Call the Senate

You know what to do. Here are the highlights to argue.

1) Need to cover more people not less
2) Don’t punish states for taking care of their own citizens
3) Blows up state budgets
4) Medicaid covers people at less cost and same satisfaction as private insurance

And once you call your Senators, call your governor. If this bill passes, thirty five governors will be handed massive problems that they cannot solve.



Site News: Hurricane

(This is a re-post from Saturday evening for those who may have missed it)

Folks,

Our hosting company, Hosting Matters, is in reach of Irma. So lines or power could go down and so could this site. They have generators, backups, all kinds of great and groovy stufff, but shit happens.

Luckily, we have a test server. Right now, it’s configured for test usage, not live site usage. So please don’t go there to check it out. But, should the main site go down, I will upgrade the memory and processers so you can use it instead. It is hosted far away from Irma (or José, for that matter!)

Even after memory and CPU upgrades, it will be much less powerful then the main server, but it will work to keep the community going.

Please consider the site a resource to help get through Irma, and whatever cruel twist of fate José might offer.

Your normal nyms should work, and it should work and look like the main site but there may be twitches – it’s a development, testing, and staging site.

The site is at https://test.balloon-juice.com

I will repost this post over the next day or so, stopping when the threat to the main site has passed.



Site News: Hurricane

Folks,

Our hosting company, Hosting Matters, is in reach of Irma. So lines or power could go down and so could this site. They have generators, backups, all kinds of great and groovy stufff, but shit happens.

Luckily, we have a test server. Right now, it’s configured for test usage, not live site usage. So please don’t go there to check it out. But, should the main site go down, I will upgrade the memory and processers so you can use it instead. It is hosted far away from Irma (or José, for that matter!)

Even after memory and CPU upgrades, it will be much less powerful then the main server, but it will work to keep the community going.

Please consider the site a resource to help get through Irma, and whatever cruel twist of fate José might offer.

Your normal nyms should work, and it should work and look like the main site but there may be twitches – it’s a development, testing, and staging site.

The site is at https://test.balloon-juice.com

I will repost this post over the next day or so, stopping when the threat to the main site has passed.



PSA: Check This Site

So Equifax had a huge loss of data – over 143 million folks’ worth. That’s pretty much everyone in the US who has credit. This is huge!

So – to read more, this great article from Ars Technica.

Most importantly, go to the Equifax site and check to see if you’re affected (I bet you are!). It will tell you to come back after a certain date to complete the process of registering for free monitoring. They say 1 year, but I bet it ends up being much longer. They have screwed all of us.

Site to check: https://www.equifaxsecurity2017.com/



You Know You Have A Problem…

…When you say sh*t like this:

“As he puts on plastic gloves to serve food at NRG Stadium…President Trump turns to press and says: “My hands are too big!”

Dude.  Special pleading like this only makes it harder to ignore the obvious inference. Seriously, Donald. Can we talk? I don’t care about your sense of adequacy, or its absence. Just let it lie, you know. This whole subject.

In other quotes from the nation’s Disaster Tourist in Chief, we find this gem:

Leaving the shelter, Trump told the survivors and gathered reporters to “have a good time.”

Ummm.

I’m sure everyone there felt the love.

Lastly, here’s the sober sitrep from a guy who, we were told by The New York Times, is all over the long-term impact of water on structures:

When asked about the devastating flooding still covering much of the region, he replied: “The flooding? Oh, yeah, yeah, there’s a lot of water, but it’s leaving pretty quickly. But there’s a lot of water, a lot of water, but it’s moving out.”

I’m not even going to get into Melania’s Stiletto-gate, Take Two (AKA Spikes of Compassion). Who cares? She has her job to do, which seems mostly to involve distracting the Ferret-Heedit Cheeto-Faced Shit-gibbon as he obsesses on hand size.

I’m thinking that all those stories about how Harvey would give Trump the platform he needed to become, at last, a president, are aging well. Don’t you?

Open thread.

Image: Rembrandt van Rijn, The Anatomy Lesson of Dr. Nicolaes Tulp, 1632.



Notes from the CBO score of the BCRA

The Congressional Budget Office released their score of the Senate’s Better Care Reconciliation Act (BCRA). It does not include the Cruz amendment. There is not a whole lot of difference since the last score as there are not many large changes on the coverage side.

I just want to pull out a few things. The most important thing to pull out is Table 3 regarding Medicaid:

The largest savings would come from a reduction in total federal spending for Medicaid resulting both from provisions affecting health insurance coverage and from other provisions. By 2026, spending for that program would be reduced by 26 percent (see Table 3, at the end of this document).3

It is a $575 billion dollar cut to Medicaid. Throwing inadequate opioid specific money or allowing for a $200 billion dollar back door CSR funding stream won’t do anything remotely sufficient to address the people who lose coverage because of these cuts.

THe next nugget is a repetition of the basic point that the value proposition of super high deductibles is absolutely atrocious for lower income individuals:

Because this legislation would change the benchmark plan (in part, by repealing the current-law federal subsidies to reduce cost-sharing payments), the average share of the cost of medical services paid by the plan would fall—for the 40-year-old with income at 175 percent of the FPL in 2026, from 87 percent to 58 percent—and his or her
payments in the form of cost sharing would rise. And the person’s net premiums would be higher under the legislation than under current law for plans of comparable actuarial value. Those changes, CBO and JCT estimate, would contribute significantly to a decrease in the number of lower-income people with coverage through the nongroup market under this legislation, compared with the number under current law.

The baseline deductible in 2026 is a mind busting $13,000. This matters a lot for the people who are losing Medicaid. The deductibles are an absurdist joke.

a single policyholder purchasing an illustrative benchmark plan (with an actuarial value of 58 percent) in 2026, the deductible for medical and drug expenses combined would be roughly $13,000, the agencies estimate… Under this legislation, in 2026, that deductible would exceed the annual income of $11,400 for someone with income at 75 percent of the FPL. For people whose income was at 175 percent of the FPL ($26,500) and 375 percent of the FPL ($56,800), the deductible would constitute about a half and a quarter of their income, respectively.

Finally, the CBO notes a clear mechanical problem that can not be fixed without 60 votes:

The limit on out-of-pocket spending in 2026 is projected to be $10,900. (Under current regulations, the limit on out-of-pocket spending is defined by a formula based on projections of national health expenditures.) Therefore, plans with an actuarial value of 58 percent and a deductible of $13,000 would exceed that limit and would not comply with the law unless the formula used to calculate the limit was adjusted. CBO and JCT estimate that a plan with a deductible equal to the limit on out-of-pocket spending in 2026 would have an actuarial value of 62 percent. A person enrolled in such a plan would pay for all health care costs (except for preventive care) until the deductible was met and none thereafter until the end of the year.

The benchmark plan can’t be built.

Oops



How the CBO projects market failure

The Congressional Budget Office projects that the AHCA will lead to 15 % of the population living in destablized insurance markets because of the MacArthur/Upton amendments.

he agencies estimate that about one-sixth of the population resides in areas inwhich the nongroup market would start to become unstable beginning in 2020. That instability would result from market responses to decisions by some states to waive two provisions of federal law, as would be permitted under H.R. 1628. One type of waiver would allow states to modify the requirements governing essential health benefits (EHBs), which set minimum standards for the benefits that insurance in the nongroup and small-group markets must cover. A second type of waiver would allow insurers to set premiums on the basis of an individual’s health status if the person had not demonstrated continuous coverage; that is, the waiver would eliminate the requirement for what is termed community rating for premiums charged to such people. CBO and JCT anticipate that most healthy people applying for insurance in the nongroup market in those states would be able to choose between premiums based on their own expected health care costs (medically underwritten premiums) and premiums based on the average health care costs for people who share the same age and smoking status and who reside in the same geographic area (community-rated premiums)

What does that mean and how does that happen? Let’s work through an simple model of a state with 1,000 people in its individual market.
Read more