The ACA in 2018 and Obama’s 2007 vision

This is worth at least an quasi-ironic chuckle.  The implementation of the Affordable Care Act in 2018 is closer to some elements of the early 2007 campaign version of Obama’s health care vision than the ACA implementation from 2010-2017 was.

Now let’s go look at the tape, from Polifact 2007:

Obama shot back: “Well, let’s talk about health care right now because the fact of the matter is that I do provide universal health care. The only difference between Sen. Clinton’s health care plan and mine is that she thinks the problem for people without health care is that nobody has mandated — forced — them to get health care.”….

One of the few differences is that Clinton and Edwards include a universal mandate….

Obama’s decision not to include a mandate is a more cautious approach, one Obama says is designed not to penalize people with modest incomes. If premiums don’t drop enough after all the reforms are implemented, people will still be unable to afford insurance.

Obama contended during the 2008 primary that the subsidies would be rich enough that no mandate would be needed. And then the desire to hit a particular CBO score came into play as well as a need to not lose a single Democratic senator dictated that subsidies were going to be a lot weaker than the House wanted.

However with Cost Sharing Reduction (CSR) sabotage leading to Silverloading and Gold gapping, subsidies for individuals who make between 100% Federal Poverty Line (FPL) and 400% FPL ($12,020-$48,080) will have become effectively much richer for people who buy plans that cost less than the benchmark.

This is just an irony if seen from a skewed point of view.



Pragmatism and pre-negotiations

In comments to the post on pragmatic evolution of US health policy on Monday, The Question raised a point that I want to respond to:

on health care why do we always have to pre-negotiate with ourselves and have ourselves primed to accept half a loaf? I am so tired of being sensible when there is no gorram reward. If loudly shouting the most extreme thing we want gets us even half what the republicans have gotten out of it why the hell not??

I want to raise an empirical point and then a broader political/policy point that explains my thought process.

First, empirically, what has “shouting the most extreme thing” gotten Republicans?

It has gotten them power.

What have they done with it so far? In 2009, Democrats at this point had a smaller functional majority in the Senate and a slightly larger majority in the House than the Republicans have today. Democrats had passed and signed into law the stimulus, CHIP re-authorization, Lily Ledbetter, and the Dodd-Frank CARD ACT by now.  They were grinding their way through what would become the ACA.

What have the Republicans accomplished as of today? Read more



Living just enough, just enough

What a fucking idiot. The first rule of opposing a livable wage is you don’t call it a livable wage.

During Tuesday night’s debate for an open U.S. House seat in Georgia, Republican candidate Karen Handel said that she does not support a “livable wage.”

I’m not raising money for Ossoff because I think the 30 million spent on the race already is enough but let’s keep raising money for the eventual Democratic nominee in all 238 districts Republicans currently hold. Let’s make the next Democratic majority a 435 seat one.

Goal Thermometer








Make Sure to Save the Date!

Oy vey…

 



Threading the Needle (Updated)

Created with Microsoft Fresh Paint

It’s instructive in a “compare and contrast” sense to read today’s NYT columns from David Brooks and Paul Krugman. Brooks is contemplating the Trumpocalypse and what it all means for professional plutocracy apologists like himself. He warns us to gird ourselves for more Applebees salad bar stories, as Doug points out downstairs, dog help us.

Brooks attributes Trump’s rise — and Sanders’ too — to a broad sense of American decline:

This election — not only the Trump phenomenon but the rise of Bernie Sanders, also — has reminded us how much pain there is in this country. According to a Pew Research poll, 75 percent of Trump voters say that life has gotten worse for people like them over the last half century.

In the morning thread, sharp-eyed commenter Jeffro noticed Brooks’ rhetorical switcheroo there, speaking of Sanders and Trump voters and then citing a poll result exclusive to the Trumpenproletariat, as if Sanders voters share the exact same concerns. And it is a sly form of both-sides-do-it-ism.

Krugman has a different take on why the Trumpites are angry as well as an explanation for why the GOP establishment candidates went down to humiliating defeat while Clinton is prevailing on the Dem side:

Both parties make promises to their bases. But while the Democratic establishment more or less tries to make good on those promises, the Republican establishment has essentially been playing bait-­and-­switch for decades. And voters finally rebelled against the con.

Krugman is right. But Brooks isn’t 100% wrong when he says there is pain on both sides of the political divide, even if he is dishonest in how he frames it. There is real pain out there, and it’s not all attributable to aggrieved white men who are finally getting a taste of the economic insecurity the rest of the world has been swallowing for decades.

Ostensibly middle-class families are one outpatient surgery deductible away from financial catastrophe. Students are graduating with crushing debt. Parents have no idea how they’ll ever retire. The unemployment rate is at a 40-year low, but try finding a decent job if you’re a 50-something woman or a 17-year-old black kid.

These things are real. And what Hillary Clinton is going to have to do is thread that needle – highlighting, protecting and expanding what President Obama and his Democratic predecessors have accomplished on the one hand while at the same time communicating that she understands how much further we have to go. It won’t be an easy task.

Yesterday, Bernie Sanders gave a speech in which he allegedly dialed back the criticism of Hillary Clinton a bit but lambasted the Democratic Party instead:

“The Democratic Party has to reach a fundamental conclusion: Are we on the side of working people or big-­money interests? Do we stand with the elderly, the children, the sick and the poor? Or do we stand with Wall Street speculators and the drug companies and the insurance companies?”

When I heard that, my first thought was, gosh, that’s not particularly helpful. How about at least acknowledging that there’s exactly one party that recently expanded healthcare coverage to 20 million people, passed Medicare, Social Security and CHIP and imposed any regulation at all on Wall Street and Big Pharma? And over the screaming intransigence of the only other party that is relevant in US elections?

But aren’t Sanders’ remarks a perfect segue for Clinton to deliver the message she must communicate? I still think Sanders will come around to endorsing Clinton and urging his supporters to support her and elect the Democratic Congressional majority she’ll need to get shit done. But in the meantime, maybe starting this conversation will do. If Hillary is going to sew it up, it’s time to thread that needle.

ETA: A piping hot new version of Cleek’s pie filter has just come out of the oven. Lay claim to your slice here.



Good news everybody: ACA cost edition

So under budget and on projection for the target uninsured rate even with Chief Justice Roberts enabling sociopaths and assholes to stop Medicaid Expansion in 20 states.

Not bad at all….

UPDATE 1: The next time there is a massive social program passing Congress with uncertain costs, we need to put in mechanisms to take advantage of success instead of safeguards against massive cost overruns. The ACA has triggers where if the total federal cost of the advanced premium tax credit and the cost sharing reduction subsidies were more than .504% of GDP, future year individual shares would increase and the thresholds for federal subsidies would decline.
There were no mechanisms in place to say if subsidies were significant below budget that either subsidies for currently qualified individuals would get richer so their out of pocket premium expense would decline OR more people would become eligible for subsidies.

This is just a note to self to find again in 20 years.



Good news everybody

Just some more good news:

and the good news will probably continue for the first quarter of 2016:

So in 3 years, all of the data sources suggest that we’ve cut the uninsured rate in half and slowed the cost curve. There are another couple percentage points of easy gains once the rest of the Confederacy and the everyone between the Mississippi’s left bank and the Columbia’s south bank expand Medicaid.

Then we’ll actually need to take another whack to get the last 5% of the population covered AND get better coverage for 25% to 30% of the currently covered population.