Care costs money

The most important concept in health finance is simple; sick people are expensive to cover. Let’s keep that in mind for the rest of the post.

The Independent Journalism Review captures the reaction of Rep. Mark Meadows (R-NC), head of the House Freedom Caucus, to the CBO score.

When reporters pointed out the portion of the CBO report saying individuals with preexisting conditions in waiver states would be charged higher premiums and could even be priced out of the insurance market — destabilizing markets in those states — under AHCA, Meadows seemed surprised.

“Well, that’s not what I read,” Meadows said, putting on his reading glasses and peering at the paragraph on the phone of a nearby reporter.

The CBO predicted:

“…the waivers in those states would have another effect: Community-rated premiums would rise over time, and people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive non-group health insurance at premiums comparable to those under current law, if they could purchase it at all — despite the additional funding that would be available under H.R. 1628 to help reduce premiums.”

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The CBO analysis was likewise adamant that AHCA’s current high-risk pool funding isn’t enough to cover sick people if states use the mandate waivers.

After reading the paragraph, Meadows told reporters he would go through the CBO analysis more thoroughly and run the numbers, adding he would work to make sure the high-risk pools are properly funded.

Meadows, suddenly emotional, choked back tears and said, “Listen, I lost my sister to breast cancer. I lost my dad to lung cancer. If anybody is sensitive to preexisting conditions, it’s me. I’m not going to make a political decision today that affects somebody’s sister or father because I wouldn’t do it to myself.”

He continued:

“In the end, we’ve got to make sure there’s enough funding there to handle preexisting conditions and drive down premiums. And if we can’t do those three things, then we will have failed.”

There is a plausible high cost risk pool design that could theoretically work. It just costs a lot of money. The Urban Institute provides an updated floor to that type of design.

Government costs for the coverage and assistance typical of traditional high-risk pools would range from $25 billion to $30 billion in 2020 and from $359 to $427 billion over 10 years. (Figure 2)

I think this is a decent lower bound as they don’t look at very high cost but uncommon conditions like hematological defects, cystic fibrosis, major gastro-intestinal conditions, slow progressing cancers or hundreds of other things. But Urban’s estimates points us in the right direction. Taking care of sick people costs somewhere between expensive and very expensive.

This is not new knowledge. Anyone of any ideological stripe who is actively trying to be a good faith broker of information on health care finance has been shouting this basic insight for months. And yet, the Senate just invited actuaries to talk with them for the first time this week. And yet, the House voted on this bill without waiting for expert opinion. The bill was written without a public hearing. The product is a consequence of a process that deliberately excluded even friendly experts who were having a nervous breakdown when they looked at the cash flows much less incorporating the criticism of unfriendly but knowledgeable experts.

Healthcare for people with high needs is expensive.



Oh boy… now it is getting real and weird

Oh yeah, the Majority Leader in the House is arguing that his statement on tape that the statement he made that the current President and a senior member of his caucus were paid by the Russians in 2016 is just a joke.

Things are getting real, and they are getting weirder than ever….



You need someone for a savior

Things happened fast last night. When Comey was first fired, even the saintly Lindsey Graham was praising the decision, Greta Van Sustern from the liberal MSNBC network was too, and there was a WaPo article from The Fix (now gone) explaining with this was a smart move for Trump. Then the subpoena story broke and by this morning everyone was calling for a special prosecutor.

I don’t think we’re out of the woods yet, though, not by any means. Republicans can still get their talking points straight in terms of defending the firing and get to work on confirming a stooge who will end the investigation. That’s still Trump’s plan:

I don’t think Giuliani could get confirmed, I’m not quite that cynical. But it will be interesting to see just how much of a stooge Trump nominates.

Update. This is in Anne Laurie’s post too but it bears repeating:

President Donald Trump weighed firing his FBI director for more than a week. When he finally pulled the trigger Tuesday afternoon, he didn’t call James Comey. He sent his longtime private security guard to deliver the termination letter in a manila folder to FBI headquarters.

He had grown enraged by the Russia investigation, two advisers said, frustrated by his inability to control the mushrooming narrative around Russia.

It’s on the record that Trump fired Comey to stop the Russia investigation. Full stop.








Trump Fires Comey

On Jeff Sessions’s recommendation.

 



Late Night ‘Our Failed Media’ Open Thread


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Too late!…

“Commentary: My Mark Zuckerberg problem — and ours”



Monday Morning Open Thread: At Least We Have A Circus to Amuse Us


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Apart from taking what pleasure we can, what’s on the agenda as we start a new week?

Some backstory, for those of you sensible enough to stay away from news media over the weekend…

The woman Raddatz is jousting with is Sarah Huckabee Sander, whose only marketable skill seems to be having been born Mike Huckabee’s daughter, bless her heart.



Both sides now

This one belongs in the false equivalence hall of fame