Is Trump Lying About His Bankroll Size, Too?

Well, the reactions to this analysis should be interesting. The Wall Street Journal goes there — “As Trump moves to raise big sums, an estimate of his 2016 income shows it short of the big money needed for general election run”:

… When his campaign began last summer, a financial disclosure Mr. Trump filed said he had between about $78 million and $232 million in cash and relatively liquid assets such as stocks and bonds.

That would go fast if Mr. Trump spent an amount close to the $721 million President Barack Obama spent in 2012 up to Election Day, or the $449 million Mitt Romney spent in the same stretch.

This would leave hundreds of millions to be made up. And Mr. Trump’s businesses don’t produce that much in a year, a Wall Street Journal analysis shows. His 2016 pretax income, according to the analysis, is likely to be around $160 million.

The Journal analysis is based on 170 items of “employment assets and income,” such as real estate, golf courses, management companies and licensing deals, listed in the financial disclosure form Mr. Trump filed last July. The Journal estimated how much pretax income each item should yield this year, relying on public documents and interviews with dozens of former and current Trump Organization executives and people who are familiar with his businesses.

In the absence of Mr. Trump’s tax returns, which he has declined to release, the analysis helps answer a question many wonder about: just how much the candidate earns…

The cash issue looms now because the political season is growing more expensive. The Trump campaign spent about 50% more in March than in February, facing higher expenses for field workers, telemarketing and voter-data operations.

Mr. Trump noted that once the general election campaign begins, the Republican National Committee will be spending heavily on his behalf. The RNC spent $386 million during the 2012 presidential campaign. A clutch of other entities such as political-action committees spent $419 million to back Mr. Romney.

This year, officials at some big Republican PACs are saying they are going to turn their funds toward keeping the Senate and House in the Republican hands, meaning their support for Mr. Trump could be diminished.

On the other hand, legal changes since 2012 make it possible for political parties to raise larger individual donations, via joint fundraising committees with their presidential candidates. Such a joint fundraising committee is what Mr. Trump said in early May that he planned to set up with the Republican Party…

And aren’t the Permanent Repub Party bigwigs with their hands on the purse strings — not to mention the ones required to fill that purse — going to enjoy giving the short-fingered vulgarian their money to waste on futilely challenging Hillary Clinton?

The whole article (I found it by Googling its title) is replete with the sort of details that will fascinate wonks, but it reinforces what non-Trump-partisan observers have been saying since Deadbeat Donald first rode that gilded escalator to announce his run: While $160 million (more or less) would be a more-than-satisfactory income to you or me or most normal human beings, it’s nowhere near enough to qualify Trump for “Really Rich Person” status. Assuming he started this shitshow in the first place to enhance his brand/salve his Obama-wounded feelings/bigly assert his yoooge hand size, the media response to this it will not be fun for him. Watching his noisy rage should provide some tasty schadenfreude for the rest of us, though!



Not observing games

PPACA has been attempting to bend the cost curve by penalizing stupid and avoidable errors.  One class of errors that has been amenable to reduction has been Medicare beneficiaries getting  re-admitted to hospitals  after their initial admission for a set of circumstances.  As soon as data started to be collected and before penalties started to be imposed, the readmission rate crashed.  Since penalties have been imposed, the rate is still going down but at a slower pace.  This does two things to the cost curve.  First, it reduces direct Medicare expenses as Medicare is not paying for another hospital day.  Secondly, changes in practices and procedures that result in lower Medicare readmission rates tend to diffuse throughout a hospital and all of its patients so people who are not covered by Medicare also benefit from the improvement in practice.

This sounds great.  We save money, save Grandma as hospitals are where old people die, and get better quality care.

However, wonks have worried that any quality measure that has real money attached to it can and will be gamed.

The easiest way to game a re-admission measure is to redefine admissions.  Hospitals have the ability to put people on “observation” status where to anyone but the billing and quality metrics department, the person looks like they are admitted.  They get the uncomfortably flimsy robe, they get the wrist band, they get poked and prodded and monitored just like an admitted patient.  They can stay in observation status for a time period including one midnight.  Yet these individuals are not part of the “admitted” or “re-admitted” population universes.

There was a possibility that a significant chunk of the seemingly great decline in readmission rates was really a bureaucratic shift of people getting moved from short term admissions to observation status.

That is not the case.

The New England Journal of Medicine  * has an interesting study on this matter:

Read more



Open Thread: Antonin Scalia, Still Roiling the Political Waters

scalia mcconnell vs voters morin

(Jim Morin via GoComics.com)
.

From the Washington Post, “Battle over Scalia’s replacement already spilling into Senate races”:

… One consideration that may force Republicans to recalibrate their strategy is the prospect of political damage to some of the embattled Senate incumbents up for reelection this fall. Sens. Kelly Ayotte (N.H.), Ron Johnson (Wis.) and Rob Portman (Ohio), all Republicans in swing states, have called for the Senate to disregard any Obama nominee. Other Republicans in tight races have remained silent so far…

Americans United for Change, a group closely allied with the White House, is trumpeting an article written by now-Senate Majority Leader Mitch McConnell (R-Ky.) in 1970. McConnell wrote that “the Senate should discount the philosophy of the nominee” and that “the president is presumably elected by the people to carry out a program and altering the ideological direction of the Supreme Court would seem to be a perfectly legitimate part of a presidential platform.”

Gawker has collected a potpourri of “The [Scalia Murder] Conspiracy Theories, Explained” — ranging from the obvious (President Obama’s minions) to the tabloid (recalling Nelson Rockefeller) to the… well, that chupacabra tweet was probably tongue-in-cheek. I hope.

Things I did not know: Michael Dukakis was Scalia’s law school classmate. Man was a revanchist pest, even then…

… I didn’t know who Scalia was until the last semester of my last year, when I took a class called Federal Courts and the Federal System, with a great man named Henry Hart. It is 1960. We are in the middle of the civil rights revolution. And there’s this guy in class who begins engaging Professor Hart every day in these long dialogues over whether it was appropriate for federal judges to reach in and take cases away from Southern criminal courts, in cases where, as everyone knew, if you were a black defendant, forget it. And this went on for about three weeks. [Laughs.] I finally turned to the guy next to me and said, “Who the hell is that guy.” He said, “That’s Scalia, he’s on the law review.” And I said, “Does he know what it’s like to be black in the South?” A bright guy—yeah. But he was to the right of Marie Antoinette for Christ’s sake. There was no consistency in his so-called philosophy…

Golden oldie… Read more



Health insurance across state lines, coercion or consent

As of last week, states could form interstate health insurance compacts to allow for a single state to approve insurance that can be sold in all compact member states.  This is part of PPACA, as Charles Gaba has been digging into this week.  Kimberly Leonard of US News and World Report has details:

The little-known provision, found in section 1333 of the roughly 1,000-page Affordable Care Act, allows for states to create “health care choice compacts” permitting insurers to sell policies to consumers in any state participating in the compact, as long as they follow specific rules. Five states – Georgia, Kentucky, Maine, Rhode Island and Wyoming – already have enacted interstate compact statutes,according to the National Conference of State Legislatures.

An interstate compact is a voluntary agreement between states that has the approval of Congress. The most common compact type according to WIkipedia is some type of watershed and littoral water management compact such as the Port Authority of New York and New Jersey or the Great Lakes Commission.

There could be several potential compacts.  Massachusetts may decide that they are happy with the regulatory approaches of Rhode Island, New York, California and New Mexico and those states could form a compact.  On the other hand, Texas could join with Oklahoma and Louisiana for a de minimis compact.  The key aspect is that each particular state could choose what the minimal regulatory level would be appropriate for the home state.  It is a compact of consent.

This is markedly different than the Republican idea of selling insurance across state lines.  In that idea, the federal government would proclaim that a license in a single state is a license for all states.  The insurance industry would become an isomorph of the credit card industry.  The state with the weakest and most easily bought regulatory structure would have 98% of the viable insurance companies headquartered there within nine months of the law being passed.

It would be a race to the bottom for coverage requirements.  Currently, some states require insurers to cover a single wig for people who are receiving chemotherapy.  That requirement would still be in effect for any policy initially approved in that state, but no policy would be approved there.  Instead, a Plains state would have not have a wig coverage requirement.  More commonly, states vary in the required length of state after a non-complicated vaginal birth.  Some states may require 24 hours, other states require 36 hours, while other states require 2 midnights and a few states require 48 hours in the hospital after delivery.  Under the Republican schema, all these requirements would remain on the books, but the only plans offered across the nation would have either no maternal stay requirements or the shortest possible maternal stay requirement.

It is coercive federalism that sets the national standard at the lowest and least protective level as determined by a single state which is easily bought out.  Massachusetts would be regulated by Mississippi or South Dakota or Wyoming or Delaware.



Balloon Juice Survival Bunker Standoff Watch: Day 1 (Updated at 12:45 AM)

I know Anne Laurie is working up a new post from checking the dashboard, but since we’ve got two aging posts and breaking news, this’ll do for both an open thread and a discussion of ongoing events until she finishes and hits publish.

Ammon Bundy, his brother Ryan, another unnamed Bundy brother, Ryan Payne, and a number of other militia folks have now occupied the Malheur National Wildlife Refuge headquarters buildings. The Bundys have stated that they are prepared to stay there for years and that they are prepared to use violence if any attempt is made to remove them. So we now have breaking and entering into a Federal facility, criminal trespass, and terroristic threats. (h/t Paul W and Kelly in comments).

Here’s the link to Oregon Live’s update. They’ve just updated at 9:15 PM local time with the following statement from the local sheriff:

Statement from Harney County Sheriff Dave Ward: ‘After the peaceful rally was completed today, a group of outside militants drove to the Malheur Wildlife Refuge, where they seized and occupied the refuge headquarters. A collective effort from multiple agencies is currently working on a solution. For the time being please stay away from that area. More information will be provided as it becomes available. Please maintain a peaceful and united front and allow us to work through this situation.'”

Here’s the link to what the Feds had to say about what the Hammonds were actually accused, tried, and convicted of.

Here’s John Ritzheimer’s Youtube video (h/t LGF commenter Backwoods Sleuth):



Fat bottomed tails make the world go round

Holy mother of god, the  catch-up care in the co-ops was worse than I thought, and I thought it was already really bad:

At Arches, only 200 people—or 0.3% of its 63,000 members—accounted for 50% of its claims. Oncology care and organ transplants, in particular, hit Arches and many co-ops hard. Green said there was a lot of pent-up demand from people who previously could not access affordable policies or pay for the care out of pocket.

“The risk was a lot worse than anybody had expected,” Greene said during the call.

Arches, a PPACA co-op start-up that closed this fall due to the lack of risk corridor money, was probably expecting between 2,500 and 3,300 people to drive 50% of their claims expense, not 200 people.  This is why PPACA originally had the 3-Rs, specifically why it had the risk corridors as non-revenue neutral.  No one knew how bad or how good the risk pool was.  And the risk pool was far worse than projected.  Part of that was the lack of Medicaid expansion as Medicaid would have picked up quite a few people, and part of it our cost control mechanism in the past was based on ability to pay.  Services don’t cost a thing if they aren’t consumed because they are too expensive.

But holy mother of god, that is a hideous risk pool.  And it is one hell of a good illustration of why consumer directed health care and high deductible plans are limited in their actual system transformation method.  Those 200 people blew through any deductible limit by Valentine’s Day.



The Razor Cuts Deep

Hanlon’s Razor states that you should “Never attribute to malice that which can adequately be explained by stupidity.”  Maybe then I’m drastically overthinking why rural Kentucky voted Matt Bevin as governor.

The 66 percent of Owsley County that gets health coverage through Medicaid now must reconcile itself with the 70 percent that voted for Republican Governor-elect Matt Bevin, who pledged to cut the state’s Medicaid program and close the state-run Kynect health insurance exchange.

Lisa Botner, 36, belongs to both camps. A Kynector — a state agent representing Kynect in the field — recently helped Botner sign up for a Wellcare Medicaid card for herself and her 7-year-old son. Without that, Botner said, she couldn’t afford the regular doctor’s visits and blood tests needed to keep her hyperthyroidism in check.

“If anything changed with our insurance to make it more expensive for us, that would be a big problem,” Botner, a community college student, said Friday at the Owsley County Public Library, where she works. “Just with the blood tests, you’re talking maybe $1,000 a year without insurance.”

Yet two weeks earlier, despite his much-discussed plans to repeal Kynect and toughen eligibility requirements for Medicaid, she voted for Bevin.

I’m just a die-hard Republican,” she said.

Bu there’s more to it than that.

The trend seemed to hold across the state. At Transylvania University, political scientist Andrea Malji said she has crunched state data and found a “99 percent confidence level” between the counties’ Medicaid enrollment levels and their gubernatorial choices. The larger the Medicaid numbers, the more likely they were to back Bevin, she said. The lower the Medicaid numbers, the more likely they were to favor the Democratic nominee, Attorney General Jack Conway.

So Bevin — who said during the campaign that “the fact that we have one out of four people in this state on Medicaid is unsustainable” — racked up votes in rural, mostly poor counties where far more of the local population than that holds a Medicaid card. This was true even in traditional Democratic Party strongholds, such as Pike and Breathitt counties.

Malji, who is from Pulaski County, where Bevin captured 72 percent of the vote, said she heard people back home denounce “Obamacare” while thousands rushed to sign up with Kynect. They didn’t seem to realize that Kynect, Kentucky’s response to the federal Patient Protection and Affordable Care Act, is the same thing as Obamacare, she said.

There’s either voter disconnect here, where the people weren’t thinking about or weren’t aware of Bevin’s stance on health care, or these counties just have higher levels of social conservatives who thought it was more important to vote on social issues,” Malji said.

I don’t buy the former because of the correlation.  Bevin made it very, very clear what his stance was and made it clear for six months.  He went to town halls in these counties and straight up told them that he would get rid of Kynect and Medicaid expansion. His ads made it clear that he thought Kynect was going to bankrupt the state.  What I do buy is that maybe they decided that they could stick it to the party of the ni-CLANG! president, and that Bevin wouldn’t take my Medicaid, just take it from those people.

Governor-elect Bevin of course has other ideas.

I do not intend to re-enroll people at the same level going forward,” Bevin told reporters several days after his election. “There is not going to be a continuation of enrolling people at 138 percent of the poverty level. That is not going to happen.”

Perhaps we should call it Bevin’s Law:  white people will vote overwhelmingly against their own self-interest if it means it hurts those people too.