Trump’s EO on the ACA

The Trump administration issued its first executive order. The subject is the ACA. The order seeks to destabilize the non-subsidized and off-Exchange portions of the risk pool by minimizing enforcement of the individual mandate.  Dan Diamond at Politico had the first link to the actual order that I saw:

Section 2 is the critical component for the individual market. Section 3 has significant impact for both Exchanges and Medicaid.

Analysis below the fold:
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Pessimism Index update

I have moved from 70% pessimism to 80% pessimism given the fast Senate and House vote to kick off reconciliation and a few other things that I’ve heard that the plan really is to jump off a cliff and weave a parachute out of pubic hair and pocket lint on the way down.



Friday Morning Open Thread: Beginning of the Downfall Arc?

Allow me an old person’s whimsy. The notorious Watergate burglary took place in June 1972; its instigators were indicted in September, but its beneficiary — Richard Nixon — was nevertheless reelected in November. Televised hearings of the Senate Watergate Committee didn’t begin until June 1973. The impeachment hearings began in May 1974, yet Nixon didn’t officially resign until August 9, 1974.

That was in an age before 24/7 cable news, much less social media.

Alex Pareene, at Deadspin, yesterday — “Republicans Have No Good Reason Not To Impeach Donald Trump“:

It’s been fun, but it’s about time for Republicans to admit that the great Donald Trump experiment isn’t going to work out—for them.

One hypothetical version of President Trump—the ideal version, for Republicans, and one that many convinced themselves he would become, given practice and training—is a new Reagan: a mouthpiece for the ideas and policies inserted into his empty head by members of an ascendant conservative movement riding his television-mastery to power. Surround this version of Trump with good party men like Reince Priebus and Mike Pence, and he takes care of entertaining the masses—and distracting the opposition—while true-believing conservatives actually run the country, enacting their entire agenda too forcefully and quickly for anyone to effectively fight them…

Another version of Trump—the nightmare for liberals and not one conservatives would welcome either—could be a second Nixon, with no real political philosophy, but a willingness to do anything to maintain his grip on power. Not just through unethical and criminal means, like the Watergate break-in or the sabotage of the Vietnam peace talks, but also in his willingness to do decidedly un-conservative things if they’d benefit him politically—like the wage and price controls he implemented, to great popular acclaim, in 1971. This is the model Steve Bannon likely hopes to emulate.

But Trump will fail to be either, and by now Republicans should recognize this. He’s too impetuous and narcissistic to be Reagan, and not smart enough to be Nixon. Half of his advisers will attempt to use him as a pitchman for conservative policy, the other half will attempt to use him to create and sustain a white nationalist international coalition, and he will instead tweet for hours about which celebrity slighted him this week. Trump will reject conservative ideas if he believes they will not be popular, but if Trump attempts to cynically abandon conservatism to maintain popularity, he will find that he has no clue how to go about doing actually popular things.

The end result won’t work for anyone. Successful corrupt right-wing populists generally tend to actually deliver tangible things to their bases of support. Trump will be unable to do this, and the Republican Party is too tied to its dead philosophy to help him. Ethno-nationalism needs welfare chauvinism to flourish, but today’s GOP might actually be too opposed to all forms of welfare (for the non-rich) to ensure their own political success….

If Republicans were smart—if they were a rational political party able to act in their own best interests—they’d impeach Trump as soon as possible. His bizarre performance today, and his brazenly inadequate response to the many very obvious conflicts of interest and opportunities for corrupt dealings that his administration will invite, give Republicans a perfectly acceptable rationale to do so. They can say it is for the good of the country, but the truth is that it would be for the good of the Republican Party and the conservative movement…

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Apart from such happy fantasies — not to mention awaiting the usual Friday Doc Dump — what’s on the agenda as we wrap up the week?



Late Night Bad-Craziness-in-the-Hall-of-Mirrors Open Thread

Not only weirder than we imagine, but weirder than we can imagine…

Steele was initially hired by FusionGPS, a Washington-based political research firm, to investigate Trump on behalf of unidentified Republicans who wanted to stop Trump’s bid for the party’s nomination. The BBC said on Wednesday, “He (Steele) was compiling this report on behalf of initially Trump’s opponent Jeb Bush,” referring to one of Trump’s 16 opponents in the 2016 Republican primary.

The BBC subsequently said on Thursday that its correspondent misspoke…

And JEB! decided to drop the issue because… the confidence that it would leak without his interference? A familial unwillingness to draw attention to The Craft? The old-WASP distaste for open talk about ‘bedroom matters’?

… Steele was kept on assignment by FusionGPS after Trump won the nomination and his information was circulated to Democratic Party figures and members of the media…

Who no doubt assumed, correctly, that if any Democrat brought it up, the Very Serious Media Villagers would’ve been calling for the whole party to be banned from the ballot.

Steele’s dealings with the FBI on Trump, initially with the senior agent who had started the FIFA probe and then moved to a post in Europe, began in July. However, Steele cut off contact with the FBI about a month before the Nov. 8 election because he was frustrated by the bureau’s slow progress.

The FBI opened preliminary investigations into Trump and his entourage’s dealings with Russians that were based in part on Steele’s reports, according to people familiar with the inquiries.

However, they said the bureau shifted into low gear in the weeks before the election to avoid interfering in the vote…

Unless such interference could kneecap the Hell-Beast Hillary, of course.

Ah, well, hope springs eternal…



Dreaming of impossible dreams and guaranteed disappointment

The Wall Street Journal has a good quote on what Americans say they want for healthcare and what has to happen for that to happen:

Cheap insurance means either very little gets covered or the people who need a lot of coverage can’t get insured. Covering sick people means either massive subsidies (public or private) from the healthy to the sick and restricting the size of those subsidies means limiting choices.  Democrats got hammered for choosing to cover sick people via either Medicaid expansion or through subsidized private sector insurance with a coercive participation mechanism.  Republicans will get hammered for telling people to go die quietly in the corner and here’s a tax deduction that only matters if you’re healthy and wealthy.

This is the core problem of health policy.  There are no pure win-win solutions for the healthy and the sick at the same time.



Evidence based care in Medicaid

We want to do evidence based care.  We want to do things that work and avoid things that don’t work.  This sounds simple.  Let’s look at two very good natural experiments on unintended pregnancy rates:

Colorado:

    Since 2008, Colorado has successfully increased access to family planning services throughout the state, particularly for the most effective contraceptive methods, such as intrauterine devices (IUDs) and implants.

  • The Colorado Family Planning Initiative has increased health care provider education and training and reduced costs for more expensive contraceptive options, enabling more than 30,000 women in the state to choose long-acting reversible contraception….
  • When contraception, particularly the long-acting methods, became more readily available in Colorado between 2009 and 2013, the abortion rate fell 42 percent among all women ages 15 to 19 and 18 percent among women ages 20 to 24.
  • Colorado is a national leader in the use of long-acting reversible contraception, and reducing teen pregnancy and repeat pregnancies.

    • Teen birth rates in our state have declined more rapidly than in any other state or the nation as a whole.
  • The birth rate for Medicaid-eligible women ages 15 to 24 dropped sharply from 2010 to 2012, resulting in an estimated $49 million to $111 million avoided expenses in Medicaid birth-related costs alone.

More reliable and effective contraception was made available to Colorado women who had the choice to elect Long Acting Reverisble Contraception (LARC) or do something else.  A significant number of women elected to use LARC and the increased autonomy and reliability produced amazingly good results.

Texas

 

Reducing contraceptive availability led to higher abortion rates and higher unplanned pregnancies. Earlier live births have massively negative multi-generational repercussions for both the parents and kids.

The evidence strong suggests that significant improvements in quality of life can be made and significant expenditures reduced if contraception is made readily available.

And guess what Congress will consider to be a high priority:

House Speaker Paul Ryan announced Thursday that Republicans will move to strip all federal funding for Planned Parenthood as part of the process they are using early this year to dismantle Obamacare.

Wahoo… the evidence will strongly support the hypothesis that this policy will lead to more unintended pregnancies, more abortions and far worse outcomes for far more Americans.

Evidence based policy making — Hoo Yaa



What about the children

From McClatchy we sit a clear trade-off between making sure kids are healthy and able to contribute to a bright future or high income tax cuts:

4.4 million children could lose health coverage in 2019 if the Affordable Care Act is partially repealed through the budget reconciliation process, according new report by the Urban Institute, a progressive, non-partisan think tank.

Likewise, the uninsured rate for … children would more than double in 2019 from … from 4.1 percent to 9.6 percent for children under age 18, the report found…

Of the 4.4 million children who would lose coverage in 2019, 88 percent would have working parents

The previous ACA repeal bill also allowed states to lower child eligibility levels for Medicaid and the Children’s Health Insurance Program (CHIP) beginning in 2017. If all states did so, another 8.9 million children would be without coverage in 2019

So we’re looking at between 4 and 13 million children being sacrificed to the altars of Moloch.

Good to know.

And we call ourselves civilized.