Early-Morning TrumpRyanCare (No) Progress Update Open Thread

That FYWP ‘upgrade’ Alain mentioned earlier did something nasty to my post-composing interface. Despite his best efforts, some combination of outdated browser/plugins and my own tech incompetence have left me limping between my normal workspace (Pale Moon) and an ugly old version of IE. Be afraid, be very afraid…

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Fixed costs, low AV coverage and barriers to entry

SRW1 asked a good question this morning:

Is it possible insurance companies are as remarkably quiet as they are because they have been promised something like the opening up of the bundle of essentials at stage 2 or 3 of the process?

Besides the fact that the major insurer groups are screaming their heads off, insurers will have a very hard time making money on low actuarial value insurance that is priced to the flat age based subsidy. Jed Graham at IBD has a very smart piece that looks at the budgetary sleight of hand of the Ryan plan and makes a very critical if subtle point:

If ObamaCare’s essential benefits requirements were axed, health policy experts believe that insurers would inevitably offer people coverage that costs no more than the value of their tax credit under the GOP plan. In other words, people would find a way to use their tax credits, even if they could only afford to buy the skimpiest coverage — too little in many cases to be considered insured under CBO’s assessment. Still, if that’s the GOP’s eventual plan, it means that the CBO is underestimating the true cost of RyanCare by about $600 billion.

A 20 year old with a $166 a month subsidy in a low cost region can buy a 60% to 75% Actuarial Value plan. A 64 year old in a high cost region with a $333 a month subsidy and a 5:1 age band can afford a 30% AV plan with a $15,000 to $20,000 deductible.

Administrative costs are a bear for insurers. My former jobs at UPMC barely scaled. For my last position there, they needed one of me for every hundred thousand covered lives. For my first position at UPMC, they needed one of me for every half million lives but hey needed one of me after the first 5,000 to 10,000 covered lives. There is a fairly large bolus of costs that have to be absorbed to sell the first policy that are minimally variant. After that there are variable costs of claims processing, authorization, appeals, and member services. Younger and healthy patients tend to have a lower cost of maintenance than older or sicker members. People who never use their insurance outside of hit by the bus events don’t call, they don’t appeal their denials and they don’t send claims to get reprocessed because the bucket accumulators aren’t working right. Sixty year olds have already gotten hit by the bus of age. They use more administrative services to manage their care. And the health insurer uses more administrative resources to either deny care or direct care to lower cost or more efficient pathways.

Insurers can make money on a cherry picked low actuarial value covered population. That was the business model of the individual market. But the combination of high need patients and high administrative costs means making a bundle on selling minimal plans that are priced at the subsidy point a hard way to make unusually large profits. It could be profitable for some insurers but it will be a grind.

Monday Evening Open Thread: Embrace the New Dystopia…

… Or at least crack jokes about it. Humor isn’t a cure, but it’s a very useful palliative while we’re working on the cure.

Apart from jests, what’s on the agenda for the evening?

Late-Night Sweet Little Leftovers Open Thread


Mmm, hamantaschen. My family wasn’t Jewish, but every sensible New Yorker takes advantage of ethnic bakeries during their various holidays. Purim, this year, actually ran from Saturday sundown to Sunday evening…

Sunday Afternoon Open Thread: People with No Fvcks Left to Give


May they continue to be an inspiration to us all…

Kiss up, piss down

Just an amazingly fast turn-around by the Kaiser Family Foundation on the distributional impacts of Trumpcare 1.0


This neglects tax and Medicaid impact and only looks at Exchange. But it is illustrative of the priorities that the Republican Party embraces.

Tuesday Morning Open Thread

(Jeff Danziger’s website)

Apart from protesting Ryan’s pathetic attempt to destroy the ACA… and the President-Asterisk’s administration’s second attempt at a Muslim ban — what’s on the agenda for the day?

Professor Krugman, on “A Party Not Ready to Govern“:

It goes without saying that Donald Trump is the least qualified individual, temperamentally or intellectually, ever installed in the White House. As he veers from wild accusations against President Obama to snide remarks about Arnold Schwarzenegger, he’s doing a very good imitation of someone experiencing a personal breakdown — even though he has yet to confront a crisis not of his own making. Thanks, Comey.

But the broader Republican quagmire — the party’s failure so far to make significant progress toward any of its policy promises — isn’t just about Mr. Trump’s inadequacies. The whole party, it turns out, has been faking it for years. Its leaders’ rhetoric was empty; they have no idea how to turn their slogans into actual legislation, because they’ve never bothered to understand how anything important works…

The story of Obamacare repeal would be funny if the health care — and, in many cases, the lives — of millions of Americans weren’t at stake.

First we had seven — seven! — years during which Republicans kept promising to offer an alternative to Obamacare any day now, but never did. Then came the months after the election, with more promises of details just around the corner…

Sure enough, the new plan reportedly does look like a sort of half-baked version of the Affordable Care Act. Politically, it seems to embody the worst of both worlds: It’s enough like Obamacare to infuriate hard-line conservatives, but it weakens key aspects of the law enough to deprive millions of Americans — many of them white working-class voters who backed Donald Trump — of essential health care.

The idea, apparently, is to deal with these problems by passing the plan before anyone gets a chance to really see or think about what’s in it. Good luck with that…

But whatever the eventual outcome, what we’re witnessing is what happens when a party that gave up hard thinking in favor of empty sloganeering ends up in charge of actual policy. And it’s not a pretty sight.