Newsworthy Items That Have Slipped Through the Cracks: We’re Doomed

I don’t mean to panic anyone, but the US breached the debt ceiling on March 16th and the current extension on the Fiscal Year 2017 continuing budget resolution runs out on April 28th. Given the dysfunction within the majority caucuses in the House and the Senate, the fact that the new Administration’s skinny budget has been declared DOA upon its arrival in Congress, and the fact that NO ONE ANYWHERE – INCLUDING THE WHITE HOUSE, CONGRESS, MOST OF THE NEWS MEDIA, AND APPARENTLY MOST AMERICANS!!!!!!! – seems to be paying any attention or talking about this, perhaps we should be just a wee bit concerned.

Have a nice evening!



ACHA EHB CBO state of play

Right now there are three primary possibilities for the ACHA tomorrow:

1) No vote is taken as more wrangling and tweaking occurs
2) Vote fails as the combination of Tuesday Morning Group Republicans and the House Freedom Caucus vote against the bill from both ends of the Republican caucus. This is where we were most likely to have been at at 1800 EST on March 22, 2017
3) ACHA advances as the House Freedom Caucus gets a major policy concession, the elimination of Essential Health Benefit requirements.

#3 is what I want to discuss. It would produce a massive cluster. The bill needs to go through the Senate as a reconciliation bill with several significant requirements. One of those requirements is the items are germane to the budget. Since the other parts of the bill have stripped the link between premiums and subsidies, lower premiums are not germane to the budget. It will get stripped.

More importantly, the optics will look ugly. The Congressional Budget Office

If there were no clear definition of what type of insurance product people could use their tax credit to purchase, some of those insurance products would probably not provide enough financial protection against high medical costs to meet the broad definition of coverage that CBO and JCT have typically used in the past—that is, a comprehensive major medical policy that, at a minimum, covers high-cost medical events and various services, including those provided by physicians and hospitals.

IF Essential Health Benefits are dropped from the bill, the CBO will project that insurers will respond by offering very skinny benefit packages (no maternity or substance abuse inpatient services for instance as both qualify as high cost events) that are targeted to be priced at precisely the subsidy value. If there is no regulation as to what a carrier needs to include with a given maximum out of pocket requirement, two things will happen. A lot of people who otherwise would not use their subsidy would use their subsidy. And most people who are buying mostly on price will be buying policies that the CBO does not deem to be insurance.

Jed Graham has been bird-dogging this angle hard:

Because the GOP bill would mostly retain ObamaCare coverage rules, insurance would be unaffordable for lower-income and older adults with the new, smaller tax credits on offer, so some 30 million people wouldn’t claim the GOP tax credit averaging $3,000 in 2020 and rising with inflation. That would add up to more than $600 billion in unclaimed subsidies through 2026, or roughly the same $600 billion amount by which House Speaker Paul Ryan’s plan cuts taxes. Those unspent subsidies go a long way to explaining why CBO found that the American Health Care Act would reduce deficits by $323 billion over a decade.

So the end result if Title 1 is the price of passage is the following:

  • Guarantee failure in the Senate
  • Adds to the deficit immediately
  • Adds millions more people to the ranks of the uninsured as defined by the CBO over and above the 24 million that is the current score

/Dave Anderson +3

Update 1:
And it looks like Option #3 is on the table

 

Update 2

Dave +3.5



We’re Gonna Party Like It’s 1899

Mind boggling legislation in WV:

State safety inspectors wouldn’t inspect West Virginia’s coal mines anymore. They would conduct “compliance visits and education.”

Violations of health and safety standards wouldn’t produce state citations and fines, either. Mine operators would receive “compliance assistance visit notices.”

And West Virginia regulators wouldn’t have authority to write safety and health regulations. Instead, they could only “adopt policies … [for] improving compliance assistance” in the state’s mines.

Those and other significant changes in a new industry- backed bill would produce a wholesale elimination of most enforcement of longstanding laws and rules put in place over many years — as a result of hundreds of deaths — to protect the health and safety of West Virginia’s coal miners.

And if there was any doubt this was basically written by the mining companies, check out this nugget:

One thing that is clear is that the bill would maintain and encourage the use of “individual personal assessments,” which target specific mine employees — rather than mine operators or coal companies — for violations, fines and, possibly, revocation of certifications or licenses needed to work in the industry. In addition, the requirement for four inspections every year for each underground coal mine would be reduced to one compliance assistance visit for each of those mines.

And, the bill would require that, by Aug. 31, the state rewrite all of its coal mine safety standards so that, instead of longstanding and separate state rules, mine operators would be responsible for following only U.S. Mine Safety and Health Administration regulations. The list of areas covered by this provision includes electrical standards, mine ventilation, roof control, safety examinations, dust control and explosives.

“It completely guts the state law,” said Josh Roberts, international health and safety director for the United Mine Workers union. “You’re taking back decades of laws.”

Basically, they saw what happened to Don Blankenship, shitlord CEO who oversaw the Upper Big Branch mine explosion in 2010 that killed 29 workers. Blankenship was given a ridiculously low prison sentence of one year for basically threatening employees to violate safety standards or lose their jobs. Mine operators saw that one year as terrifying, so now they are working to make sure that only the patsy’s get in trouble.

THIS. IS. FUCKING. INSANE.



Bronze is a great age

I want to look at one element of the CBO score. It is the offered actuarial value of plans. Under the House Bill, out of pocket maximums would be fixed but there would be no age banding. The CBO sees this having an interestingly low effect.

Beginning in 2020, the legislation would repeal those requirements, potentially allowing plans to have an actuarial value below 60 percent. However, plans would still be required to cover 10 categories of health benefits that are defined as “essential” under current law, and the total annual out-of-pocket costs for an enrollee would remain capped. In CBO and JCT’s estimation, complying with those two requirements would significantly limit the ability of insurers to design plans with an actuarial value much below 60 percent.

Mechanically, under the House bill without a follow-on phase 2 or phase 3 bill, insurers can probably design plans that have at least 55% actuarial value (AV) coverage as the minimum level of coverage. Bronze right now is 60% +/-2 points of AV.

It will be very hard for people to buy a non-Bronze plan because insurers won’t offer them except at exorbirant prices. Let’s work through my logic.

Insurers are currently required to offer at least one Silver and one Gold plan if they want to sell on Exchange. Those plans are age rated at 3:1 with subsidies absorbing almost all of the local price increase risk for the Silver plan. Under the AHCA, those requirements are not in place and the subsidy is not tied to local pricing. Young buyers who are healthy will either opt out or buy the lowest actuarial value coverage possible because it will cost them very little.

Insurers then have to look at the people who actually need coverage and cost money to cover. They’ll offer a Bronze plan to get the young people in. But if they see a 58 year old asking for a Silver or Gold plan, they know that this person is going to be hyper expensive to cover as they have just self-identified as being high risk and high expense. Insurers won’t offer actuarial value levels above the minimum requirements because they will lose money on those policies.

So we will quickly see a proliferation of $6,000 to $9,000 deductible plans and very little else. That means the 64 year old who is seeing a $10,000 a year premium increase will also see their deductibles increase by $4,000 to $7,000 a year.



Lazy Fucking Moocher Fetuses

Party of life, my ass:

WHEN REPUBLICAN CONGRESSMAN John Shimkus expressed outrage during a House committee hearing Wednesday “about men having to purchase prenatal care” in their health insurance — the video clip of which caught fire on social media as an example of misogyny and cluelessness — he wasn’t going rogue. He was just getting ahead of party leaders, who haven’t publicly announced their next steps quite yet.

In a conference call with GOP allies on Thursday, however, House Republican Conference chair Cathy McMorris Rodgers outlined the party’s “three-phase approach” to repealing the Affordable Care Act and suggested that the Essential Benefits Package, a provision of the law with sweeping consumer protections, could soon be on the chopping block. The benefits package, a core provision of the ACA, requires qualifying health insurance plans to cover a set of medical treatments, including pregnancy-related medical care.

The conference call was for other Republican House members and state leaders from the American Legislative Exchange Council, an influential conservative advocacy group that brings lawmakers and lobbyists together to form policy solutions. It was obtained by The Intercept and the Center for Media and Democracy.

***

The insurance industry aggressively fought against the required coverage rules. Insurance giants UnitedHealth Group, Anthem Inc., and Aetna have lobbied policymakers for years on the Essential Benefits Package, records show. America’s Health Insurance Plans, the trade group representing much of the industry, has also bitterly complained about the consumer mandate.

This happened Friday:

America’s second-largest health insurer voiced its support for the ObamaCare repeal and replacement bill proposed by GOP House leaders in a letter to lawmakers this week.

Anthem is urging lawmakers to launch the ObamaCare repeal process “as quickly as possible,” Politico reported Friday.

“[It] addresses the challenges immediately facing the individual market and will ensure more affordable health plan choices for consumers in the short term,” Anthem CEO Joseph Swedish wrote to the chairmen of the House Energy and Commerce and Ways and Means committees Thursday, the same day both panels advanced the repeal legislation.

“These provisions are essential and must be finalized quickly to have the intended impact on products and prices to benefit consumers,” he added, citing the bill’s repeal of ObamaCare’s health insurance tax, tax credits for customers off the ObamaCare exchanges and temporarily keeping the law’s cost-sharing subsidies.

Anthem, which is the largest insurer in the ObamaCare exchanges, said it was formulating rates and making decisions for 2018.

It’s all about the benjamins:

Health insurer Anthem Inc. on Wednesday posted a decrease in profits amid a rise in medical costs.

The company said it now expects revenue for 2016 to be about $83.5 billion, compared with its earlier estimate of between $82.5 billion and $83.5 billion. It expects adjusted earnings per share to be about $10.80 per share; it previously forecast earnings of “greater than” $10.80 per share.

Shares of Anthem slid 0.6% to $116.78 in premarket trading.

In the latest quarter, total medical enrollment grew 3.1% from to 39.9 million. Enrollment in its commercial and specialty business increased 2.2% from a year earlier to 30.5 million members, while members in its government business grew 6.2% to 9.4 million.

In all, the company posted a profit of $617.8 million, or $2.30 a share, down from $654.8 million, or $2.43 a share, a year earlier. On an adjusted basis, earnings fell to $2.45 from $2.73. Revenue climbed 7.5% to $21.4 billion.

A half a billion in profits just ain’t enough, especially when you got mouths to feed:

As Chair, President and Chief Executive Officer at ANTHEM INC, Joseph R. Swedish made $13,604,681 in total compensation. Of this total $1,298,077 was received as a salary, $1,668,678 was received as a bonus, $2,599,957 was received in stock options, $7,800,073 was awarded as stock and $237,896 came from other types of compensation. This information is according to proxy statements filed for the 2015 fiscal year.

Those lazy fucking fetuses should pull themselves up by their bootstraps.



The Invisible Fist

Yesterday, we had a storm in Rochester with 81 MPH gusts. Since our power grid is shit (lots of wires above ground, lots of trees), about 100,000 of the 300,000 or so households here lost power. Our local utility is working hard, but it will be 10 degrees tomorrow night and probably 25-50K households won’t have heat. I have a generator so I have (gas) heat and my food won’t spoil, but I do not have cable Internet. I know that sounds like the ultimate first world problem, but bear with me for a second.

In the past 15-20 years, cable companies have been selling packages that include TV, Internet and telephone. A lot of people purchased those packages, and tonight every single one of them in an area without power is also without a telephone. Even if you have a generator, you don’t have a phone if your phone provider is the cable company. We’re about 30 hours into this outage, so many of the housebound elderly and disabled don’t have much charge left on their cell phones. They’re huddled up under a blanket with no way to call for help, if they bought a cable package with a phone.

I still have a land line and an old-fashioned telephone. It’s working because our legacy telephone infrastructure is subject to the worst imaginable limitation on freedom: government regulation. The cable companies are much less regulated than the phone company, even though they have the same right to string wires on poles (as well as other monopoly rights) as the phone companies.

Over the years, cable companies have slowly but surely vacuumed money out of our wallets without providing quality service. TV bundling forces us to buy channels we don’t want. The speed of our cable Internet is a joke compared to other developed countries, and cable providers don’t deploy the latest technology unless thy are under competitive pressure from providers like Google. And they’re allowed to replace a far more reliable telephone service with one that is flaky at best, and dangerous at worst. This might seem like a minor issue in the days of Trump, but it is one that crosses class, race and gender. Everyone fucking hates the cable company. I’d love to see Democrats make this a signature issue. I get that there are a lot more important things in life, but I’ll bet that we’d get a bunch of votes from otherwise uninterested voters if we become enemies of these greedy bastards.



The Common Inheritance, The Common Defense

A bit of self promotion here, but I’ve got a piece in today’s Boston Globe that might be of interest to some here.

It’s a look at what the idea of the commons — not just the abstract, model commons of Garrett Hardin’s famous essay, but the historical commons as actually lived and used — can tell us about current problems.  The TL:DR is that commons are not inherently prone to tragedy, but that the preservation of communal goods requires…wait for it…communal action: regulation, self-regulation.

This is, of course, exactly what the Republican Party denies — more, loathes and condemns.  With Trump, they’re getting their way, but its vital to remember that the consequences that will flow from these decisions are not down to him, or simply so: the entire Republican power structure is eager to do this, and when we pay the price, we must remember who ran up the bill.

Anyway, here’s a taste from my piece.  Head on over to the Globe’s site if you want more.

The idea of the commons is deeply woven through the history of the English countryside. Shakespeare captured this idyllic approach to nature’s wealth in “As You Like It,” when the shepherd Corin explains to the cynic Touchstone the joys of his life. “I earn that I eat, get that I wear,” he says, adding that “the greatest of my pride is to see my ewes graze and my lambs suck” — in the unowned, readily shared Forest of Arden.

There can be trouble in such an Eden, as Hardin pointed out in an influential 1968 paper. Hardin asked what would happen if access to a commons were truly unfettered — if Corin and every other villager ran as many sheep as they could there. In such cases, Hardin argued, the endgame is obvious: Too many animals would eat too much fodder, leaving the ground bare, unable to support any livestock at all.

The evolution of resistance to antibiotics fits that story perfectly. The first modern bacteria-killing drug, penicillin, came into widespread use in 1944, as American laboratories raced to produce millions of doses in time for D-Day. The next year, its discoverer, Alexander Fleming, used his Nobel Prize lecture to describe precisely how this wonder drug could lose its power, telling the sad tale of a man who came down with a strep infection. In his tale, Mr. X didn’t finish his course of penicillin, and his surviving microbes, now “educated” (Fleming’s term), infected his wife. When her course of penicillin failed to eradicate these now-resistant microbes, Mrs. X died — killed, Fleming said, by her husband’s carelessness. It took just one more year for this fable to turn into fact: In 1946, four American soldiers came down with drug-resistant gonorrhea, the first such resistance on record.

 

Go on — check it out.  You want to hear about the great Charnwood Forest rabbit riot.  You know you do…

Image: Jacopo da Ponte, Sheep and Lambc. 1650.