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.



Pictures from today’s march in Raleigh

I’m not normally a marching purpose. I’ll cut turf, I’ll optimize a data set, I’ll make phone calls but I don’t march. Well today, I marched. And I had a blast. I ended up walking with the ACLU contingent as they seemed to be a great group and met up with some people I’ve recent met in the Triangle for a burger and a beer afterwards as well as a plan to help build infrastructure so I can get back to cutting turf and optimizing data sets. One of the things I liked is that there were organizers and voter registration folks going throughout the crowd getting information. I switched my registration from Pennsylvania to North Carolina this morning and got hit for contact information at least five times.

Here are some pictures from me and other Balloon Juicers.

If you have any more, please send them to me at via the Contact an Author widget in the top right hand corner.

 

And here are a few from AMinNC:

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Peaceful Assembly & Personal Security: Threepeat

I know a number of you all are planning to join one of the marches that will begin taking place between now through, and then after, the inauguration. So I wanted to re-up the post – again – for anyone that missed it the first and second time.

Everyone be safe out there!

(Originally posted on 18 December 2016)

Congress shall make no law… abridging…the right of the people peaceably to assemble, and to petition the Government for a redress of grievances. — Amendment 1, Bill of Rights, US Constitution

One of our readers/commenters emailed me about a week ago and asked if I would put up a post about personal security for those going to peaceably assemble to petition the Government for a redress of grievances. I put a list together and ran it past a select group of our Balloon Juice legal eagles (those I’ve corresponded with before/have corresponded with me, so if you didn’t get asked, don’t be insulted I didn’t want to just impose on you with a cold request) – thank you all for getting back to me. Here’s my list of what I think anyone going to peacefully assemble should do to enhance their personal security.

  1. Go with a buddy, that way you have at least one person looking out for you/watching your back and vice versa.
  2. Carry cash and make sure to carry a valid picture ID!
  3. Bring a pocket flashlight.
  4. Get and wear a go pro that is automatically updating to the cloud.
  5. Bring a pocket charger for your cell phone and go pro regardless of whether it is supposed to be a long day.
  6. Make sure your personal electronic devices all have sufficient password protection and encryption on them. And have them set to upload to the cloud at a regular interval.
  7. Turn off fingerprint access to unlock your phone and delete your finger prints from the memory. Some jurisdictions allow law enforcement to compel you to unlock your phone if it has finger print based access. Or get a disposable phone just for this occasion.
  8. Turn off your phone and other personal electronic devices option to connect to known wifi as it can be used as a way to fail your encryption.
  9. Bring a bandana or neck gaiter and water so you can make a make shift gas mask in case things get out of hand and tear gas or pepper spray is deployed.
  10. Bring a bottle of saline eye rinse in case you need to rinse your eyes out if tear gas or pepper spray is deployed.
  11. Bring plenty of water and some snacks to make sure you’re properly hydrated and you’ve got enough fuel in your system to get through the day.
  12. Dress in layers so you are prepared for the weather and make sure you have good shoes/boots and a change of socks in case they should get wet. A set of silk base layer undersocks is a good idea regardless of the weather. They’ll help keep your feet warm or cool as needed and they’ll provide some protection in case your shoes/boots and socks get wet. And something to keep the back of your neck and your ears warm if you’re going to be someplace cold.
  13. Bring/wear a hat to keep the sun off your head or to keep it warm depending on the weather.
  14. Bring/wear eye protection. Specifically sunglasses that are impact rated. (You should be able to pick up military surplus ones pretty cheap).
  15. Sunscreen, skin moisturizer, and lip balm. Even if its cold you’ll need these.
  16. If you need to take regular/routine prescription medication: bring it in its original container, with the prescription details on the label. If its a gel based application and comes in a packet, make sure you’ve got a hard copy of the prescription with you.
  17. Be aware of your surroundings at all times. You don’t have to be paranoid, but have a sufficient level of situational awareness. If something looks and/or feels hinky or the hair on the back of your neck stands up, head on home or go get a drink or go back to your hotel. Know who and what is around you, keep your valuables in front pockets or in secure/securable purses/bags, and keep those where they can’t be easily snatched or accessed.
  18. Have a contact plan for both linking up and communicating in case one gets separated from anyone you’re with.
  19. Have a contact plan to stay in touch with someone who isn’t at the march, but knows that you’re there and a regular set of contact times.
  20. Have a lawyer you can contact if necessary and that your outside contact could contact if you don’t check in. Make sure you have all of your contact’s phone numbers memorized in case your phone is damaged or taken by law enforcement should the worst happen and you’re arrested.
  21. Bring a sharpie to take down badge numbers if necessary. And if necessary write them on your hand.

Should the worst happen and you get caught up in a peaceable assembly that suddenly turns not so peaceable:

  1. Do not resist law enforcement. Just do what they say, let your arms go limp, and do what you can to avoid a reflex response to resist – that can get you charged with assault on a law enforcement officer.
  2. Be respectful and polite when dealing with the authorities – law enforcement, the National Park Service, whoever.
  3. If you are arrested, ask for a lawyer and then shut up. Do not say anything else or answer any other questions until your lawyer arrives. In fact let the lawyer do the talking.

One last item: some of you probably carry a pocket knife or multitool everywhere. Or everywhere that you’re normally allowed. I would recommend not carrying anything on your possession that could be construed as a concealed weapon or even an openly carried one. Even if you’re in a state/jurisdiction that allows for concealed or open carry of knives and/or other weapons – don’t. Being part of a march or peaceful assembly that turns ugly is not a good time to attempt firearms (or knife) normalization.

Stay Frosty!



Peaceful Assembly and Personal Security – Re-upped

I know a number of you all are planning to join one of the marches that will begin taking place between now through, and then after, the inauguration. So I wanted to re-up the post for anyone that missed it the first time.

(Originally posted on 18 December 2016)

Congress shall make no law… abridging…the right of the people peaceably to assemble, and to petition the Government for a redress of grievances. — Amendment 1, Bill of Rights, US Constitution

One of our readers/commenters emailed me about a week ago and asked if I would put up a post about personal security for those going to peaceably assemble to petition the Government for a redress of grievances. I put a list together and ran it past a select group of our Balloon Juice legal eagles (those I’ve corresponded with before/have corresponded with me, so if you didn’t get asked, don’t be insulted I didn’t want to just impose on you with a cold request) – thank you all for getting back to me. Here’s my list of what I think anyone going to peacefully assemble should do to enhance their personal security.

  1. Go with a buddy, that way you have at least one person looking out for you/watching your back and vice versa.
  2. Carry cash and make sure to carry a valid picture ID!
  3. Bring a pocket flashlight.
  4. Get and wear a go pro that is automatically updating to the cloud.
  5. Bring a pocket charger for your cell phone and go pro regardless of whether it is supposed to be a long day.
  6. Make sure your personal electronic devices all have sufficient password protection and encryption on them. And have them set to upload to the cloud at a regular interval.
  7. Turn off fingerprint access to unlock your phone and delete your finger prints from the memory. Some jurisdictions allow law enforcement to compel you to unlock your phone if it has finger print based access. Or get a disposable phone just for this occasion.
  8. Turn off your phone and other personal electronic devices option to connect to known wifi as it can be used as a way to fail your encryption.
  9. Bring a bandana or neck gaiter and water so you can make a make shift gas mask in case things get out of hand and tear gas or pepper spray is deployed.
  10. Bring a bottle of saline eye rinse in case you need to rinse your eyes out if tear gas or pepper spray is deployed.
  11. Bring plenty of water and some snacks to make sure you’re properly hydrated and you’ve got enough fuel in your system to get through the day.
  12. Dress in layers so you are prepared for the weather and make sure you have good shoes/boots and a change of socks in case they should get wet. A set of silk base layer undersocks is a good idea regardless of the weather. They’ll help keep your feet warm or cool as needed and they’ll provide some protection in case your shoes/boots and socks get wet. And something to keep the back of your neck and your ears warm if you’re going to be someplace cold.
  13. Bring/wear a hat to keep the sun off your head or to keep it warm depending on the weather.
  14. Bring/wear eye protection. Specifically sunglasses that are impact rated. (You should be able to pick up military surplus ones pretty cheap).
  15. Sunscreen, skin moisturizer, and lip balm. Even if its cold you’ll need these.
  16. If you need to take regular/routine prescription medication: bring it in its original container, with the prescription details on the label. If its a gel based application and comes in a packet, make sure you’ve got a hard copy of the prescription with you.
  17. Be aware of your surroundings at all times. You don’t have to be paranoid, but have a sufficient level of situational awareness. If something looks and/or feels hinky or the hair on the back of your neck stands up, head on home or go get a drink or go back to your hotel. Know who and what is around you, keep your valuables in front pockets or in secure/securable purses/bags, and keep those where they can’t be easily snatched or accessed.
  18. Have a contact plan for both linking up and communicating in case one gets separated from anyone you’re with.
  19. Have a contact plan to stay in touch with someone who isn’t at the march, but knows that you’re there and a regular set of contact times.
  20. Have a lawyer you can contact if necessary and that your outside contact could contact if you don’t check in. Make sure you have all of your contact’s phone numbers memorized in case your phone is damaged or taken by law enforcement should the worst happen and you’re arrested.
  21. Bring a sharpie to take down badge numbers if necessary. And if necessary write them on your hand.

Should the worst happen and you get caught up in a peaceable assembly that suddenly turns not so peaceable:

  1. Do not resist law enforcement. Just do what they say, let your arms go limp, and do what you can to avoid a reflex response to resist – that can get you charged with assault on a law enforcement officer.
  2. Be respectful and polite when dealing with the authorities – law enforcement, the National Park Service, whoever.
  3. If you are arrested, ask for a lawyer and then shut up. Do not say anything else or answer any other questions until your lawyer arrives. In fact let the lawyer do the talking.

One last item: some of you probably carry a pocket knife or multitool everywhere. Or everywhere that you’re normally allowed. I would recommend not carrying anything on your possession that could be construed as a concealed weapon or even an openly carried one. Even if you’re in a state/jurisdiction that allows for concealed or open carry of knives and/or other weapons – don’t. Being part of a march or peaceful assembly that turns ugly is not a good time to attempt firearms (or knife) normalization.

Stay Frosty!



BBD in North Carolina (and hire lawyers)

Big Biden Deal out of North Carolina yesterday.

WRAL:

Because the federal government is funding 95 percent of the cost of Medicaid expansion, Cooper called on hospitals to put assessments on themselves to generate the other 5 percent because they are “by far the largest beneficiaries” of any expansion.

Cooper said he plans to file by Friday an amendment to North Carolina’s Medicaid plan submitted to federal regulators to allow an expansion.

State lawmakers in 2013 passed legislation blocking any expansion, and the governor told reporters after his speech he believes that law infringes on his executive powers.

“I do believe it invades on the core executive authority of the governor to accept federal funds to look out for the public health of the people, but I would rather not get into a dispute with that. I think it’s important for us to try to be cooperative,” he said. “Someone needs to take action. So, I’m going to take action, and then we’ll try to work it out with them.”

My first thought is that this is a Big Biden Deal. North Carolina is one of the Big-4 non-Expansion states. If Governor Cooper (D-NC) can get expansion, that is a massive improvement in the welfare and well being of the currently uncovered.

My second thought is that this would be a great time to be a North Carolina lawyer specializing in North Carolina constitutional law as the billable hours were already promising a great year with the Lame Duck disputes going before the state courts. Now this will almost inevitably be in court by the weekend. And then we have a great question as to which court can hear North Carolina constitutional questions as those are now in dispute given the Lame Duck.

I think the effort is to create facts on the ground for any repeal and replace by getting North Carolina qualified as an expansion state before any potential cut-off date that comes out of Congress for the status quo.

So good news from last night!



Thinking Security

Several of you have asked in comments or by email if I’d write a little bit (a lot of bit?) about security. Specifically, personal security. I intended to get this up earlier in the week, but things went sideways on Tuesday, then did an inversion on Wednesday, then a triple lindy yesterday, so…

The first thing that I think is important is something I, and several others, have stressed here in posts and comments: freaking out is not a useful activity. I’m not stating that to pooh pooh anyone’s reactions to the elections, whether they be anger, fear, anxiety, stress, depression, or any combination thereof. All of these are normal and understandable responses. And, of course, if you are feeling really overwhelmed and are having trouble finding/regaining your equilibrium please go see a professional counselor or therapist.

The second thing is don’t do this!

CLEVELAND – Police are investigating the theft of seven guns swiped from a Cleveland home sometime early Tuesday morning.

A mom and her two children were asleep upstairs when she said the thief or thieves broke into the home and cleaned out two gun cabinets. “They’re ready for a war, we were ready for a war,” said Teena Brayen

Brayen and her family are doomsday preppers. “We’re preppers, we believe in preparing for what could happen,” said Brayen.

The Brayens are part of the Three Percenters Club, a militia group that ‘exists to… protect and defend the constitution and our way of life’ by helping people ‘execute Military Strategies to defend against foreign and domestic enemies’.

But the items they wanted to use to defend against invasion in Rome made them a target for invasion in Cleveland.

On November 22, burglars – who, Brayen believes, spotted the weapons when she was moving into the home – took seven guns, 12 machetes, body armor, smoke grenades, more than $1,000 in ammo and some of their food.

Two gun cabinets were emptied of their contents: a high-powered, armor-piercing sniper rifle; five shotguns, and a pellet gun.

Leaving aside the Brayens and the Three Percenters Club, which is not the same as the other Three Percenters, what was missing here was a failure to think security.

Thinking security means to proactively consider what the potential threats might be in order to establish effective, reasonable solutions to them. This means to consider what the potential threats and dangers are to oneself, one’s family, and one’s property (home, business, etc) and what reasonable steps should be taken ahead of time to either deter them or, should deterrence fail, respond to them in the most effective and safe manner possible. This is not just for human threats like crime or terrorism, but also for preparing to deal with natural or man made disasters such as a hurricane or blizzard or earthquake or a gas main explosion or a fracking induced sinkhole or earthquake. To do this one needs to consider several questions.

  1. Who or what is the threat? And what kind of threat is it?
  2. Does the location, item, and/or person need to be secured against a potential threat?
  3. What is the extent of the location’s vulnerability?
  4. Does the potential security countermeasure need to be human, animal, technological, or a combination of them?
  5. How far can I, and how would I go about, extending my secure zone away from myself, my family, my home, etc?
  6. What effect will the potential security response have on me, my family, my friends, my neighbors, my employees, coworkers, and/or customers?

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APTC Hacks: A comment for meaningful difference improvement

Last night I submitted a fairly long comment (below the fold) to the Center for Medicare and Medicaid Services (CMS). My comment is on the initial parameters for the 2018 Exchange year. I and several colleagues think that CMS needs to pay more attention to meaningful difference regulation because the current set of rules allows for too much gaming of the system and minimization of the membership pool via the Silver Spamming strategy. The comment identifies the problem and proposes a viable solution.

I do not know what my expectations are for this comment. I know it will be read. I know some low level analyst will bucket the letter into two or three categories and there may be a response. Beyond that, I do not know if CMS will alter their policy at all on this issue. I hope they do as I think getting to a tighter definition of meaningful difference will boost enrollment while stabilizing the risk pool which is an objective that CMS shares. But I don’t know.

Now I’m going to get on Tim F’s beat — if you see something that the Federal government is doing that either intrigues you, pisses you off or touches on an area of specialized knowledge that you have, comment on the rule making. This letter took me three or four hours to write and revise with the other signers. It will be read, and it will be remembered by CMS technical staff as it engages them and it is not a mindless screaming of rage (from what I’ve heard, the EPA gets the best rage-grams.) Thoughtful, relevant responses that point to possible ways of accomplishing the mission of the agency in question will be read and they will be remembered. So please, do so especially as the comment submission process through Regulations.Gov is much easier than I thought it would have been.

The comment is below the fold:

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