The summary of the Senate AHCA

Here is the TLDR of the Senate AHCA draft.

There are a lot of details that matter (I even like Sec. 102-b-1-B-II) but that is the fundamental difference.

CPI-U comes into play for Medicaid funding in FY 2025.
Per Capita Caps are in play for Medicaid
Enrollment caps for block grants for Medicaid are in play.

Old people in Alaska will be paying 16% of their income in premiums before receiving subsidy assistance.

Taxes are being cut massively with no incentive effect intentions.

There are massive work disincentives embedded in multiple spots throughout the bill

Deductibles are going up

Silver and Gold plans will be hideously priced and hyper narrow networks to dodge sick people

Section 1332 waiver protections are gutted

Any federal dollar can not be in the same zip code as a dollar that is used for abortion

New York is getting hit hard on both the Buffalo Kickback and the Basic Health Plan as immigration status is tightly defined.



Open Thread: Shakespeare in the KULCHA! Wars

As reported in the Washington Post:

Two right-wing activists interrupted the Friday evening performance of a controversial production of Shakespeare’s “Julius Caesar” in New York’s Central Park, causing a stir on social media — where numerous videos of the protest proliferated — and resulting in one woman’s arrest.

In the videos, a woman identified as Laura Loomer, an employee of the far-right website Rebel Media, can be seen storming the stage during the scene of the title character’s assassination, shouting “Stop the normalization of political violence against the right! This is unacceptable!”…

Within the commotion, a second pro-Trump protester, Jack Posobiec, can be seen standing and yelling in the audience, “You are all Goebbels!” and “The blood of Steve Scalise is on your hands!”…

In a string of tweets, the Public Theater confirmed the interruption at its Friday show and said it had been “part of a paid strategy driven by social media.”…

Posobiec, a Washington-based Trump supporter who formerly also worked for Rebel Media, told The Washington Post on Saturday that, contrary to some media reports, he and Loomer did not coordinate their protests. Rather, he had attended the performance at the encouragement of alt-right personality Mike Cernovich, who posted a “challenge” on Periscope last week offering a $1,000 prize for anyone who could get tickets to the play and interrupt the show….

Cash Rules Everything Around Them — dolla-dolla, get tha monee…


(John Wilkes Booth)
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Could A London-Tower-Style Fire Happen Here?

Count on Megan McArglebargle to act as point-person for the Worst Glibertarian Hot Take. For those of us who aren’t being paid to prioritize money over humanity, here’s Justin Davidson, in NYMag, “Could the Grenfell Tower Disaster Happen in New York?”

There is no such thing as an accident when a high-rise building fails. If gas leaks, wires spark, or a wall crumbles, those are not acts of fate, but the preventable consequence of people not doing their jobs. Terminology matters; if it turned out that the fire that consumed Grenfell Tower in London, killing at least 30 people (and probably many more), had been set by a radicalized Muslim immigrant or an anti-Muslim white supremacist, those facts would shape the U.K.’s foreign and security policies. If it’s just an instance of faulty construction, politicians can wring their hands on television, appropriate some emergency funds, and then move on.

It’s too soon to be sure exactly what caused the Grenfell Tower to burn. A thick plume of accusations suggests a lot of possible culprits: a faulty refrigerator; the recently installed cladding of cheap aluminum panels with a flammable core; the gap between the wall and the rain screen, which could have created a chimney effect and sped flames and smoke up the building’s exterior; ineffectual fire alarms; a lack of sprinklers; the presence of just a single fire stair. Behind the technical factors is another layer of social issues. Residents have accused building management and authorities of ignoring their chillingly specific complaints, perhaps because of a generalized disinterest in the building’s poor and largely Muslim population, or because of the pressures of gentrification from the neighborhood all around…

New Yorkers might be tempted to react complacently to some items on this list. Aluminum panels are common, but the slightly less expensive version with the flammable polyethylene core is not legal here. All buildings higher than 50 feet must have automatic sprinklers and two fire stairs, not one. And yet to argue those points is to miss the larger awfulness of the situation. Whether the proximate causes turn out to be corruption, venality, racism, or some combination of all three, the underlying sin is contempt for the people who must live in conditions they cannot control…
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Trump and Putin: Some 1980s Background

 

What do interviews in the 1980s and 1990s with Donald Trump tell us about his attitudes toward Russia and nuclear weapons?

The interviews are oblivious to world events taking place at that time. They are basically gossip columns by Lois Romano and William E. Geist, 1984; Ron Rosenbaum, 1987; Mark Singer, 1997. Descriptions of Trump’s lavish quarters and sycophantic workers, his expensive clothes, and his ease in getting a table at a restaurant figure prominently in the introductory paragraphs. Read more



Reciprocity?

Tonight’s Trump-Russia news dump comes from the Washington Post, presaged earlier in the day by an article in Sputnik tweeted out by the Russian Embassy in the United States.

Last December, in response to Russian hacking of the election and harassment of American diplomats in Moscow, President Barack Obama ordered 35 Russian diplomats out of the country and demanded that Russia vacate properties in Long Island and on Maryland’s Eastern Shore, supposedly for rest and recreation of the Russian diplomatic corps in the United States but suspected of also functioning to gather intelligence.

That was on December 29. The next day Michael Flynn, President-elect Trump’s presumptive National Security Advisor, spent a lot of time on the phone with Sergey Kislyak, the Russian ambassador to the United States. After those phonecalls, Russian President Vladimir Putin magnanimously decided against reciprocating, an unexpected move. Usually expulsion of diplomats is followed by an equal and opposite expulsion of the first country’s diplomats. But it was the Christmas season.

Earlier today, the Russian government Sputnik reminded the United States government of this principle of reciprocity. The Russian Embassy in the United States emphasized it with a tweet.

And a few hours later, Karen DeYoung and Adam Entous tell us that the United States government is indeed thinking of allowing the Russians to reoccupy the properties. Earlier, the United States had linked reoccupation to allowing the United States to build a consulate on a particular piece of land in St. Petersburg that the Russians had been blocking. But then that link was dropped.

Supposedly nothing is decided yet. It looks like Trump is willing to end part of the sanctions against the Russians for their election hacking just because he’s a nice guy. Or because the Russians were nice guys and didn’t reciprocate the expulsion.

 

Cross-posted to Nuclear Diner.



Medicaid in the President’s budget request

The Department of Health and Human Services accidentally leaked their own budget this evening. Bob Herman at Axios saved a copy. The biggest aspect of the budget is it laid out another $600 billion dollars in cuts to Medicaid and CHIP over ten years in addition to the $820 billion in Medicaid cuts in the AHCA.

Between these two documents Medicaid would lose 47% of its federal funding over a decade.

Loren Adler at Brookings thinks the cuts would be to tie the AHCA block grants to no more than inflation rate growth without regard to population or case mixture. As the Baby Boomers retire, more of them will require nursing home care that is currently paid for by Medicaid but there would be no federal money.

This is a budget wishlist that pits old people versus kids, the disabled against the pregnant and state budgets against upper income tax cuts in the federal budget.

Call Congress and give them an earful.



CSR and Certainty

Cost Sharing Reduction (CSR) subsidies are the 2017 Sword of Damocles. Insurers have to provide an actuarial value bump to low income on-Exchange buyers but they don’t know if the Federal government will pay for the bump. Their current contracts with the Center for Medicare and Medicaid Services (CMS) allows carriers to withdraw from the Exchanges mid-year if allowed by state law if CSR is not paid. This is the Samson option for Trump.

Yesterday’s post looked at the dynamics of how insurers want to price for 2018. They can either assume the government will pay CSR or not pay. There are probabilities as to what could happen but the actuarial assumptions collapse to two poles.

This is interesting information:

Sure looks like it would be gross negligence for any insurer to assume that the government will pay CSR subsidies in 2018 rate filings. And until there is black letter law making CSR an appropriated and ideally a mandatory expenditure, insurers will have to assume that they could and will disappear at any time and thus price accordingly.