I said hey, hey hey, what’s going on

What’s happening here?

If he resigns tomorrow, he went from being a powerful committee chair to a lurking presence in the 2020 Utah governor’s race to a schmuck in a week or so.

What is going on here?

The health policy implication is that this would be one less guaranteed Yes vote for whatever healthcare bill that hits the House Floor. Right now, it looks like there is a minimum blocking coalition of the Tuesday Morning Group members without any House Freedom Caucus members needed. One less Yes vote makes holding that blocking coalition together easier as there is a touch more wiggle room and more deals that lose support at the other end of the caucus would need to be made.

But that all might be irrelevant as there is again talk that there will be no vote on Wednesday. Let’s keep calling just to make sure Congress knows what we think.

Finally, assuming Chaffetz does resign, does it make sense to back the Democrat who was gearing up to challenge him in November, 2018 or does it make sense to back McMullin as a more probable anti-Trump vote in the House? Can both be backed? I don’t know.

Third time’s a harm

The Huffington Post has the outline of yet another Republican healthcare deal:

he deal, brokered between House Freedom Caucus chairman Mark Meadows (R-N.C.) and Tuesday Group co-chairman Tom MacArthur (R-N.J.), would allow states to get waivers eliminating the so-called community rating provision ― the rule that prohibits insurers from charging higher premiums to people with pre-existing conditions. In order to obtain the waiver, states would have to participate in a federal high-risk pool or establish their own, and satisfy some other conditions.

In exchange for that conservative concession, the amendment would reinstate the Essential Health Benefits that were already taken out of the bill ― though, again, states could waive those provisions as well if they were able to show that doing so would lower premiums, increase the number of people insured, or “advance another benefit to the public interest in the state.”

What does this mean?
Read more

Good News for People Who Love Bad News

And now for some more bad news via the New York Times reporting on the Centers for Disease Control:

One in 10 pregnant women in the continental United States with a confirmed Zika infection had a baby with brain damage or other serious birth defects, according to the most comprehensive report to date on American pregnancies during the Zika crisis….
Despite a C.D.C. recommendation that brain scans be performed on all babies born to women with possible Zika infection, only 25 percent of the babies in the study had brain imaging, so the actual number of impaired infants could be higher….

Birth defects, ranging from the condition of abnormally small heads, known as microcephaly, to neural tube defects and eye malformations, occurred in 5 percent, or 51, of those pregnancies, including 45 live births. Of the 250 cases where the presence of a Zika infection was confirmed with laboratory testing, 10 percent, or 24 pregnancies, resulted in birth defects, the report said.

All but eight of the 51 cases involved severe brain abnormalities such as microcephaly;

Why does this matter beyond the individual tragedy? Medicaid is the dominant payer for births in this country. Most Medicaid births are paid for by Legacy Medicaid funds where the states pay a significant portion of the cost. Almost all childhood Medicaid expenditures are also Legacy Medicaid expenditures where the states. We are having a policy debate that looks to significantly reduce Medicaid’s ability to respond to emerging public health crisises:

the current system where the Feds give the states an open ended funding stream that is a state specific multiple of the state contribution. The block grant removes the variability of the federal spending commitment. In the Ryan plans, it also shrinks in terms of real purchasing power over time so states either spend more money to maintain current level of enrollment and services or cuts to enrollment and services have to occur.

And here is where there is a problem. The capitated payments would be based on average expected costs in year 1 and then get weaker. States with disproportionate clustering of high cost conditions will be significantly worse off. Long run Zika neurological impairments will hit warmer states’ Medicaid budgets much harder and more dis-proportionally than Zika will hit cold weather states’ Medicaid budgets…. The block grant system fails unless there is a side payment of new federal funds. And given the political fights over natural disaster relief bills and the Zika bill, I have a hard time seeing Congress routinely providing multi-billion dollar cash infusions to a few states for new diseases or threatening epidemics.

Further more, the new CDC data indicates that severe birth defects are occurring more often than previously thought.

This is a case example of the problems with block granting with a shrinking real-dollar allocation. It can’t handle shocks.

Friday Morning Open Thread: At Least It Is Friday…

… and hopefully most of the GOP liars will take the weekend off, even if the President-Asterisk down in his Mar-A-Largo dacha gets his tiny little hands on the Twitter-enabled phone again…

What’s on the agenda as we (try to) wrap up the week?

Mr. President, have pity on the working man

Trump has not come out in favor of the Ryancare bill yet. If he comes out against it, then it’s probably dead.

I have no love for Trump, obviously, but it’s not clear to me that he will end up supporting this crappy bill. I just emailed the White House, asking him not to support the bill, saying that he promised something better than Obamacare and this is something much worse. I tried calling too but the line was busy. I’ll try again later.

It will be bad for Republicans politically if they pass this bill, but it will also be bad for millions of Americans. This is one case where I wish a motherfucker wouldn’t.

Update. I guess I’m too late.

(h/t reader amk)

Trump Hiding Behind A SEAL’s Death: Possibly The Nadir in A Speech Full of Lows

From the Guardian:

In attendance tonight is Carryn Owens, the widow of a US Navy Special Operator, Senior Chief William “Ryan” Owens, who died in a raid in Yemen in January, shortly after Trump’s inauguration…

Carryn Owens is in tears as the Chamber gives her and her late husband a standing ovation.

Trump notes that the clapping just “broke a record” because it went so long.

“Ryan laid down his life for his friends, for his country, and for our freedom –- we will never forget Ryan,” says Trump…

Earlier today:

218 in the House

This is interesting. The Republican strategy right now seems to be a game of chicken run against their own members.

The idea is that there are not 24 House members who fear a general election more than their primary or 3 Senators who have either principles or a legitimate fear of a general election to vote against the leadership. They would try to rush through a reconciliation bill that takes out most of the funding of the ACA, the individual mandate, the employer mandate and perhaps add some type of age adjusted subsidies to replace income related subsidies. The idea is that this bill can pass with 50 Republican Senators and the Vice President voting for it in the Senate.

There is a problem:

Now via CNN:

Republican Rep. Mark Meadows, the chairman of the conservative House Freedom Caucus, told CNN on Monday that he will vote against a draft of the GOP Obamacare repeal bill that was leaked last week….
Meadows said what is unacceptable to him are the refundable tax credits included in the draft of the bill. Those tax credits, the North Carolina congressman said, are nothing short of an “entitlement program.”

The House Freedom Caucus thinks that the 2009 individual market and Medicaid levels are too generous and too nice. A bill without any age adjusted subsidies of any sort is guaranteed to death spiral the individual market instead of only possibly death spiral the market. The House Freedom Caucus is also sufficiently large to deny a majority to the bill. The challenge is that anything that makes the bill more tenable to the House Freedom Caucus makes it much harder for the twenty three Republicans who are in districts that Hillary Clinton won last year and the dozen or so that are in competitive districts to hide the fact that they are killing the individual market.

Getting to 218 could be much harder than I thought as I always placed my hope on assembling a 51 vote blocking coalition in the Senate.

The following map is where rates for a 40 year old non-smoker would be for the cheapest Bronze plan on the market if there is age adjusted subsidies only. These are plans with $7,000 out of pocket limits. The red zones are very expensive plans for very high deductibles and are the points of local constituent pain that can be used to hammer representatives to look out for their own districts.

Let’s tell local stories with good data of the pain that the House Freedom Caucus wants to inflict on us.