A BFD that passed amongst the chaos

In most strands of the multi-verse, the below would have sent the health wonk community ablaze. Instead in this strand, we spent all day yesterday talking about a proposed rule from CMS and generally shaking our head as our government continues to say “Hold my beer and watch this….”

But this is normally a BFD:

What does this mean?

Repeal and Replace or Repeal and Delay and Pray is dead. There is no coherent coalition of 218 and 51. The Republican Senate caucus can afford to lose two votes (assuming Democrats are healthy and have everyone show up). The 2016 ACA Repeal bill defunded Planned Parenthood and knocked out Medicaid Expansion. Either of those elements will cost the Republicans at least two votes. Combined, those two provisions probably cost the Republicans six to ten votes. That is a blocking coalition when combined with Democrats.

In the House, Speaker Ryan would like to pass anything with only Republican votes in order to not be hung out to dry like former Speaker Boehner (remember he has tough votes on the debt ceiling coming up). That means he needs 90% of his caucus on board with anything. The Republican House Freedom Caucus has enough members to deny Ryan a Republican only majority. The HFC is demanding a word for word replica of the 2016 bill.

This is a Big Biden Deal as the status quo bias works in our favor for the avalanche approach that I feared in November can’t get started. Long, boring committee meetings, calls to the CBO, wonks ripping apart a plan to help advocates find very sympathetic people to tell true stories with high emotional punch is where we’re going for anything more complicated than a technical correction bill or rebranding.



Thursday Morning Open Thread: Brown Bag Democracy

More immediately, the Resistance targets the expense-account demographic…

Doggedly painstaking NYTimes explainer:

The campaign, spread on social media and messaging apps, has called for a “day without immigrants.” It asks foreign-born people nationwide, regardless of legal status, not to go to work or go shopping in a demonstration of the importance of their labor and consumer spending to the United States’ economy.

Activists and groups in cities across the country have picked up the call, reposting fliers found online, and in some cases organizing demonstrations to coincide with the event. Several activists said that they did not know how the campaign began or how many people would heed it, and that as far as they knew, there was no national organization behind it.

But the dining scene in Washington, where the new Trump administration is taking a hard line on immigration and deportation, took notice. At least a few dozen restaurants in and around the Beltway have committed to staying closed on Thursday. Others have said they would offer limited service in the expectation that many of their employees would be out for the day. Some restaurants in other cities, including several of the Blue Ribbon restaurants in New York, have joined in…

Hey, when it was just lobbyists schmoozing backbenchers down in The Swamp, cute little joke. But if it inconveniences the important Media People and financiers in the Big Apple, well…

Actually, I expect a spate of mean-girl posts tattling on colleagues who Just Can’t (make their own lunches). Betting on Maureen Dowd to be first into pixels, since she doesn’t seem like she consumes many calories in solid form.
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What’s on the agenda as we slog through this interminable week?



Is this lump out of my head? I think so

I don’t have any particular suggestions of activist things to do today, so I’ll let people leave suggestions.

In the interest of encouraging everyone to be more militant, I’ll relay a story. I was talking with a moderately totebaggerish friend of mine (he works in finance but has totebagger tendencies) and he was feeding me the line that, although he voted for Hillary, he hated having to do choose between a crook (Hillary) and a lunatic (Trump). I’m sure that he, and many people who think this way, get those kinds of ideas by reading MoDo and Bobo and Frank Bruni and the rest. There’s no other way to put it: centrist punditry rots your brain. I used to like to read that stuff to get a sense of how people were thinking, and I still do occasionally hate read it in limited doses. But it does represent a some kind of propaganda state that many people live in, no different from North Korea in its own way. It took me a while — probably a couple years — to get that crap out of my brain once and for all.



4.29% enrollment loss is the cost of Trump’s First Day EO

I’ve been playing a bit more with the 2016 and 2017 QHP data in an attempt to figure out the incremental cost of the Trump Executive order.  I think 4.25% is a good lower estimate.

My data is still here:

Data and Methods

I again excluded Kentucky and Louisiana.  Kentucky was switching from Kynect to Healthcare.gov while Louisiana had a mid-year Medicaid expansion.  I wanted to isolate the effect of the executive order from whatever the general trend in enrollment was.  I used the CMS enrollment snapshot for 2016 and 2017 that contained January 14th.  2016 was goes through January 16 while 2017 only goes through January 14th.  The 2016 report contains two extra days worth of data and more importantly, 2016 contains a deadline day as people who buy coverage by the 15th would see their policy start on February 1st.  We know deadlines spur enrollment.

CMS recognized this problem:

More than 8.8 million Americans were signed up for 2017 coverage through HealthCare.gov as of January 14, 2017. This compares to about 8.7 million sign-ups as of January 14 last year, as Americans continue to demonstrate strong demand for 2017 Marketplace coverage.

So on the 14th of each year, 2017 was running slightly ahead of 2016.  My data due to timing constraints will show 2016 running slightly ahead of 2017.   This is fine as the known flaw in the data favors the argument that the executive order had no impact.

So the question is what was the deviation from 1/15 to 1/31? If the Executive Order and the dropping of advertising and potentially elite knowledge networks disseminating anti-enrollment messaging or more likely fear, uncertainty and doubt about PPACA being a good play?

Analysis and Conclusion

2017 using my known flawed data was running .96% behind 2016 on the January 14th inclusive update.  2017 ended up running 5.25% behind 2016 on Healthcare.gov states.  The increment (using favorable to the null hypothesis data) slowdown in pace that can be attributed to Trump Administration actions is 5.25-.96 or 4.29% of enrollment was lost due to the executive order and other Trump administration actions such as shutting down some outreach and advertising in the last eleven days of enrollment.

4.29% is a minimal level of enrollment loss.  Using the January 14th pace, 2017 was running 1.1% ahead of 2016.  Charles Gaba is collecting data from the state based exchanges.  The state based exchanges ran their own marketing campaigns that did not get shut off on 1/20/17.  He is showing at least a 1.5% enrollment increase.  So more aggressive baselines can credibly argue that the Trump Administration actively discouraged 6% of the market from signing up.

Finally, here are some charts that I had fun creating as I worked through this problem.



Keep ya head up

What bullshit:

Democrats don’t know how long they’ll be able to keep up the pace of protests against President Donald Trump — and they’re worried Trump and his team are counting on them to run out of energy before the White House does.

Two weeks into the Trump administration, party leaders have already reached a frantic, fevered pitch, throwing around talk of constitutional crisis and raising the specter of impeachment.

“The thing that we don’t want to do is anesthetize the public with dozens and dozens of press conferences and marquee events,” said Seattle Mayor Ed Murray. “Then it’ll just become background noise. I’m worried that’s exactly what they’re trying to maneuver us into doing.”

Look, we can do the time. We can keep it up for years. We can keep it up for eight if necessary. And personally, I’m going to love every minute of it. I’m sad that Trump is doing so much damage to people’s lives and to the future of the country, but what can we do except fight back and have as much fun as we can doing it.

I’m tired of hearing about outrage fatigue. Fuck fatigue! Fatigue only hurts, it never helps. You fight through that shit. Cause fours year from now, when Kirsten Gillibrand is kicking it in the White House…

Here’s what’s going on in my local supermarket.



Wanna be starting something

This is how you take back the House:

Democrats are moving urgently to harness the wave of grass-roots protests that have greeted President Trump in his first weeks in office to reclaim the House majority in next year’s midterm elections.

As of this week, the Democratic Congressional Campaign Committee is hiring full-time operatives to do political organizing work in 20 key Republican-held districts — an unusually early investment in House races that do not even have declared candidates yet.

I’m not a big fan of how the DCCC and DNC usually do things. They blow a lot of money on ads that don’t accomplish anything. Putting operatives on the ground early *does* accomplish something. Kudos to the DCCC.

I’m giving them $50 a month as long as they keep this up.








Call Congress (and see results)

If you’re happy and you know it —- Call Congress
If you’re scared and you know it — Call Congress
If you’re mad and you know it — Call Congress

Keep up the calls. Call about what you are passionate about, call about what you care about. Call about what you can.

And see results:

As you’re calling Democrats who are in tough Districts (Senate Heitkamp is in a Trump +30 state) tell their staffers thank you. Tell them you appreciate that their boss is going out on the limb for our vision and values of America. The staffer answering the phone has no power and is getting deluged right now. Be nice and then register your opinion.

We’re getting results, so keep calling