specimen simply must be questioned under oath.

I’ve read a theory that Trump die-hards in the wingnut media are recognizing that this Russia business has the potential to bring the orange fart-sack down, so they’re creating an alternative narrative that, while the Trump campaign was thoroughly infested with Russian operators, he was personally clueless about it during the campaign but has now turned wily spy-hunter. That’s the line taken by tabloid trash purveyor David Pecker, Trump friend and aptly named publisher of the National Enquirer.

In another curious turnabout, Trump favorite and notorious Hillary-hater Judge Napolitano of Fox News published an op-ed questioning FBI Director Comey’s handling of the Russia investigation before the election:

How could Comey justify the public revelation of a criminal investigation and a summary of evidence of guilt about one candidate for president and remain silent about the existence of a criminal investigation of the campaign of another? How could he deny knowledge of surveillance that was well-known in the intelligence community, even among his own agents? Why would the FBI director inject his agents, who have prided themselves on professional political neutrality, into a bitterly contested campaign having been warned it might affect the outcome? Why did he reject the law’s just commands of silence in favor of putting his thumb on political scales?

I don’t know the answers to those questions. But the American public, and Hillary Clinton, is entitled to them.

Truth from an unlikely source. Will the fact that even Fox News bigwigs are questioning his precious integrity and impugning his self-cherished aura of bipartisan competence spur Comey to attempt to unshit the bed he so thoroughly shat in 2016? We’ll see.

It also appears that Trump got pantsed by Canada and Mexico after blustering about NAFTA yesterday. He’s agreed to “renegotiations” rather than following through on threats to unilaterally withdraw. Possibly Peña and Trudeau simply explained how the treaty works, just as President Xi held an impromptu “North Korea for Dummies” seminar at Trump’s private club, clueing Twitler in on the complexities of that situation.

Were I a citizen of Canada or Mexico, I’d be dancing with glee at the prospect of the upcoming negotiations with such an easily provoked, idiotic ass. The upside for us? Maybe we’ll get taco trucks on every corner after all, with a Tim Horton’s across the street!

There are at least half a dozen more news items that would be screaming headlines for weeks in a normal administration, such as Trump’s idea to break up the 9th Circuit Court because he doesn’t like its rulings. I didn’t need to read about that after watching the first three episodes of “A Handmaid’s Tale” yesterday.

Anyhoo, I miss the days when a tan suit could cause a media furor. Open thread!

Keep swimming, just keep swimming

Keep on swimming, keep on calling


Update 1
Keep on calling:

The vulnerable Republicans are getting squeezed hard, so time to pop them like a zit three days before prom.

Call Congress

Medicaid is the key. The AHCA is still cutting $800 billion plus from Medicaid over a decade and this is the point of resistance for the Tuesday Morning Group, a group of 40 to 50 less conservative Republicans who are likely to represent districts that are vulnerable in wave elections.

Let them know that this is important and that killing Medicaid kicks them out of a job in 2018.

With Chaffetz going out for surgery, Ryan can afford to lose 21 votes assuming every Democrat shows up. (Any Democrat who is not in the ICU or at the funeral of spouse and does not vote should be primaried). The House Freedom Caucus might still have two or three No Votes, Rep. Massie from Tennessee is still a NO vote. The Tuesday Morning Group needs to supply at least seventeen or eighteen No votes to defeat the legislation.

Call Congress and tell them what you think…

Double counting: reinsurance and risk adjustment

A friend of the blog raised a very interesting point about the current state reinsurance efforts. These efforts don’t modify risk adjustment coefficients. This leads to double counting of claims leading to risk based payments. This is a major problem with a couple of solutions.

We need to get deep into the weeds of chasing money like a rabbit at a greyhound track.

First, risk adjustment is zero sum at the state level. A dollar that Plan A receives is a dollar that Plan B gives up. Risk adjustment works by assigning a risk score to a collection of diagnoses. That risk score is then multiplied against average premium and a few standardization factors to calculate the individual’s risk value. The company’s risk values are summed and normalized against the state wide risk profile. If the company has less than state level risk, they pay into the risk adjustment fund which then pays their competitors who have more than state wide average risk.

Hemophilia receives a risk score of about 52 times average monthly premium to treat. In a state with an average premium of $500, that means this patient receives a risk value of $26,000 per month or $312,000 per year. A portion of that $312,000 covers ongoing maintenance medication that everyone receives. A portion covers catastrophic costs as a bad bleed can quickly run to a million dollar month.

Minnesota’s new reinsurance program pays a portion of claims that run from $50,000 to $250,000. That means a Hep-C cure will be paid for via risk adjustment and reinsurance. That means the maintenance prescriptions for a hemophiliac will be paid for by both risk adjustment and reinsurance. This means solid tumor cancers will be paid partially for by both risk adjustment and reinsurance.

Double counting is a problem on a market stabilization level and a political level. It needs to be fixed.

When I worked for UPMC Health Plan, the last three years had me focusing a significant chunk of my time on Medicaid risk adjustment. Pennsylvania Medicaid had revenue neutral risk adjustment like Exchange and a high cost risk sharing pool. These two elements of risk played nicely with each other. Risk adjustment was capped to be no more than approximately $75,000. Everything after $75,000 was put into a high cost risk sharing pool where money was spread around to cover unusually high expense cases. A dollar of spend was only ever going to be at risk for pool smoothing purposes once.

Minnesota or any other state that is thinking of using an aggressive reinsurance scheme to stabilize pricing needs to re-calibrate their risk adjustment co-coefficients to prevent double-dipping where the same dollar of spend will be credited to both risk adjustment values and reinsurance. They can also choose to apply risk adjustment corrections to the claims data that is used to trigger reinsurance payments. Both require local technical expertise, political will and time to implement.

As more states think about reinsurance, they also need to think about how they do risk adjustment. There are solutions, they just need to find the local solution that works.

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Thursday Morning Open Thread: Turnabout, for Real Education

I much prefer this idea from Richard V. Reeves, at Quartz:

When the event was founded back in 1993 as Take Your Daughter to Work Day, the idea was to promote gender equality. It expanded to include sons 10 years later, and has since lost much of its animating purpose. It also remains a largely white-collar exercise: Sponsors of the foundation that advocates for the holiday include MetLife, HP, AOL, and Goldman Sachs…

But in practice, Take Our Daughters and Sons to Work Day hasn’t changed much. We need to turn it on its head. At Brookings we are trying to practice what we preach, and so this Friday we will be hosting over 100 high schoolers from DC Public Schools, as a result of a new partnership with two non-profit organizations—Build DC and the Latin American Youth Center—and DC Public Schools.

One of the biggest challenges the US is a lack of intergenerational social mobility. Too many children end up in similar positions to their parents on the social and economic ladder. Given this, the case for exposing disadvantaged kids to white-collar jobs is pretty clear. But there is something to be said for the other side of coin, too. Teenagers from affluent backgrounds often live in a bubble, surrounded by friends, neighbors and fellow students who share similar backgrounds. “Our kids are increasingly growing up with kids like them who have parents like us,” writes the Harvard social scientist Robert Putnam in his book Our Kids. He warns this represents “an incipient class apartheid.” It couldn’t hurt for upper-middle-class kids to step outside their bubble and spend a day in a working-class job…

Apart from tween-wrangling, what’s on the agenda for the day?

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

Read more

Defining the True Progressive (Pt. II): Not An Intentional Joke, Apparently…

‘Our Revolution’, it appears, will be carefully curated:

The People’s Summit is a conference with a goal. To express a set of ideas, values and priorities that reflect our political vision. So instead of a ‘first come, first serve’ registration process, we’re deliberate about who we want to attend. With that in mind, we’ve crafted an application process that allows us to get to know you better before we seal the deal.

We’re looking for organizers and activists, thinkers and doers, grassroots and grasstops. And we know that simply opening the doors to whoever can buy a ticket will result in a space that is too white, too old, too local (also too Chicago and nearby areas), too many paid staffers, and too many consultants.

So we’re asking for personal information about people who want to come not to exclude anyone – but to make sure the balance reflects who we want to be. Our movement is leaderful, accessible, safe, and reflects the diversity of our country.
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